Factors associated with positive human papillomavirus (HPV) test results in cervical precancer screening: a cross-sectional study at Souro Sanou National Teaching Hospital (SSNTH) in Bobo Dioulasso, Burkina Faso.

INTRODUCTION: Human papilloma virus testing is a new method of screening for precancerous cervical lesions. Here we identified factors associated to the positive Human papilloma virus-testing in the context of cervical precancer screening at the Souro Sanou National Teaching Hospital in Burkina Faso. MATERIALS AND METHOD: Conducted from June 2021-May 2022, this was a cross-sectional study, including patients aged between 25 and 55 years-old and screened for precancerous lesions and received HPV-testing at the Department of Gynecology, Obstetrics and Reproductive Medicine (DGORM) of the SSNTH. The proportion of positive HPV-test was calculated, and we identified factors associated to positive HPV-test using logistic regression. RESULTS: Of the 759 patients came for precancerous lesions screening, 559 patients were included. Their mean-age was 38.8 ± 7.9 years-old, 94.3% were from urban area and 50.3% identified as housewives. Regarding the past medical history, it noted: number of gestures (3.2 ± 2.0), parity (2.8 ± 1.9), number of living children (2.8 ± 1.9), having abortion experience (24.0%), age of first-sexual-intercourse(18.6 ± 2.3 years), alcohol (9.1%) and tobacco (1.0%) consumption, sexually-transmitted-infection (27.0%), Human immunodeficiency virus (HIV)infection (5.0%); none had been vaccinated against HPV. Biologically, 16.6% [95% CI: 13.6-20] of the women had a positive HPV-test. The factors significantly associated with positive HPV-test were: occupation in the private sector [OR: 0.06(0.0-0.5); p < 0.001], having a sexually-transmitted-infection [OR: 3.9(2.0-7.7); p < 0.001], age of first-sexual-intercourse [OR: 0.7(0.6-0.9); p < 0.001], sexual-multiple-partnership [OR: 17.5(8.1-39.6); p < 0.001], and HIV status [OR: 13.2(4.4-40.5); p < 0.001]. CONCLUSION: These results call for health actions through the reinforcement for behavioral change mainly about sexually-transmitted-infections, and for the raising awareness of the population for the screening related to the precancerous lesions and HIV.

Coût de la prise en charge des pathologies cardio-vasculaires au Burkina Faso.

INTRODUCTION: The management of cardiovascular pathologies has a high cost for users. PURPOSE OF THE RESEARCH: It is therefore important to assess the costs of hospitalization to gain a better understanding of its impact on care. RESULTS: This was a case series-type, descriptive, observational study with prospective data collection. RESULTS: A total of 103 patients were included, with a mean age of 51 years and extremes ranging from 14 to 86 years. The average length of stay was 7.1 days. Heart failure was the most frequent pathology (61.7%). The average monthly income per patient was 101,360 CFA francs. The average total direct cost during hospitalization was 114,015 CFAF. The average direct cost of drugs and consumables was 60,553.77 CFAF. The average direct cost of paraclinical examinations was 34,360.29 CFAF. Hospitalization costs averaged 16,747.47 CFAF. Total direct costs during hospitalization were 11,737,060 CFAF, dominated by drugs and medical consumables (53.14%), followed by complementary examinations (29.86%) and non-medical expenses (17%). During the study, 13.59% of patients were discharged against medical advice. Expenses were covered by the parents in 71.84% of cases. CONCLUSIONS: The average direct cost of hospitalization is well above the purchasing power of the majority of patients.

Facteurs influençant le délai de prise en charge aux urgences chirurgicales du CHU Sourô Sanou.

INTRODUCTION: Assessing patient turnaround times is essential for improving the quality of care in emergency service departments. PURPOSE OF THE RESEARCH: This study looked at waiting and treatment times, and their associated factors, in the surgical emergency service department at the Souro Sanou National Teaching Hospital (SSNTH) in Bobo-Dioulasso, Burkina Faso. RESULTS: This study was carried out on 380 patients with a median age of thirty-eight. The sex ratio was 0.54. In 63.7 percent of cases, the participants lived in urban areas. Most of the patients surveyed were farmers (34.7 percent). The median waiting time for patients was eleven minutes. The nature of the trauma sustained was associated with the waiting time. The median time taken to administer first aid was sixty-three minutes, with the unavailability of medication at the hospital pharmacy cited as a factor contributing to this delay. The median time taken to obtain paraclinical results was 134 minutes and 102 minutes for laboratory tests and scans, respectively. The factor associated with delays in obtaining scan results was the need for surgical intervention. The median waiting time for surgery was 24.3 hours. CONCLUSIONS: The turnaround times in the SSNTH surgical emergency department are long. For the improvement of patient turnaround times to be possible, an overhaul of the department is in order. In particular, a rapid consultation team needs to be established, and essential drugs for emergency care need to be made readily available.

Tuberculose résistante au Burkina Faso : audit organisationnel et enquête de satisfaction.

INTRODUCTION: Drug-resistant tuberculosis is a public health priority and shortcomings in health services can make matters worse. PURPOSE OF THE RESEARCH: The aim of the study was to carry out an organizational audit inspired by the accreditation standards of the Agence nationale d’accréditation et d’évaluation en santé (ANAEH) (French National Agency for Health Accreditation and Assessment) for the management of resistant tuberculosis patients and to determine the level of patient satisfaction in order to identify any failings and possible solutions. RESULTS: The overall audit score was 63.2 percent for the Centre hospitalier universitaire Yalgado Ouédraogo (CHUYO) (Yalgado Ouédraogo University Hospital) and 59.8 percent for the Centre de lutte anti-tuberculose (CLAT) (French Tuberculosis Prevention Center). The problems raised were related to “intake, equipment, and infrastructure,” “patient rights and information,” and “management and administration.” Overall, patients were satisfied with their care. The majority of them noted that the care centers were safe and equipped with toilets that, in addition to improving hygiene, should take account of the specific nature of different illnesses and genders. The patients indicated that their privacy was relatively well respected, but that the quality of the meals provided remains unsatisfactory. Treatment was free, notwithstanding certain paraclinical examinations. Most of the patients and service providers were unaware of the cost of tuberculosis treatment. Non-compliance with treatment, thought to stem from the adverse side effects of anti-tuberculosis drugs, was cited as the main cause of resistance. CONCLUSIONS: A number of operational shortcomings exist in the management of patients with resistant tuberculosis, stemming from unfamiliarity with the treatment protocol. The application of the patient-centered approach could allow for the fight against tuberculosis, especially its resistant form, to be waged more effectively.

Evaluation of the impact of COVID-19 in people coinfected with HIV and/or tuberculosis in low-income countries: study protocol for mixed methods research in Burkina Faso.

BACKGROUND: An issue of particular concern is the impact of the 2019 novel coronavirus (2019 nCOV) on the people coinfected with the Human Immuno-deficiency Virus (HIV) and/or tuberculosis (TB). Unfortunately, this interaction has not been well explored in African despite the large proportion of these risk populations living with HIV and/or patients and/or tuberculosis (TB) in the African region. This study aims to design a research protocol for assessment of the impact of coronavirus disease 2019 (COVID-19) on these risk populations in response to COVID-19 strategic plans in Burkina Faso by generating serological, epidemiological, virological, clinical and socio-anthropological evidence-based data. METHODS: A multidisciplinary research will be conducted in the city of Bobo-Dioulasso, Burkina Faso using mixed methods. Data will be collected from a cohort of people living with HIV and/or TB patients in the city (i) to determine the proportion of people with specific antibodies against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using retrospective data ; (ii) to determine the proportion of people infected with Covid-19 and the dynamics of viral loads and antibodies in these people based on prospective data; (iii) to identify circulating SARS-COV-2 variants and novel biomarkers using prospective data ; (iv) to analyze perceptions, community experiences and response strategies during the public health emergencies imposed by COVID-19 through a qualitative study. DISCUSSION: This study will generate factual and comprehensive data that will contribute in improving response strategies to COVID-19 and the other possible emerging diseases with keen interest on the risk populations living with HIV and/or TB infected patients.

Risk factors for mortality in an African pediatric emergency department: case of Sourô Sanou Hospital, a prospective, cross-sectional study.

BACKGROUND: Childhood mortality rates remain high in sub-Saharan Africa. This study aimed to assess the causes and associated factors of pediatric emergency mortality at the Sourô Sanou University Hospital of Bobo-Dioulasso. METHODOLOGY: This was a cross-sectional study with prospective collection from June to August 2020. We documented and analyzed demographic and clinical characteristics by means or proportions. Logistic regression was performed to identify the factors associated with childhood mortality. RESULTS: From 618 pediatric patients admitted to pediatric emergency unit, 80 (12.9%) were documented as death outcomes. The mean age was 34.10 ± 36.38 months. The male sex represented 51.25%. The main diagnoses were severe malaria (61.25%), acute gastroenteritis (11.25%) and pneumonia (10%); 48.75% of the patients were malnourished and only 55% were fully immunized. The average length of hospitalization was 2.73 ± 3.03 days. Mortality was a strongly significant association with late come to the emergency unit (AOR = 1.11, CI = 1.04-1.18), young maternal age (AOR = 0.95, CI = 0.92-0.99) and incomplete vaccination (AOR = 1.94, CI = 1.13-3.31). CONCLUSION: The in-hospital mortality rate was 12.94%; younger maternal age, delay in consultation, unimmunized or incompletely immunized status and shorter hospital stays were significantly associated with death.

Infant mortality rates remain high in sub-Saharan Africa jeopardizing the achievement of targets for the sustainable development goals. In this article, we identify the causes and factors associated with infant mortality at the Sourô Sanou University Hospital Pediatric Emergency Room in Bobo-Dioulasso. During the study period, the main diagnoses were severe malaria, acute gastroenteritis and pneumonia. Mortality was strongly associated with late arrival at the emergency room, young maternal age and incomplete vaccination. The in-hospital mortality rate was 12.94%, and younger maternal age, delay in consultation, unimmunized or incompletely immunized status and shorter hospital stays were significantly associated with death.

Additional payment despite free health care in Burkina Faso / Paiement additionnel malgré la gratuité des soins au Burkina Faso

Introduction: Free health care for children under five years of age in Burkina Faso was introduced in 2016 in order to remove the financial barrier to accessing care. Additional health expenses remain despite this free health care, which may compromise access to health services for the poorest patients. Methods: This partial medico-economic evaluation included a descriptive study of additional health expenses paid by parents. Payment receipts and parents' declarations were consulted. Results: The average monthly income of the parents was 73,026.79 FCFA ($132) with 5.08% of the parents having no income. The total direct cost was 6,043,785 FCFA ($10939). The total additional direct cost was 2,181,150 FCFA ($3,950) or 36.09% of the total direct cost. The average percentage of free care was 65.50%. 7.7% of parents were dissatisfied with the free schooling. 34.48% were unprepared for additional expenses, 43.97% of parents had difficulty paying the additional costs and of these 80% reported that they had exhausted their savings to meet the prescriptions. Conclusions: Additional health expenses remain high despite free care. This can compromise the care of the poorest patients. A reorganization of free health care is necessary.

Introduction: La gratuité des soins chez les enfants de moins de 5 ans au Burkina Faso a été introduite en 2016 afin de lever la barrière financière dans l'accès aux soins. Des dépenses de santé additionnelles subsisteraient malgré cette gratuité, ce qui peut compromettre l'accès aux services de santé des patients les plus démunis. Méthodes: Il s'agit d'une évaluation médico-économique partielle, notamment l'étude descriptive des dépenses de santé additionnelles payées par les parents. Nous avons consulté les reçus de paiement et les déclarations des parents. Résultats: Le revenu mensuel des parents était en moyenne de 73 026,79 FCFA (132 $) avec 5,08 % des parents qui n'ont pas de revenu. Le coût direct total était de 6 043 785 FCFA (10 939 $). Le coût direct total additionnel était de 2 181 150 FCFA (3 950 $), soit 36,09 % du coût direct total. Le pourcentage moyen de prise en charge de la gratuité était de 65,50 %. Près de 10 % (7,7 %) des parents étaient insatisfaits de la gratuité ; ils étaient 34,48 % à ne pas être préparés à honorer des dépenses supplémentaires, 43,97 % avaient eu du mal à payer les frais supplémentaires et parmi ces derniers, 80 % ont déclaré avoir épuisé leur économie pour honorer les prescriptions. Conclusions: Les dépenses de santé additionnelles restent élevées malgré la gratuité des soins. Cela peut compromettre la prise en charge des patients les plus pauvres. Une réorganisation de la gratuité des soins s'avère nécessaire.

Spatiotemporal analysis of dengue fever in Burkina Faso from 2016 to 2019.

BACKGROUND: Burkina Faso experienced an epidemic resurgence of dengue in 2016, which led to the implementation of several control strategies. In order to allow a better adaptation of these strategies, we studied the spatio-temporal distribution of dengue. METHODS: Monthly dengue cases from 2016 to 2019, aggregated at the health district level, were used to map the crude incidence, excess risk, and smoothed incidence of dengue in Burkina Faso with GeoDa software. A Kulldoff scan on Satscan software was then used to identify spatio-temporal clustering of cases. RESULTS: The results show that the distribution of dengue fever across the health districts of Burkina Faso is heterogeneous. Dengue was considered non-endemic in 9 out of the 70 health districts, minimally endemic in 45 districts (< 10 incidences), moderately endemic (10-100 incidences) in 12 districts, and highly endemic (> 100 incidences) in 4 districts. The main cluster covered the health districts of Baskuy, Nongr-massom, Sig-noghin, Boulmiougou, and Bogodogo. The months of October and November corresponded to the peak of cases and a significant temporal cluster in 2017. CONCLUSION: This study identified the spatial and temporal clustering of dengue cases in Burkina Faso. These results may help to develop better preventive strategies.

[Prognostic factors for neonatal mortality at the Souro Sanou University Hospital in Bobo-Dioulasso, Burkina Faso: a cross-sectional study]. / Facteurs pronostiques de la mortalité néonatale au CHU Sourô Sanou de Bobo-Dioulasso, Burkina Faso: une étude transversale.

Introduction: to help reduce neonatal mortality in Burkina Faso, we identified the prognostic factors for neonatal mortality at the Sourô Sanou University Hospital. Methods: we conducted a cross-sectional and analytical study in the neonatal department from July 25, 2019 to June 25, 2020. Patients' medical records, consultation and hospital records were reviewed. Prognostic factors for neonatal mortality were identified using a Cox model. Results: data from 1128 newborn babies were analysed. Neonatal mortality was 29.8%. Most of these deaths (89%) occurred in the early neonatal period. The mean weight of newborns at the admission was 2,285.8 ± 878.7 and 43.6%. They were at a healthy weight. Four out of five newborns had been hospitalized for infection or prematurity. The place of delivery (HR weight <1000g = 5.45[3.81 -7.79]) and the principal diagnosis (HR asphyxiation= 1.64[1.30-2.08]) were prognostic factors for neonatal mortality. Conclusion: improving technical facilities for the etiological investigation of infections and an efficient management of low-weight newborns suffering from respiratory distress would considerably reduce in-hospital neonatal mortality in Bobo-Dioulasso.

Spatio-Temporal Determinants of Dengue Epidemics in the Central Region of Burkina Faso.

The aim of this study was to analyze the spatio-temporal distribution and determinants of the 2017 dengue epidemic in Burkina Faso. A principal component analysis of meteorological and environmental factors was performed to reduce dimensions and avoid collinearities. An initial generalized additive model assessed the impact of the components derived from this analysis on dengue incidence. Dengue incidence increased mainly with relative humidity, precipitation, normalized difference vegetation index and minimum temperature with an 8-week lag. A Kulldoff Satscan scan was used to identify high-risk dengue clusters, and a second generalized additive model assessed the risk of a health area being at high risk according to land-use factors. The spatio-temporal distribution of dengue fever was heterogeneous and strongly correlated with meteorological factors. The rural communes of Sabaa and Koubri were the areas most at risk. This study provides useful information for planning targeted dengue control strategies in Burkina Faso.

Seroprevalence of SARS-CoV-2 IgG and associated factors among people living with HIV over the first 12 months following the outbreak of COVID-19 in Burkina Faso, a sub-Saharan African country.

OBJECTIVE: This study aimed to evaluate the seroprevalence of anti-SARS-CoV-2 IgG and factors associated with the infection among PLWHIV over the first 12 months following the outbreak of COVID-19 in Burkina Faso. DESIGN: A retrospective cross-sectional study of plasma samples collected from March 9, 2020, and March 8, 2021, at the outpatient HIV referral center, before the introduction of the SARS-CoV-2 vaccine in Burkina Faso. METHODS: Anti-SARS-CoV-2 IgG were detected in plasma using DS-ЕIA-ANTI-SARS-CoV-2-G (S) kit. Logistic regressions were used to compare SARS-CoV-2 specific immune responses between groups and within subgroups. RESULTS AND DISCUSSION: A total of 419 plasma were subjected to serological diagnosis. None of the participants was vaccinated against COVID-19 during the period of sample collection, and 130 samples were positive for anti-SARS-CoV-2 IgG, giving a prevalence of 31.0% (95% CI 26.6-35.7). The median CD4 cell count was 661 cells/µL (IQR,422-928). Retailers had half the risk of being infected compared to housemaids with an OR of 0.49 (p = 0.028, 95% CI 0.26-0.91). Likewise, the risk of infection was 1.69 times higher in patients on integrase inhibitors compared to that of patients on non-nucleoside reverse transcriptase inhibitors (p = 0.020, 95% CI 1.09-2.63). CONCLUSION: Our study reveals a high seroprevalence among PLWHIV to SARS-CoV-2 during the first year of the pandemic. In addition, PLWHIV on integrase inhibitors are 1.69 times more likely to be infected than PLWHIV on non-nucleoside inhibitors, and this observation remains an intriguing topic that still needs to be clarified.

Long-term evolution of immunological and virological parameters in patients undergoing treatments for HIV-1 infection at the Day Hospital of Bobo-Dioulasso, Burkina Faso.

Introduction: antiretroviral therapy enables the suppression of the plasma viral load and the restoration of immune responses. Therapeutic failures are still observed in patients living with HIV despite the considerable benefits of antiretroviral therapy. This study aimed to describe the long-term evolution of immunological and virological parameters in patients undergoing treatments for HIV-1 at the Day Hospital of Bobo-Dioulasso in Burkina Faso. Methods: a retrospective descriptive and analytical study covering 10 years from 2009 was conducted at the Sourô Sanou University Hospital Center (CHUSS) in Bobo-Dioulasso. HIV-1-positive patients with at least two viral load measurements and two CD4 T cell counts were included in this study. Excel 2019 and RStudio were used to analyze the data. Results: a total of 265 patients were included in this study. The mean age of the patients was 48 ± 8.98 years and women accounted for 77.7% of the study population. A considerable decrease in the number of patients with TCD4 lymphocytes below 200 cells/µl from year 2 of treatment and a progressive increase in those with TCD4 lymphocytes above 500 cells/µl were observed in the study. Regarding the evolution of viral load, an increase in the proportions of patients with an undetectable viral load and a decrease in those with a viral load greater than 1000 copies/ml were noticed in years 2, 5, 6, and 8 of the follow-up. However, a decrease in the proportions of patients with undetectable viral load and an increase in those with viral load above 1000 copies/ml were observed in the years 4, 7, and 10 of follow-up. Conclusion: this study highlighted the different trends of viral load and LTCD4 evolution over 10 years of antiretroviral treatment. It showed a good immunovirological response was shown at the beginning of antiretroviral therapy, and then, a poor evolution of these markers at certain periods during the follow-up of HIV-positive patients.

Impact of mentoring on the implementation of the quality management system in clinical laboratories in Burkina Faso, West Africa.

In Burkina Faso, the implementation of the quality management system remains weak in diagnostic laboratories. Integrating mentoring into the life of clinical diagnostic laboratories, a qualified mentor is essential for quality system control. The objective of this study was to evaluate the impact of the mentoring process on quality improvement. Mentoring process was implemented at nine laboratories. The process consisted of a one-week mentor stay in the laboratory as one visit, with four in total. The SLIPTA checklist was used as a measurement tool. Two audits were performed (before and after the implementation of the mentoring process. The audit data were analyzed to estimate the effect of mentoring on quality improvement. A score difference of 24.55% was found significant between the two audits (paired Student's t-test p-value = 0.0002). The variables non-conformities, corrective/preventive actions, and facilities/safety have factored more than eight points between the two audits. However, the management/customer service and information one have only slightly increased (2.27 and 0.63, respectively). Mentoring has improved the quality management system in laboratories. However, some points of the process need to be improved to bring these laboratories toward international accreditation.

Climate factors and dengue fever in Burkina Faso from 2017 to 2019.

Dengue is now a major health concern in sub-Saharan Africa. Understanding the influence of local meteorological factors on the incidence of dengue is an important element for better prediction and control of this disease. This study aims to assess the impact of meteorological factors on dengue transmission in the central region of Burkina Faso. We analyzed the lagged effects of meteorological factors on the weekly incidence of dengue from 2017 to 2019 in the central region of Burkina Faso using a General Additive Model. The results show that maximum and minimum temperature, relative humidity, and wind speed have a significant non-linear effect on dengue cases in the region with 83% of case variance explained. The optimal temperature that increases dengue cases was 27°C to 32°C for the maximum temperature and 18°C to 20°C for the minimum temperature with a decrease beyond that. The maximum temperature shifted by six weeks had the best correlation with dengue incidence. The estimated number of dengue cases increases as the maximum relative humidity increases from 15 to 45% and then from 60 to 70%. In general, an increase in daily wind speed is estimated to decrease the number of daily dengue cases. The relationship between rainfall and dengue cases was not significant. This study provides local information about the effect of meteorological factors on dengue that should help improve predictive models of dengue cases in Burkina Faso and contribute to the control of this disease.

Spatial-temporal pattern of malaria in Burkina Faso from 2013 to 2020.

Despite the implementation of different strategies to fight against malaria in Burkina Faso since 2005, it remains today the leading cause of hospitalization and death. Adapting interventions to the spatial and temporal distribution of malaria could help to reduce this burden. This study aims to determine the structure and stability of malaria hotspots in Burkina Faso, with the objective of adapting interventions at small geographical scales. Data on malaria cases from 2013 to 2020 were acquired at municipalities level. Municipality-wise malaria endemicity levels were mapped through geographical information system (GIS) tools. Spatial statistical analysis using Kulldoff sweeps were carried out to identify malaria hotspots. Then we mapped the monthly malaria risk. Malaria is endemic in all the municipalities of Burkina Faso. However, two stable main spatial clusters (South-Western and Eastern part of the country) are emerging with seasonal reinforcement. Interventions targeting the identified clusters could significantly reduce the incidence of malaria in Burkina Faso. This also prompts for further studies to identify the local determinants of this high transmission for the future success of malaria control.

Diagnostic yield and grading acid-fast bacilli from serial sputum smears of HIV- infected and uninfected tuberculosis patients in routine microscopy laboratory in Ouagadougou, Burkina Faso

We compared 100 HIV-infected and 100 non-infected adult patients with pulmonary tuberculosis (TB) to evaluate the association between the HIV status and the microscopic yield, and between the HIV status and the grading of acid-fast bacilli (AFB) sputum smears. We stained specimens by Ziehl-Neelsen hot method. The first serial sputum smears diagnosed 89 por cento HIV- infected and 94 por cento uninfected. The additional yields of the second and third sputum smears identified respectively 10 por cento and 1 por cento among the HIV-infected against 5 por cento and 1 por cento among the patients without HIV. Considering grading of AFB, the HIV- positive patients were more scanty and less positive 2+ and 3+ at the first (P=0.089) and the second sputum smears (P=0.010). For the second AFB-smears grading, there was a significant difference between HIV-infected and uninfected among the males (P=0.031), the group of age ranging from 15 to 44 years old (P=0.003) and among the ambulatory patients (P=0.015); when we analyzed data for subgroups by HIV serological status, the difference was not significant in the results among the females (P=0.417) and the TB-hospitalized (P=0.501). In conclusion, the morning sputum smears improved the diagnostic yield in both HIV-infected and uninfected patients. However, globally the frequency of scanty was significantly associated with HIV serological status.