[Survey of investigation around cases of Rift Valley Fever at Tagant, Mauritania]. / Enquête d'investigation sur des cas de fièvre de la vallée du Rift au Tagant, Mauritanie.

BACKGROUND: Rift Valley Fever (RVF) is a zoonotic arbovirosis. Among animals, it mainly affects ruminants, causing abortions in gravid females and deaths among young animals. In humans, RVF virus infection is usually asymptomatic or characterized by a moderate fever. However, in 1-3% of cases, the disease progresses to a severe form with 50% mortality. OBJECTIVE: Search for risk factors and to propose appropriate measures to prevent the potential for extension of the epidemic, and to make recommendations for disease monitoring and control. METHODS: This investigation involved human RVF cases reported between October 12 and November 20, 2012 in the area of Tagant in Mauritania. Arbovirosis diagnosis was established by the laboratory of the National Institute of Public Health Research in Nouakchott (Mauritania) in collaboration with the Pasteur Institute of Dakar (Senegal). RESULTS: Of 212 subjects, RVF serology was positive in 26 (12%). Among those seropositive for RVF, 11 (42%) had severe hemorrhagic forms. The case fatality rate was 91%. A series of animal abortions (cattle, sheep and goats) was observed in the area where all but two subjects resided. Exposure to potential risk factors for RVF virus infection was found in all patients. CONCLUSION: Mortality is very high in the hemorrhagic forms of RVF. Disease prevention is necessary by strengthening the fight against vectors, avoiding contact and consumption of organic products from diseased animals and vaccination of animals in areas where the disease is endemic. Furthermore, it is essential to establish management procedures for patients infected with the RVF virus. An appropriately equipped referral hospital is necessary, together with strengthened epidemiological surveillance by notifying all suspected cases of hemorrhagic fevers.

Management of necrotizing and non-necrotic bacterial erysipelas of the face in tropical areas: a series of four cases and a review of the literature.

The necrotizing and not necrotizing acute bacterial dermohypodermitis (DHD) are acute bacterial infections of tissues situated between the skin and the muscles. The localizations of the face are infrequent, and sometimes put diagnostic difficulties with other current facial dermatosis. We report in this article 4 cases of DHD of the face with skin source, hospitalized in the service of the Infectious and Tropical Diseases of the Teaching Hospital Yalgado Ouédraogo of Ouagadougou (Burkina Faso). The objective is to make a current situation of their etiologies and complications, and to look for the difficulties to take care of them in a country with limited resources. The patient's care journey for this disease is long while it constitutes a medical or medical-surgical emergency. Imaging, which is essential for the diagnosis of heart valve disease and the daunting complications of necrotizing fasciitis and mediastinitis, is generally available only in tertiary hospitals. Antibiotic therapy is most often inadequate or insufficient. Anti-inflammatories, widely used, according to several authors contribute to serious forms and excess mortality. Health workers in resource-limited settings need to be better educated and guidelines issued to recognize the signs of this condition in order to enable early referral of patients in specialized settings. In addition, education of the population and hygiene awareness of skin lesions should be a priority to reduce complications.

[About 98 cases of dengue hospitalized in a private clinic of Ouagadougou: epidemiology, diagnostic and evolution]. / À propos de 98 cas de dengue hospitalisés dans une clinique privée de Ouagadougou : aspects épidémiologiques, diagnostiques et évolutifs.

Extremely widespread, the dengue is a reemerging infectious disease. In Burkina Faso, dengue is a reality that was little known. The aim of this study was to study epidemiology, diagnostic and outcomes of dengue patients in Ouagadougou. A retrospective study covered a period of two years, from 1 January 2013 to 31 December 2014 in a private clinic in Ouagadougou. Patients included in the study were hospitalized for fever and painful syndrome with a positive test to the dengue non-structural antigen 1 (NS1 Ag). Ninety-eight cases of dengue on 343 suspected cases were registered. The average age of patients was 35.9 years. The sex-ratio (M/F) was 1.18. According to the professional activity, there was a predominance of civil servants (35.7%). The pain syndrome was found in 93.9% of patients. Leukopenia (73.5%), neutropenia (56.1%) and severe thrombocytopenia (57.1%) were the predominant hematological disturbances. Of the patients, 18.4% had hemorrhagic dengue and 11.2%, a dengue shock syndrome. Four patients died. The use of non-steroidal antiinflammatory drugs was associated with the severity of the infection (p=0.04). Dengue fever occurs in our context and constitutes a risk of mortality. The diagnosis of dengue should be performed systematically in front of a painful and febrile syndrome. The vector control is the best way of prevention against dengue pending the development of a vaccine.

[Prevalence of smear-positive pulmonary tuberculosis in Aïoun hospital (Hodh El Garbi)]. / Prévalence de la tuberculose pulmonaire à bacilloscopie positive dans un centre hospitalier d'Aïoun (Hodh El Garbi).

In this retrospective study in the regional hospital Aioun from 1st January 2010 to 31st April 2014, the objective was to determine the prevalence of smear-positive PTB. In total, 320 cases have been identified giving a proportion of 9%. The male subjects (74%) were three times higher than for female subjects with a sex-ratio man/woman of 2.8. The average age of patients was 41±16 years with extremes of 15 and 90 years and the most affected age group was 15-30 years (41%). The majority of our patients (85%) came from rural areas. No patient had been screened for HIV infection. There was a statistically significant relationship between gender, age group (P=0.005) and resistant cases after 6months of anti-TB treatment (P=0.04). Tuberculosis remains a public health problem in our country. Many efforts will still be provided for screening and epidemiological surveillance for a good control of the disease.

[Inventory of fixtures on the tolerance of the treatment) of the resistant multi-tuberculosis (Burkina Faso)]. / Etat des lieux sur la tolerance du traitement de la tuberculose multi resistante (Burkina Faso).

OBJECTIVES: Estimate the tolerance of antituberculous drugs prescribed in the treatment of multi resistant tuberculosis on patients followed in the service of Pneumology of the University hospital of Yalgado Ouedraogo. PATIENTS AND METHODS: It was a retrospective and prospective longitudinal investigation. The files of patients allowed to inform the questionnaire for the retrospective phase (2010-2011), the follow-up of patients during the prospective phase (2011-2013) allowed for data collection. All the patients under antituberculous treatment of 2nd line between January 1st, 2010 and the August 31st, 2013 were included. RESULTS: 71 cases of multi resistant tuberculosis (MRT) were included. The sex-ratio was 3.4. The age bracket from 30 to 39 was the most represented (39.4 %). A notion of tubercular contage was found in 18 (25.3%) patients. All MRT patient had histories of treatment including aminoside lasting more than 2 months. Intolerance of the treatment was reported in 57 patients. Intolerance predominated in 30 to 39 years olds and in Tuberculosis/HIV co-infected patients. The neurological (47.9%) and psychiatric (47.9%) infringements were the most represented. Vestibulocochlear impact was seen in 42.3% of cases with 18.3% reporting of total deafness. CONCLUSION: The intolerance of the antituberculous treatment of the second line is real focus for clinicians. Shorter timeframes would avoid certain therapeutic modifications thought to be at the origin of failures.

OBJECTIFS: Apprécier la tolérance des antituberculeux prescrits dans le traitement de la tuberculose multi résistante chez les patients suivis dans le service de Pneumologie du Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU YO). PATIENTS ET MÉTHODES: Il s'est agi d'une enquête longitudinale rétrospective et prospective. Les dossiers des patients ont permis de renseigner le questionnaire pour la phase rétrospective (2010­2011), le suivi des patients durant la phase prospective (2011­2013) a permis la collecte des données. Etaient inclus tous les patients sous traitement antituberculeux de 2ème ligne entre le 1er Janvier 2010 et le 31 Aout 2013. RÉSULTATS: Au total 71 cas de tuberculose multi résistante (TB-MDR) ont été recrutés. Le sex- ratio était 3,4. La tranche d'âge de 30 à 39 était la plus représentée (39,4%). Une notion de contage tuberculeux a été retrouvée chez 18 (25,3%) des patients. Tous les patients TB-MR avaient des antécédents de traitement incluant des aminosides de durée supérieure à 2 mois. L'intolérance au traitement a été rapportée chez 57 patients. Elle prédominait chez les 30 à 39 ans et chez les sujets co-infectés Tuberculose/VIH. Les atteintes neurologiques (47,9%) et psychiatriques (47,9%) étaient les plus représentées. L'atteinte vestibulo-cochléaire était de 42,3% avec 18,3% de surdité totale. CONCLUSION: L'intolérance du traitement antituberculeux de deuxième ligne est un véritable hantise pour le clinicien. Des régimes plus courts éviteraient certainement des modifications thérapeutiques à l'origine de survenue d'échecs.

[Rabies in children: an often unknown risk among populations at risk]. / La rage chez l'enfant: un risque encore méconnu des populations exposées.

INTRODUCTION: Rabies is a public health problem in many African countries including Burkina Faso. Although animal bites, including dog bites, are relatively common, the persistence of public ignorance about their risk means that children who are bitten may receive no prophylaxis and are thus at serious risk. We report two cases of early childhood rabies in the past 2 years; both children were bitten by infected dogs. The clinical manifestations were those of encephalitis, with agitation and hydrophobia. In the absence of a reference laboratory for human rabies testing, confirmation of this diagnosis was not possible. Neither child received prophylaxis after being bitten. These cases are a reminder that rabies remains a problems today, a disease to which humans and animals of all ages are subject. Access to prevention messages about post-exposure prophylaxis against this disease is essential, for it is always fatal once its symptoms appear. Awareness and education about rabies should be intensified in view of the widespread ignorance of this risk.

[Epidemiological, clinical, and prognostic study of the measles in the Aioun regional hospital in Mauritania]. / Aspects épidémiologiques, cliniques et pronostiques de la rougeole au centre hospitalier régional d'Aïoun, Mauritanie.

Our cross-sectional study was conducted at the Aioun Regional Hospital from February 1 to April 30, 2011, and included all cases of active measles. Its objectives were to determine the epidemiological, clinical, prognostic features of this disease. The case definition was that of World Health Organization (WHO). In three months, we collected 36 cases, which accounted for 8.84% (36/407) of admissions. The M/F sex ratio was 1.25, and the patients' mean age 16.5 years (range: 1-33 years). The majority of the patients came from rural areas (72%) and 89% had not been vaccinated against measles. The maculopapular rash had irregular contours and intervals of healthy skin. The main clinical manifestations that accompanied the fever and rash were respiratory (83%) and digestive (42%) manifestations. Other associated signs included dehydration (22%), malnutrition (14%), and convulsions (8%). The average duration of hospitalization was 7.5 days ± 3 days (range: 2-12). The overall case fatality rate was 8%. The factors of poor prognosis were non-vaccination (P = 0.018), malnutrition (P = 0.0059), and convulsions (P = 0.0553). Measles remains a public health problem in Mauritania. Strong efforts should be made to improve epidemiological surveillance and vaccination for better control of this disease.

[Severe hemorrhagic form of Rift Valley Fever in Mauritania]. / Forme hémorragique grave de la fièvre de la Vallée du Rift en Mauritanie.

We report three severe cases of hemorrhagic form of Rift Valley Fever which have been observed in the Hospital of Aïoun (two cases) and in the regional hospital of Tidjikdja (one case). The disease manifested itself by an infectious syndrome, an early infectious syndrome (on the second day) with onset of hemorrhagic complications and disorder of consciousness ranging from an agitation to deep coma. The biological examinations showed a severe anemia. Multiple organ failures were also observed. Of the three patients treated one died. Therefore, the management of both suspected and confirmed cases must be initiated as soon as possible in order to control organ damages and prevent fatality. There is no specific treatment. The importance of the epidemiological survey must be emphasized to avoid outbreaks and control any epidemic due to this virus.

[State of tolerance of multi resistant tuberculosis treatment (Burkina Faso)]. / Etat des lieux sur la tolerance du traitement de la tuberculose multi resistante (Burkina Faso).

OBJECTIVES: Estimate the tolerance of antituberculous drugs prescribed in the treatment of multi resistant tuberculosis on patients followed in the service of Pneumology of the University hospital of Yalgado Ouedraogo. PATIENTS AND METHODS: It was a retrospective and prospective longitudinal investigation. The files of patients allowed to inform the questionnaire for the retrospective phase (2010-2011), the follow-up of patients during the prospective phase (2011-2013) allowed for data collection. All the patients under antituberculous treatment of 2nd line between January 1st, 2010 and the August 31st, 2013 were included. RESULTS: 71 cases of multi resistant tuberculosis (MRT) were included. The sex-ratio was 3.4. The age bracket from 30 to 39 was the most represented (39.4 %). A notion of tubercular contage was found in 18 (25.3%) patients. All MRT patient had histories of treatment including aminoside lasting more than 2 months. Intolerance of the treatment was reported in 57 patients. Intolerance predominated in 30 to 39 years olds and in Tuberculosis/HIV co-infected patients. The neurological (47.9%) and psychiatric (47.9%) infringements were the most represented. Vestibulocochlear impact was seen in 42.3% of cases with 18.3% reporting of total deafness. CONCLUSION: The intolerance of the antituberculous treatment of the second line is real focus for clinicians. Shorter timeframes would avoid certain therapeutic modifications thought to be at the origin of failures.

OBJECTIFS: Apprécier la tolérance des antituberculeux prescrits dans le traitement de la tuberculose multi résistante chez les patients suivis dans le service de Pneumologie du Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU YO). PATIENTS ET MÉTHODES: Il s'est agi d'une enquête longitudinale rétrospective et prospective. Les dossiers des patients ont permis de renseigner le questionnaire pour la phase rétrospective (2010­2011), le suivi des patients durant la phase prospective (2011­2013) a permis la collecte des données. Etaient inclus tous les patients sous traitement antituberculeux de 2ème ligne entre le 1er Janvier 2010 et le 31 Aout 2013. RÉSULTATS: Au total 71 cas de tuberculose multi résistante (TB-MDR) ont été recrutés. Le sex-ratio était 3,4. La tranche d'âge de 30 à 39 était la plus représentée (39,4%). Une notion de contage tuberculeux a été retrouvée chez 18 (25,3%) des patients. Tous les patients TB-MR avaient des antécédents de traitement incluant des aminosides de durée supérieure à 2 mois. L'intolérance au traitement a été rapportée chez 57 patients. Elle prédominait chez les 30 à 39 ans et chez les sujets co-infectés Tuberculose/VIH. Les atteintes neurologiques (47,9%) et psychiatriques (47,9%) étaient les plus représentées. L'atteinte vestibulo-cochléaire était de 42,3% avec 18,3% de surdité totale. CONCLUSION: l'intolérance du traitement antituberculeux de deuxième ligne est un véritable hantise pour le clinicien. Des régimes plus courts éviteraient certainement des modifications thérapeutiques à l'origine de survenue d'échecs.

[The Neisseria meningitidis W135 epidemic in 2012 in Burkina Faso]. / L'épidémie de méningite à Neisseria meningitidis W135 en 2012 au Burkina Faso.

We describe the main features of a meningitis outbreak caused by Neisseria meningitidis W135 which occurred in Burkina Faso from January to April 2012. Data were collected from the health districts. Meningitis cases were defined as suspected cases, probable or confirmed, according to clinical and laboratory criteria. The epidemic reached 13 health districts with a total of 5300 reported cases and 553 deaths (10.4%), mainly in the age group 5-14 years. The sex ratio was 1.3 for males. N. meningitidis W135 was reported in 49 of 63 (78%) districts and identified by latex test in 68% of cerebrospinal fluid. Three health districts have benefited from a reactive vaccination campaign with the tetravalent vaccine polysaccaridic (A, C, Y, W135). Patients were treated with ceftriaxone or ampicillin, in accordance with national guidelines. This study emphasized the necessity to strengthen the epidemiological surveillance and laboratory capacities, and make available the tetravalent conjugated vaccine in order to improve the response to meningitis outbreaks.

[Actor of health in Asthmatic patients management in Burkona Faso]. / Acteurs de sante dans la prise en charge de l'Asthme au Burkina Faso.

OBJECTIVE: Identify the obstacles with the best coverage of the patient asthmatic by the actors of the health in Ouagadougou. METHOD: Transverse Study with descriptive aim from January till December 2012, associated with a review of the literature concerning the role of the actors of health in the coverage of the asthma. RESULT: the technique of demonstration of the grip of the spray measuring glass was known to 46 % of the doctors. A medical prescription was required by 9 % of the pharmacists before the delivery of medicine asthmatic. The check of the conformity of the prescription was made by 30 % of the pharmacists, the demonstration of the grip of the spray measuring glass to the pharmacy was assured by 73,6 % of the pharmacists and mastered well by 34,5 %.Within the framework of the treatment of the asthma, 43,2 % of the male nurses knew that ß2-mimetic and corticoids were the most used medicine. ß2-mimetic inhaled by quick action was recommended by 40,6 % of the male nurses in the occasional asthma, this prescription is not in compliance with the recommendations of GINA. CONCLUSION: A need for training / recycling is expressed by almost all of the actors of health occurring in the coverage of the asthma in Burkina Faso.

OBJECTIF: Identifier les entraves à la meilleure prise en charge du patient asthmatique par les acteurs de la santé à Ouagadougou. MÉTHODE: Etude transversale à visée descriptive de Janvier à décembre 2012, associée à une revue de la littérature portant sur le rôle des acteurs de santé dans la prise en charge de l'asthme. RÉSULTAT: La technique de démonstration de la prise de l'aérosol doseur était maitrisée chez 46% des médecins. Une ordonnance médicale était exigée par 9% des pharmaciens avant la délivrance des médicaments asthmatiques. La vérification de la conformité de la prescription médicale était faite par 30% des pharmaciens, la démonstration de la prise de l'aérosol doseur à l'officine était assurée par 73,6% des pharmaciens et bien maîtrisée par 34,5%. Dans le cadre du traitement de l'asthme, 43,2 % des infirmiers savaient que les bronchodilatateurs et les corticoïdes étaient les médicaments les plus utilisés. Les bronchodilatateurs inhalés d'action rapide étaient recommandés par 40,6 % des infirmiers dans l'asthme intermittent, cette prescription n'est pas conforme aux recommandations de la GINA. CONCLUSION: Un besoin de formation/recyclage est exprimé par la quasi-totalité des acteurs de santé intervenant dans la prise en charge de l'asthme au Burkina Faso.

[Pulmonary tuberculosis: knowledge, beliefs and practices of tubercular patients' carers in Ouagadougou]. / Tuberculose pulmonaire: connaissances, croyances et pratiques des accompagnateurs des patients tuberculeux a Ouagadougou.

OBJECTIVE: Describe the knowledge, beliefs and practices on tuberculosis of tubercular patients' carers in Ouagadougou. METHODS: A prospective descriptive transversal study was carried out. Participants were sourced from the four Centers of Diagnosis and Treatment, the National Center for the Fight Against Tuberculosis and the department of Pneumology of the Yalgado Ouédraogo University hospital. The recruitment was exhaustive and included the carers of tubercular patients (pulmonary tuberculosis with positive microscopy). RESULTS: The average age of the carers was 36 years ± 14, with a majority of them bring male. In 33.7% of the cases the carer was a sibling and not schooled in 45.2%. A good understanding of tuberculosis was found at 20.2 % of the carers. Among the subjects which had a good understanding, 71.4 % were schooled and 88.1% came from an urban environment. Understanding tuberculosis is associated with academic level. Knowledge of the modes of contamination of tuberculosis was low (48,1%). Among the carers, 37% did not know that the tubercular patient should not be isolated by their circle of acquaintances, 19.2% assured the supervision of medicine intake. Respectively, 1.4% and 5.8% believe that tuberculosis is associated with witchcraft and divine punishment. Approximately two thirds of the carers refused to share the same dish as the tubercular patient. CONCLUSION: An insufficient general knowledge of tuberculosis emerges from our work and modes of contamination. The beliefs and behavioral practices of the carers towards the tubercular patients tend to increase the stigmatization of tuberculosis.

OBJECTIF: Décrire les connaissances, croyances et pratiques sur la tuberculose des accompagnateurs des patients tuberculeux à Ouagadougou. MATÉRIELS ET MÉTHODES: Étude transversale prospective à passage unique et à visée descriptive. Les sites de recrutement étaient représentés par les quatre Centres de Diagnostic et de Traitement, le Centre National de Lutte Anti Tuberculeuse et le service de Pneumo-phtisiologie du Centre Hospitalier Universitaire Yalgado Ouédraogo. Le recrutement a été exhaustif et a concerné les accompagnateurs des patients tuberculeux. RÉSULTATS: L'âge moyen des accompagnateurs était de 36 ans ± 14, une prédominance masculine a été observée. Ils étaient dans 33,7% des cas représentés par la fratrie (frère et/ou sœur) et non scolarisés dans 45,2%. Une bonne connaissance de la tuberculose était retrouvée chez 20,2% des accompagnateurs. Parmi ceux qui avaient une bonne connaissance, 71,4 % étaient scolarisés et 88,1% provenaient du milieu urbain. La connaissance de la tuberculose était associée au niveau d'instruction. La connaissance des modes de contamination de la tuberculose était faible (48,1%). Parmi les accompagnateurs 37% ne savaient pas que le tuberculeux ne devrait pas être isolé de l'entourage, 19,2% assuraient la supervision des prises des médicaments. Respectivement 1,4% et 5,8% d'entre eux croyaient que la tuberculose relevait de la sorcellerie et d'une punition divine. Environ deux tiers des accompagnateurs refusaient de partager le même plat avec le patient tuberculeux. CONCLUSION: Une insuffisance des connaissances générales sur la TB et des modes de contamination a été observée. Les croyances et pratiques comportementales des accompagnateurs vis-à-vis des patients tuberculeux tendent à stigmatiser d'avantage la tuberculose.

Rationality of drug prescriptions in rural health centres in Burkina Faso.

The objective of this study is to investigate the quality of drug prescriptions in nine health centres of three districts in rural Burkina Faso. 313 outpatient consultations were studied by methods of guided observation. Additionally interviews were held with the health care workers involved in the study. A total of 793 drugs prescribed by 15 health care workers during the observation period and 2815 prescribed drugs copied from the patient register were analyzed. An average of 2.3 drugs were prescribed per visit. 88.0% of the prescribed drugs were on the essential drug list. 88.4% were indicated according to the national treatment guidelines. 79.4% had a correct dosage. The study revealed serious deficiencies in drug prescribing that could not be detected by assessing selected quantitative drug-use indicators as recommended by the WHO. In two-thirds of the cases the patients received no information on how long the drug had to be taken. Errors in dosage occurred significantly more often in children under 5 years. The combined analysis of choice and dosage of drugs showed that 59.3% of all the patients received a correct prescription. Seven out of 21 pregnant women received drugs contraindicated in pregnancy. We conclude that assessment of quantitative drug-use indicators alone does not suffice in identifying specific needs for improvement in treatment quality. We recommend that prescribing for children under 5 and for pregnant women should be targeted in future interventions and that the lay-out, content and distribution of treatment guidelines must be improved.