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1.
PLoS One ; 19(3): e0297674, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38478539

RESUMO

Micronutrient deficiency remains a daunting issue in many parts of the world. Effective interventions are needed to deal with the problem, which should consider production and consumption traditions and trends to improve their success. Parboil rice is a growing staple in Burkina Faso, where micronutrient deficiency remains high. This paper assesses the market feasibility of fortified rice through parboiling using a limited-water soaking method. Our findings suggest that consumers are willing to pay a premium for fortified rice versus conventional parboiled rice after they are informed about the importance of the problem and the potential benefits of fortified rice. A stylized cost analysis also reveals that the cost of producing fortified rice using a limited-water soaking method could exceed the premiums consumers are willing to pay, and therefore that public intervention may be needed to improve the odds of adoption by consumers. The findings have implication beyond Burkina Faso, and could guide market development in other regions where production and consumption of parboiled rice is well established.


Assuntos
Oryza , Burkina Faso , Água , Micronutrientes , Alimentos Fortificados
2.
BMC Public Health ; 24(1): 827, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38491462

RESUMO

BACKGROUND: Over- and undernutrition coexist in many African countries and pose a threat to metabolic health. This study assessed the associations between relationship satisfaction and Body Mass Index (BMI), waist circumference (WC), and glycated hemoglobin (HbA1c), in a rural population of older adults in Burkina Faso. It also explored potential gender differences and the mediating role of depressive symptoms. METHODS: Data from the "Centre de Recherche en Santé de Nouna (CRSN) Heidelberg Aging Study (CHAS)," a cross-sectional population-based study conducted in 2018 in Burkina Faso, were used in our study. Hierarchical linear regression models were applied for each of the three outcome variables. Among 2291 participants aged 40 years or older who provided data on relationship satisfaction, 2221, 2223, and 2145 participants had BMI, waist circumference (WC), and HbA1c values respectively. RESULTS: Higher relationship satisfaction (CSI-4 score) was associated with increased BMI (ß = 0.05, p = 0.031) and WC (ß = 0.12, p = 0.039). However, the association of CSI-4 and BMI became non-significant after controlling for depressive symptoms (PHQ-9 score) and physical inactivity (BMI: ß = 0.04, p = 0.073). Depressive symptoms fully mediated the relationship between relationship satisfaction and BMI (ß = -0.07, p = 0.005). There was no significant association between relationship satisfaction and HbA1c. These results were consistent across genders and age groups. CONCLUSION: Higher relationship satisfaction may lead to increased body weight among Burkinabe adults aged 40 years and older, and depressive symptoms may be a mediator in this association.


Assuntos
Satisfação Pessoal , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Transversais , Hemoglobinas Glicadas , Índice de Massa Corporal , Circunferência da Cintura , Burkina Faso/epidemiologia , Fatores de Risco
3.
Influenza Other Respir Viruses ; 18(3): e13271, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38501305

RESUMO

BACKGROUND: Although influenza viruses cause only one-fifth of severe acute respiratory infections (SARI) in Burkina Faso, the other viral causes of SARI remain poorly investigated to inform clinical and preventive decision making. METHODS: Between 2016 and 2019, we prospectively enrolled inpatients meeting the World Health Organization (WHO) case definition of SARI in Burkina Faso. Results of viral etiologies among inpatients tested negative for influenza using the Fast Track Diagnostics Respiratory Kits (FTD-33) were reported. RESULTS: Of 1541 specimens tested, at least one respiratory virus was detected in 76.1% of the 1231 specimens negative for influenza virus. Human rhinoviruses (hRVs) were the most detected pathogens (476; 38.7%), followed by human adenoviruses (hAdV) (17.1%, 210/1231), human respiratory syncytial virus (hRSV) (15.4%, 189/1231), enterovirus (EnV) (11.2%, 138/1231), human bocavirus (hBoV) (7.9%, 97/1231), parainfluenza 3 (hPIV3) (6.1%, 75/1231), human metapneumovirus (hMPV) (6.0%,74/1321), parainfluenza 4 (hPIV4) (4.1%, 51/1231), human coronavirus OC43 (hCoV-OC43) (3.4%, 42/1231), human coronavirus HKU1(hCoV-HKU1) (2.7%, 33/1231), human coronavirus NL63 (hCoV-NL63) (2.5%, 31/1231), parainfluenza 1 (hPIV1) (2.0%, 25/1231), parainfluenza 2 (hPIV2) (1.8%, 22/1231), human parechovirus (PeV) (1.1%, 14/1231), and human coronavirus 229E (hCoV-229E) (0.9%, 11/1231). Among SARI cases, infants aged 1-4 years were mostly affected (50.7%; 622/1231), followed by those <1 year of age (35.7%; 438/1231). Most detected pathogens had year-long circulation patterns, with seasonal peaks mainly observed during the cold and dry seasons. CONCLUSION: Several non-influenza viruses are cause of SARI in Burkina Faso. The integration of the most common pathogens into the routine influenza surveillance system might be beneficial.


Assuntos
Enterovirus , Influenza Humana , Orthomyxoviridae , Infecções por Paramyxoviridae , Pneumonia , Infecções Respiratórias , Vírus , Lactente , Humanos , Influenza Humana/epidemiologia , Infecções Respiratórias/epidemiologia , Burkina Faso/epidemiologia , Orthomyxoviridae/genética , Betacoronavirus , Infecções por Paramyxoviridae/epidemiologia
5.
BMJ Open ; 14(3): e081682, 2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38479748

RESUMO

INTRODUCTION: Seasonal malaria chemoprevention (SMC) involves repeated administrations of sulfadoxine-pyrimethamine plus amodiaquine to children below the age of 5 years during the peak transmission season in areas of seasonal malaria transmission. While highly impactful in reducing Plasmodium falciparum malaria burden in controlled research settings, the impact of SMC on infection prevalence is moderate in real-life settings. It remains unclear what drives this efficacy decay. Recently, the WHO widened the scope for SMC to target all vulnerable populations. The Ministry of Health (MoH) in Burkina Faso is considering extending SMC to children below 10 years old. We aim to assess the impact of SMC on clinical incidence and parasite prevalence and quantify the human infectious reservoir for malaria in this population. METHODS AND ANALYSIS: We will perform a cluster randomised trial in Saponé Health District, Burkina Faso, with three study arms comprising 62 clusters of three compounds: arm 1 (control): SMC in under 5-year-old children, implemented by the MoH without directly observed treatment (DOT) for the full course of SMC; arm 2 (intervention): SMC in under 5-year-old children, with DOT for the full course of SMC; arm 3 (intervention): SMC in under 10-year-old children, with DOT for the full course of SMC. The primary endpoint is parasite prevalence at the end of the malaria transmission season. Secondary endpoints include the impact of SMC on clinical incidence. Factors affecting SMC uptake, treatment adherence, drug concentrations, parasite resistance markers and transmission of parasites will be determined. ETHICS AND DISSEMINATION: The London School of Hygiene & Tropical Medicine's Ethics Committee (29193) and the Burkina Faso National Medical Ethics Committee (Deliberation No 2023-05-104) approved this study. The findings will be presented to the community; disease occurrence data and study outcomes will also be shared with the Burkina Faso MoH. Findings will be published irrespective of their results. TRIAL REGISTRATION NUMBER: NCT05878366.


Assuntos
Antimaláricos , Malária , Pré-Escolar , Humanos , Lactente , Antimaláricos/uso terapêutico , Burkina Faso/epidemiologia , Quimioprevenção/métodos , Combinação de Medicamentos , Malária/epidemiologia , Malária/prevenção & controle , Malária/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Estações do Ano , Criança
6.
Lancet Glob Health ; 12(4): e599-e610, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38485427

RESUMO

BACKGROUND: Typhoid Fever remains a major cause of morbidity and mortality in low-income settings. The Severe Typhoid in Africa programme was designed to address regional gaps in typhoid burden data and identify populations eligible for interventions using novel typhoid conjugate vaccines. METHODS: A hybrid design, hospital-based prospective surveillance with population-based health-care utilisation surveys, was implemented in six countries in sub-Saharan Africa. Patients presenting with fever (≥37·5°C axillary or ≥38·0°C tympanic) or reporting fever for three consecutive days within the previous 7 days were invited to participate. Typhoid fever was ascertained by culture of blood collected upon enrolment. Disease incidence at the population level was estimated using a Bayesian mixture model. FINDINGS: 27 866 (33·8%) of 82 491 participants who met inclusion criteria were recruited. Blood cultures were performed for 27 544 (98·8%) of enrolled participants. Clinically significant organisms were detected in 2136 (7·7%) of these cultures, and 346 (16·2%) Salmonella enterica serovar Typhi were isolated. The overall adjusted incidence per 100 000 person-years of observation was highest in Kavuaya and Nkandu 1, Democratic Republic of the Congo (315, 95% credible interval 254-390). Overall, 46 (16·4%) of 280 tested isolates showed ciprofloxacin non-susceptibility. INTERPRETATION: High disease incidence (ie, >100 per 100 000 person-years of observation) recorded in four countries, the prevalence of typhoid hospitalisations and complicated disease, and the threat of resistant typhoid strains strengthen the need for rapid dispatch and implementation of effective typhoid conjugate vaccines along with measures designed to improve clean water, sanitation, and hygiene practices. FUNDING: The Bill & Melinda Gates Foundation.


Assuntos
Febre Tifoide , Vacinas , Humanos , Febre Tifoide/epidemiologia , Febre Tifoide/prevenção & controle , Gana , Madagáscar , Burkina Faso/epidemiologia , Etiópia , Incidência , Nigéria , Estudos Prospectivos , Teorema de Bayes , República Democrática do Congo
7.
BMC Infect Dis ; 24(1): 331, 2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38509462

RESUMO

BACKGROUND: Viruses are the leading etiology of acute respiratory infections (ARI) in children. However, there is limited knowledge on drivers of severe acute respiratory infection (SARI) cases involving viruses. We aimed to identify factors associated with severity and prolonged hospitalization of viral SARI among children < 5 years in Burkina Faso. METHODS: Data were collected from four SARI sentinel surveillance sites during October 2016 through April 2019. A SARI case was a child < 5 years with an acute respiratory infection with history of fever or measured fever ≥ 38 °C and cough with onset within the last ten days, requiring hospitalization. Very severe ARI cases required intensive care or had at least one danger sign. Oropharyngeal/nasopharyngeal specimens were collected and analyzed by multiplex real-time reverse-transcription polymerase chain reaction (rRT-PCR) using FTD-33 Kit. For this analysis, we included only SARI cases with rRT-PCR positive test results for at least one respiratory virus. We used simple and multilevel logistic regression models to assess factors associated with very severe viral ARI and viral SARI with prolonged hospitalization. RESULTS: Overall, 1159 viral SARI cases were included in the analysis after excluding exclusively bacterial SARI cases (n = 273)very severe viral ARI cases were common among children living in urban areas (AdjOR = 1.3; 95% CI: 1.1-1.6), those < 3 months old (AdjOR = 1.5; 95% CI: 1.1-2.3), and those coinfected with Klebsiella pneumoniae (AdjOR = 1.9; 95% CI: 1.2-2.2). Malnutrition (AdjOR = 2.2; 95% CI: 1.1-4.2), hospitalization during the rainy season (AdjOR = 1.71; 95% CI: 1.2-2.5), and infection with human CoronavirusOC43 (AdjOR = 3; 95% CI: 1.2-8) were significantly associated with prolonged length of hospital stay (> 7 days). CONCLUSION: Younger age, malnutrition, codetection of Klebsiella pneumoniae, and illness during the rainy season were associated with very severe cases and prolonged hospitalization of SARI involving viruses in children under five years. These findings emphasize the need for preventive actions targeting these factors in young children.


Assuntos
Influenza Humana , Desnutrição , Pneumonia , Infecções Respiratórias , Viroses , Vírus , Criança , Humanos , Lactente , Pré-Escolar , Tempo de Internação , Burkina Faso/epidemiologia , Viroses/epidemiologia , Infecções Respiratórias/epidemiologia , Vírus/genética , Hospitalização , Influenza Humana/epidemiologia
8.
Environ Microbiol ; 26(3): e16588, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38450576

RESUMO

Dengue represents an increasing public health burden worldwide. In Africa, underreporting and misdiagnosis often mask its true epidemiology, and dengue is likely to be both more widespread than reported data suggest and increasing in incidence and distribution. Wolbachia-based dengue control is underway in Asia and the Americas but has not to date been deployed in Africa. Due to the genetic heterogeneity of African Aedes aegypti populations and the complexity of the host-symbiont interactions, characterization of key parameters of Wolbachia-carrying mosquitoes is paramount for determining the potential of the system as a control tool for dengue in Africa. The wAlbB Wolbachia strain was stably introduced into an African Ae. aegypti population by introgression, and showed high intracellular density in whole bodies and different mosquito tissues; high intracellular density was also maintained following larval rearing at high temperatures. No effect on the adult lifespan induced by Wolbachia presence was detected. Moreover, the ability of this strain to strongly inhibit DENV-2 dissemination and transmission in the host was also demonstrated in the African background. Our findings suggest the potential of harnessing Wolbachia for dengue control for African populations of Ae. aegypti.


Assuntos
Aedes , Dengue , Wolbachia , Animais , Burkina Faso/epidemiologia , Wolbachia/genética , Ásia , Dengue/prevenção & controle
9.
Bull World Health Organ ; 102(3): 187-195, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38420571

RESUMO

Objective: To estimate the feasibility, positivity rate and cost of offering child testing for human immunodeficiency virus (HIV) to mothers living with HIV attending outpatient clinics in Burkina Faso. Methods: We conducted this implementation study in nine outpatient clinics between October 2021 and June 2022. We identified all women ≤ 45 years who were attending these clinics for their routine HIV care and who had at least one living child aged between 18 months and 5 years whose HIV status was not known. We offered these mothers an HIV test for their child at their next outpatient visit. We calculated intervention uptake, HIV positivity rate and costs. Findings: Of 799 eligible children, we tested 663 (83.0%) and identified 16 new HIV infections: 2.5% (95% confidence interval, CI: 1.5-4.1). Compared with HIV-negative children, significantly more HIV-infected children were breastfed beyond 12 months (P-value: 0.003) and they had not been tested before (P-value: 0.003). A significantly greater proportion of mothers of HIV-infected children were unaware of the availability of child testing at 18 months (P-value: < 0.001) and had more recently learnt their HIV status (P-value: 0.01) than mothers of HIV-negative children. The intervention cost 98.1 United States dollars for one child testing HIV-positive. Barriers to implementing this strategy included shortages of HIV tests, increased workload for health-care workers and difficulty accessing children not living with their mothers. Conclusion: Testing HIV-exposed children through their mothers in outpatient clinics is feasible and effective in a low HIV-prevalence setting such as Burkina Faso. Implementation of this strategy to detect undiagnosed HIV-infected children is recommended.


Assuntos
Infecções por HIV , Soropositividade para HIV , Adulto , Criança , Feminino , Humanos , Lactente , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Burkina Faso/epidemiologia , Mães , Teste de HIV
10.
BMJ Glob Health ; 8(Suppl 3)2024 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-38382997

RESUMO

Climate change is an increasing threat to the health of populations in Africa, with a shift in seasonal temperatures towards more extreme heat exposures. In Burkina Faso, like other countries in the Sahel, many women have little protection against exposure to high temperatures, either outside or inside the home or place of work. This paper investigates how women perceive the impacts of heat on their physical and mental health, in addition to their social relationships and economic activities. Qualitative methods (in-depth interviews and focus group discussions) were conducted with women, community representatives and healthcare professionals in two regions in Burkina Faso. A thematic analysis was used to explore the realities of participants' experiences and contextual perspectives in relation to heat. Our research shows extreme temperatures have a multifaceted impact on pregnant women, mothers and newborns. Extreme heat affects women's functionality and well-being. Heat undermines a woman's ability to care for themselves and their child and interferes negatively with breast feeding. Heat negatively affects their ability to work and to maintain harmonious relationships with their partners and families. Cultural practices such as a taboo on taking the baby outside before the 40th day may exacerbate some of the negative consequences of heat. Most women do not recognise heat stress symptoms and lack awareness of heat risks to health. There is a need to develop public health messages to reduce the impacts of heat on health in Burkina Faso. Programmes and policies are needed to strengthen the ability of health professionals to communicate with women about best practices in heat risk management.


Assuntos
Calor Extremo , Lactente , Criança , Humanos , Feminino , Recém-Nascido , Gravidez , Burkina Faso , Antropologia Cultural , Mães , Relações Interpessoais
11.
Sante Publique ; 35(6): 149-159, 2024 02 23.
Artigo em Francês | MEDLINE | ID: mdl-38388395

RESUMO

The rapid deployment of COVID-19 vaccines to a large proportion of the population requires a focus on safety. However, few studies have assessed the safety of COVID-19 vaccines in Africa. In Burkina Faso, this issue has not yet been addressed. The objective of this study was to contribute to the description of the characteristics of adverse events following immunization (AEFIs) related to COVID-19 vaccines in Burkina Faso. This was a cross-sectional descriptive retrospective study of spontaneous reports of COVID-19 vaccine-related AEFIs recorded in VigiBase® between June 2021 and November 2022 in Burkina Faso. Individual case safety reports (ICSRs) were extracted from VigiBase® using the Anatomical Therapeutic Chemical level 2 (ATC2) code. The proportion of ICSRs according to the reporter's qualification, the reporting rate, the time taken to submit and record ICSRs, and the completeness score were calculated. A total of 973 ICSRs concerned COVID-19 vaccines and represented 32.6% of all 2,988 reports in VigiBase®. Overall, 82.0% of the reporters were nurses/midwives, 7.8% were physicians, 6.7% were pharmacists, and 3.4% were patients. The median time between the onset of AEFIs and the submission of the report to the Pharmacovigilance Center was 180 days (IQR: 136; 281). The median registration time was 188 days (IQR: 149; 286). The mean ICSR completeness score was 0.8 (standard deviation = 0.1). The overall AEFI reporting rate was 27.8 per 100,000 vaccine doses. The AEFI reporting rates for the ChAdOx1-nCoV-19, JNJ 78436735, Elasomeran, Tozinameran, and HB02 vaccines were 454.2, 17.4, 11.0, 10.2, and 0.4 per 100,000 vaccine doses, respectively. The majority of AEFIs were systemic in nature (90.1%). Headache (21.2%), fever (19.4%), and myalgia (11.0%) were the most frequently reported AEFIs. Eighteen cases (1.8%) of serious AEFIs (9 hospitalizations, 4 life threatening, 3 temporary disabilities, and 2 others unspecified) were reported. The majority of AEFIs reported were systemic in nature and mild. However, there have been reports of serious AEFIs. The overall AEFI reporting rate was low. There is a need to strengthen the monitoring of these vaccines to better organize strategies to optimize the adherence of the population of Burkina Faso.


Le déploiement rapide des vaccins anti COVID-19 sur une grande partie de la population nécessite de mettre l'accent sur la sécurité. Cependant, peu d'études ont évalué la sécurité des vaccins anti COVID-19 en Afrique. Au Burkina Faso, cette question n'a pas encore été abordée. La présente étude avait pour objectif de contribuer à la description des caractéristiques des manifestations post-vaccinales indésirables (MAPI) liées aux vaccins anti COVID-19 au Burkina Faso. Il s'est agi d'une étude transversale rétrospective ayant porté sur les notifications de MAPI liées aux vaccins anti COVID-19 enregistrées dans VigiBase® entre juin 2021 et novembre 2022 au Burkina Faso. Les cas individuels de rapports de sécurité (CIRS) ont été extraits de VigiBase® à l'aide du code Anatomical Therapeutic Chemical niveau 2 (ATC2). La proportion de CIRS selon la qualification du notificateur, le taux de notification, le délai de transmission et d'enregistrement des CIRS et le score d'exhaustivité ont été calculés. Au total 973 CIRS concernaient les vaccins anti COVID-19 et représentaient 32,6 % des 2 988 rapports enregistrés dans VigiBase®. La répartition des notifications en fonction de la qualification du notificateur a montré que 82,0 % étaient des infirmiers/sage femmes, 7,8 % des médecins, 6,7 % des pharmaciens et 3,4 % des patients. Le délai médian entre l'apparition des MAPI et la transmission du rapport au Centre de pharmacovigilance était de 180 jours (IQR : 136 ; 281). Le délai médian d'enregistrement était de 188 jours (IQR : 149 ; 286). Le score d'exhaustivité moyen des CIRS était de 0,8 (écart type = 0,1). Le taux global de notifications des MAPI était de 27,8 pour 100 000 doses de vaccins. Les taux de notification des MAPI pour les vaccins ChAdOx1-nCoV-19, JNJ 78436735, Elasomeran, Tozinameran et HB02 étaient de 454,2 ; 17,4 ; 11,0 ; 10,2 et 0,4 pour 100 000 doses, respectivement. La majorité des MAPI était de manifestation systémique (90,1 %). Les céphalées (21,2 %), la fièvre (19,4 %) et les myalgies (11,0 %) étaient les MAPI les plus fréquemment notifiés. Dix-huit cas (1,8 %) de MAPI graves (9 hospitalisations, 4 mises en jeu du pronostic vital, 3 incapacités temporaires et 2 autres non précisés) ont été rapportés. La majorité des cas notifiés dans le cadre de la surveillance des MAPI était de manifestation systémique et de nature bénigne. Néanmoins, des cas de MAPI graves ont été notifiés. Le taux global de notification des MAPI était faible. Il est nécessaire de renforcer la surveillance de ces vaccins pour mieux organiser les stratégies visant à optimiser l'adhésion de la population burkinabé.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Vacinas , Humanos , Ad26COVS1 , Sistemas de Notificação de Reações Adversas a Medicamentos , Burkina Faso/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Estudos Transversais , Imunização/efeitos adversos , Estudos Retrospectivos , Vacinas/efeitos adversos
12.
Ann Parasitol ; 69(3-4)2024.
Artigo em Inglês | MEDLINE | ID: mdl-38423519

RESUMO

Schistosomiasis is a common neglected helminthic disease in the tropics and sub-tropics particularly in sub-Saharan countries including Burkina Faso. It is the second world parasitic endemic disease after malaria. The two prevalent species infecting human in Burkina Faso are are Schistosoma haematobium and Schistosoma mansoni which cause respectively the urogenital schistosomiasis and the intestinal schistosomiasis. This review aimed at providing an historical perspective of research on schistosomiasis from 1960 to 2020 and shedding some light on the gaps in knowledge useful for the disease control and the elimination efforts in Burkina Faso. Formal systematic review was not followed for this review. Published studies on the schistosomiasis in Burkina Faso over the period from 1960 to 2020, were search in Medline, PubMed, Google Scholar, EMBASE and the libraries of main universities in Burkina Faso namely: Joseph KI-ZERBO University and Nazi BONI University. The following key words used were: Schistosomiasis, Bilharzia, Bulinus, Biomphalaria, Upper-Volta and Burkina Faso. Over a period of 60 years, a total of 87 scientific research documents were identified. The original scientific research articles represent the majority of the scientific documents found (65.52%). Urinary schistosomiasis was the most common from the documentation. There has been a gradual decrease in the prevalence, more significantly since the implementation of the National Schistosomiasis Control Program (NSCP). The effectiveness of the NSCP could therefore contribute to the elimination of schistosomiasis in Burkina Faso.


Assuntos
Esquistossomose Urinária , Esquistossomose mansoni , Humanos , Animais , Burkina Faso/epidemiologia , Esquistossomose Urinária/epidemiologia , Schistosoma haematobium
13.
J Int Bioethique Ethique Sci ; 34(3): 69-81, 2024.
Artigo em Francês | MEDLINE | ID: mdl-38423979

RESUMO

INTRODUCTION: A legal exception to the principle of equal health rights, discriminatory subsidies often pose an ethical dilemma in the field of application. AIM: To analyze discriminatory subsidies for healthcare in the light of the ethical principle of justice and to propose alternatives to any inherent legal and ethical conflicts. METHOD: This was a qualitative, descriptive and analytical study based on semi-structured interviews with caregivers. RESULTS: Participants felt that the application of discriminatory subsidies has a negative impact on substantial distributive justice. The infringements of the award conditions were exclusively for the benefit of the patients concerned. Their impact was considered positive on distributive justice and negative on formal justice. DISCUSSION: Discriminatory care subsidies generally stem from a legal requirement whose application should not be ambiguous. It is apparent that the infringements of the conditions for attribution were in favour of substantial distributive justice. This opposition is a potential source of decision-making difficulties for caregivers who often choose to violate conditions for the benefit of their indigent patients. There are therefore violations of ethically understandable standards, which must be admitted. This could be done through the provision of exceptions for the application of standards for ”noble causes” and conscientious objection clauses in health policy texts. CONCLUSION: The legitimacy of health policy norms is essential for their effective application, hence the interest of taking distributive justice into account in the genesis of formal norms.


Assuntos
Acesso aos Serviços de Saúde , Direitos Humanos , Humanos , Burkina Faso , Justiça Social
14.
Malar J ; 23(1): 39, 2024 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-38308288

RESUMO

BACKGROUND: Seasonal Malaria Chemoprevention (SMC) is a highly effective intervention for preventing malaria, particularly in areas with highly seasonal transmission. Monitoring and evaluating (M&E) SMC programmes are complex due to the scale, time-sensitive delivery of the programme, and influence of external factors. This paper describes the process followed to develop a comprehensive M&E framework tailored specifically for the SMC context. METHODS: The Framework was developed through a literature and programme review, and stakeholder dialogues across three implementing countries-Burkina Faso, Chad, and Nigeria. Expert consultation further refined the Framework through an iterative approach drawing upon data collected through the three sources. The Framework was designed using the Logical Framework Approach incorporating external factors and intentionally aligned with global malaria M&E standards. RESULTS: An overall aim and seven programme objectives were developed measured by 70 indicators. The indicators also capture the causal links between the implementation and results of the programme. The Framework leverages the use of current data sources and existing mechanisms, ensuring efficient data use without requiring a significant increase in resources for overall programme optimization. It also promotes the use of data triangulation, and stratification for a more nuanced understanding of factors affecting programme performance and timely data informed decision-making. CONCLUSIONS: The SMC M&E Framework presented here provides a standardized approach for programme implementers to enhance decision-making for optimal programme performance. This is an essential tool as the scope of SMC programmes expands to new geographies and target age groups.


Assuntos
Antimaláricos , Malária , Humanos , Lactente , Estações do Ano , Burkina Faso , Nigéria , Quimioprevenção , Antimaláricos/uso terapêutico
15.
Am J Clin Nutr ; 119(2): 393-405, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38309828

RESUMO

BACKGROUND: Seasonal cycles in climatic factors affect drivers of child growth and contribute to seasonal fluctuations in undernutrition. Current growth seasonality models are limited by categorical definitions of seasons that rely on assumptions about their timing and fail to consider their magnitude. OBJECTIVE: We disentangle the relationship between climatic factors and growth indicators, using harmonic regression to determine how child growth is related to peaks in temperature, precipitation, and vegetation. METHODS: Longitudinal anthropometric data collected between August 2014 and December 2016 from 5039 Burkinabè children measured monthly from age 6 to 28 mo (108,580 observations) were linked with remotely sensed daily precipitation, vegetation, and maximum air temperature. Our models parsimoniously extract a cyclic signal with multiple potential peaks, to compare the magnitude and timing of seasonal peaks in climatic factors and morbidity with that of nadirs in growth velocity (cm/mo, kg/mo). RESULTS: Length and weight velocity were slowest twice a year, coinciding both times with the highest temperatures, and peak fever incidence. Length velocity is slowest 13 d after the first temperature peak in April, and 5 d after the second. Similarly, weight velocity is slowest 13 d before the first temperature peak, and 11 d before the second. The statistical relationship between temperature and anthropometry shows that when the current temperature is higher, weight velocity is lower (ß = -0.0048; 95% CI: -0.0059, -0.0038), and length velocity is higher (ß = 0.0088; 95% CI: 0.0070, 0.0105). CONCLUSIONS: Results suggest that child health and development are more affected by high temperatures than by other aspects of climatic seasonality such as rainfall. Emerging shifts in climatic conditions will pose challenges to optimal growth, highlighting the importance of changes that optimize the timing of nutrition interventions and address environmental growth-limiting conditions. CLINICAL TRIAL REGISTRY: Clinicaltrials.gov: NCT02071563.


Assuntos
Temperatura , Pré-Escolar , Humanos , Burkina Faso/epidemiologia , Incidência , Estudos Longitudinais , Estações do Ano , Lactente
16.
BMC Infect Dis ; 24(1): 166, 2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38326750

RESUMO

BACKGROUND: In Burkina Faso, the prevalence of malaria has decreased over the past two decades, following the scale-up of control interventions. The successful development of malaria parasites depends on several climatic factors. Intervention gains may be reversed by changes in climatic factors. In this study, we investigated the role of malaria control interventions and climatic factors in influencing changes in the risk of malaria parasitaemia. METHODS: Bayesian logistic geostatistical models were fitted on Malaria Indicator Survey data from Burkina Faso obtained in 2014 and 2017/2018 to estimate the effects of malaria control interventions and climatic factors on the temporal changes of malaria parasite prevalence. Additionally, intervention effects were assessed at regional level, using a spatially varying coefficients model. RESULTS: Temperature showed a statistically important negative association with the geographic distribution of parasitaemia prevalence in both surveys; however, the effects of insecticide-treated nets (ITNs) use was negative and statistically important only in 2017/2018. Overall, the estimated number of infected children under the age of 5 years decreased from 704,202 in 2014 to 290,189 in 2017/2018. The use of ITNs was related to the decline at national and regional level, but coverage with artemisinin-based combination therapy only at regional level. CONCLUSION: Interventions contributed more than climatic factors to the observed change of parasitaemia risk in Burkina Faso during the period of 2014 to 2017/2018. Intervention effects varied in space. Longer time series analyses are warranted to determine the differential effect of a changing climate on malaria parasitaemia risk.


Assuntos
Inseticidas , Malária , Criança , Humanos , Lactente , Pré-Escolar , Burkina Faso/epidemiologia , Teorema de Bayes , Malária/epidemiologia , Malária/prevenção & controle , Malária/parasitologia , Modelos Logísticos , Clima , Parasitemia/epidemiologia , Parasitemia/prevenção & controle , Inseticidas/farmacologia
17.
Viruses ; 16(2)2024 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-38400020

RESUMO

This study aimed at investigating the genetic lineages of peste des petits ruminants virus (PPRV) currently circulating in Burkina Faso. As part of PPR surveillance in 2021 and 2022, suspected outbreaks in different regions were investigated. A risk map was produced to determine high-risk areas for PPR transmission. Based on alerts, samples were obtained from three regions and all sampled localities were confirmed to fall within PPR high risk areas. We collected swab samples from the eyes, mouth, and nose of sick goats. Some tissue samples were also collected from dead animals suspected to be infected by PPRV. In total, samples from 28 goats were analysed. Virus confirmation was performed with RT-PCR amplification targeting the nucleocapsid (N) gene. Partial N gene sequencing (350 bp) was carried out using the RT-PCR products of positives samples to characterise the circulating lineages. Eleven sequences, including ten new sequences, have been obtained. Our study identified the presence of the PPRV lineage IV in the three studied regions in Burkina Faso with a genetic heterogeneity recorded for the sequences analysed. Previously published data and results of this study suggest that PPRV lineage IV seems to be replacing lineage II in Burkina Faso.


Assuntos
Doenças das Cabras , Peste dos Pequenos Ruminantes , Vírus da Peste dos Pequenos Ruminantes , Animais , Vírus da Peste dos Pequenos Ruminantes/genética , Peste dos Pequenos Ruminantes/epidemiologia , Burkina Faso/epidemiologia , Epidemiologia Molecular , Doenças das Cabras/epidemiologia , Filogenia , Ruminantes , Cabras
18.
JAMA ; 331(6): 482-490, 2024 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-38349371

RESUMO

Importance: Repeated mass distribution of azithromycin has been shown to reduce childhood mortality by 14% in sub-Saharan Africa. However, the estimated effect varied by location, suggesting that the intervention may not be effective in different geographical areas, time periods, or conditions. Objective: To evaluate the efficacy of twice-yearly azithromycin to reduce mortality in children in the presence of seasonal malaria chemoprevention. Design, Setting, and Participants: This cluster randomized placebo-controlled trial evaluating the efficacy of single-dose azithromycin for prevention of all-cause childhood mortality included 341 communities in the Nouna district in rural northwestern Burkina Faso. Participants were children aged 1 to 59 months living in the study communities. Interventions: Communities were randomized in a 1:1 ratio to receive oral azithromycin or placebo distribution. Children aged 1 to 59 months were offered single-dose treatment twice yearly for 3 years (6 distributions) from August 2019 to February 2023. Main Outcomes and Measures: The primary outcome was all-cause childhood mortality, measured during a twice-yearly enumerative census. Results: A total of 34 399 children (mean [SD] age, 25.2 [18] months) in the azithromycin group and 33 847 children (mean [SD] age, 25.6 [18] months) in the placebo group were included. A mean (SD) of 90.1% (16.0%) of the censused children received the scheduled study drug in the azithromycin group and 89.8% (17.1%) received the scheduled study drug in the placebo group. In the azithromycin group, 498 deaths were recorded over 60 592 person-years (8.2 deaths/1000 person-years). In the placebo group, 588 deaths were recorded over 58 547 person-years (10.0 deaths/1000 person-years). The incidence rate ratio for mortality was 0.82 (95% CI, 0.67-1.02; P = .07) in the azithromycin group compared with the placebo group. The incidence rate ratio was 0.99 (95% CI, 0.72-1.36) in those aged 1 to 11 months, 0.92 (95% CI, 0.67-1.27) in those aged 12 to 23 months, and 0.73 (95% CI, 0.57-0.94) in those aged 24 to 59 months. Conclusions and Relevance: Mortality in children (aged 1-59 months) was lower with biannual mass azithromycin distribution in a setting in which seasonal malaria chemoprevention was also being distributed, but the difference was not statistically significant. The study may have been underpowered to detect a clinically relevant difference. Trial Registration: ClinicalTrials.gov Identifier: NCT03676764.


Assuntos
Antibacterianos , Azitromicina , Mortalidade da Criança , Malária , Humanos , Azitromicina/provisão & distribuição , Azitromicina/uso terapêutico , Burkina Faso/epidemiologia , Quimioprevenção/métodos , Quimioprevenção/estatística & dados numéricos , Mortalidade da Criança/tendências , Malária/epidemiologia , Malária/mortalidade , Malária/prevenção & controle , Antibacterianos/provisão & distribuição , Antibacterianos/uso terapêutico , Estações do Ano , Lactente , Pré-Escolar
19.
Int J Food Microbiol ; 415: 110637, 2024 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-38422679

RESUMO

Rural and small-scale chicken farming is a major source of income in most African countries, and chicken meat is an important source of nutrients. However, chicken meat can be contaminated with Campylobacter spp. and Salmonella spp., pathogens with a high reported burden of foodborne illnesses. Therefore, it is essential to control these pathogens in chicken meat. Quantitative microbial risk assessments (QMRA) can aid the development of effective food safety control measures and are currently lacking in chicken meat supply chains in the African context. In this study, we developed stochastic QMRA models for Salmonella spp. and Campylobacter spp. in the chicken meat supply chain in Burkina Faso and Ethiopia employing the modular process risk model in @Risk software. The study scope covered chicken farming, transport, slaughtering, consumer handling, and consumption. Effectiveness of candidate interventions was assessed against baseline models' outputs, which showed that the mean annual Campylobacter spp. risk estimates were 6482 cases of illness per 100,000 persons and 164 disability adjusted life years (DALYs) per 100,000 persons in Burkina Faso, and 12,145 cases and 272 DALYs per 100,000 persons in Ethiopia. For Salmonella spp., mean annual estimates were 2713 cases and 1212 DALYs per 100,000 persons in Burkina Faso, and 4745 cases and 432 DALYs per 100,000 persons in Ethiopia. Combining interventions (improved hand washing plus designated kitchen utensils plus improved cooking) resulted in 75 % risk reduction in Burkina Faso at restaurants and 93 to 94 % in Ethiopia at homes for both Salmonella spp. and Campylobacter spp. For Burkina Faso, adding good hygienic slaughter practices at the market to these combined interventions led to over 91 % microbial risk reduction. Interventions that involved multiple food safety actions in a particular step of the supply chain or combining different interventions from different steps of the supply chain resulted in more risk reduction than individual action interventions. Overall, this study demonstrates how diverse and scanty food supply chain information can be applied in QMRA to provide estimates that can be used to stimulate risk-based food safety action in African countries.


Assuntos
Campylobacter , Galinhas , Animais , Carne , Burkina Faso , Microbiologia de Alimentos , Etiópia , Inocuidade dos Alimentos , Salmonella , Manipulação de Alimentos , Contaminação de Alimentos/prevenção & controle , Contaminação de Alimentos/análise
20.
Lancet ; 403(10426): 533-544, 2024 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-38310910

RESUMO

BACKGROUND: Recently, we found that a new malaria vaccine, R21/Matrix-M, had over 75% efficacy against clinical malaria with seasonal administration in a phase 2b trial in Burkina Faso. Here, we report on safety and efficacy of the vaccine in a phase 3 trial enrolling over 4800 children across four countries followed for up to 18 months at seasonal sites and 12 months at standard sites. METHODS: We did a double-blind, randomised, phase 3 trial of the R21/Matrix-M malaria vaccine across five sites in four African countries with differing malaria transmission intensities and seasonality. Children (aged 5-36 months) were enrolled and randomly assigned (2:1) to receive 5 µg R21 plus 50 µg Matrix-M or a control vaccine (licensed rabies vaccine [Abhayrab]). Participants, their families, investigators, laboratory teams, and the local study team were masked to treatment. Vaccines were administered as three doses, 4 weeks apart, with a booster administered 12 months after the third dose. Half of the children were recruited at two sites with seasonal malaria transmission and the remainder at standard sites with perennial malaria transmission using age-based immunisation. The primary objective was protective efficacy of R21/Matrix-M from 14 days after third vaccination to 12 months after completion of the primary series at seasonal and standard sites separately as co-primary endpoints. Vaccine efficacy against multiple malaria episodes and severe malaria, as well as safety and immunogenicity, were also assessed. This trial is registered on ClinicalTrials.gov, NCT04704830, and is ongoing. FINDINGS: From April 26, 2021, to Jan 12, 2022, 5477 children consented to be screened, of whom 1705 were randomly assigned to control vaccine and 3434 to R21/Matrix-M; 4878 participants received the first dose of vaccine. 3103 participants in the R21/Matrix-M group and 1541 participants in the control group were included in the modified per-protocol analysis (2412 [51·9%] male and 2232 [48·1%] female). R21/Matrix-M vaccine was well tolerated, with injection site pain (301 [18·6%] of 1615 participants) and fever (754 [46·7%] of 1615 participants) as the most frequent adverse events. Number of adverse events of special interest and serious adverse events did not significantly differ between the vaccine groups. There were no treatment-related deaths. 12-month vaccine efficacy was 75% (95% CI 71-79; p<0·0001) at the seasonal sites and 68% (61-74; p<0·0001) at the standard sites for time to first clinical malaria episode. Similarly, vaccine efficacy against multiple clinical malaria episodes was 75% (71-78; p<0·0001) at the seasonal sites and 67% (59-73; p<0·0001) at standard sites. A modest reduction in vaccine efficacy was observed over the first 12 months of follow-up, of similar size at seasonal and standard sites. A rate reduction of 868 (95% CI 762-974) cases per 1000 children-years at seasonal sites and 296 (231-362) at standard sites occurred over 12 months. Vaccine-induced antibodies against the conserved central Asn-Ala-Asn-Pro (NANP) repeat sequence of circumsporozoite protein correlated with vaccine efficacy. Higher NANP-specific antibody titres were observed in the 5-17 month age group compared with 18-36 month age group, and the younger age group had the highest 12-month vaccine efficacy on time to first clinical malaria episode at seasonal (79% [95% CI 73-84]; p<0·001) and standard (75% [65-83]; p<0·001) sites. INTERPRETATION: R21/Matrix-M was well tolerated and offered high efficacy against clinical malaria in African children. This low-cost, high-efficacy vaccine is already licensed by several African countries, and recently received a WHO policy recommendation and prequalification, offering large-scale supply to help reduce the great burden of malaria in sub-Saharan Africa. FUNDING: The Serum Institute of India, the Wellcome Trust, the UK National Institute for Health Research Oxford Biomedical Research Centre, and Open Philanthropy.


Assuntos
Vacinas Antimaláricas , Malária , Nanopartículas , Saponinas , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Anticorpos Antivirais , Burkina Faso , Método Duplo-Cego , Imunização , Malária/tratamento farmacológico , Vacinas Antimaláricas/efeitos adversos
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