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1.
Sante Publique ; Vol. 32(1): 123-140, 2020 Jun 18.
Artigo em Francês | MEDLINE | ID: mdl-32706222

RESUMO

INTRODUCTION: In Burkina Faso, despite actions to improve women’s health, the percentage of those with unmet needs in terms of family planning remains high (35.6% in 2015 to 20.2% in 2018 according to projections from the Performance Monitoring and Accountability project [PMA2014-15/Burkina]). METHODS: The study used data from demographic and public health investigations as well as multiple indicator cluster surveys for Burkina Faso in 2010. Two analysis techniques were used: a Multiple Correspondence Analysis, then an Ascending Hierarchical Classification (AHC). A multi-level logistic regression model was used to estimate the net effects of individual and environmental factors associated with these unmet needs. RESULTS: The analysis of the random effects shows that the propensity of having unmet needs in terms of family planning varies considerable from one household to another and from one enumeration zone to another. The net effects also show that women between the ages of 35 and 49 are 6.94 times at risk of having unmet needs in terms of limiting births than for those aged 20 to 34. For the unmet need of spacing births, this risk is estimated at 69% less high for women between 35 to 49 years of age than for those aged 15 to 19. CONCLUSION: It is necessary to strengthen local awareness programs geared towards women and their spouses about the benefits and the importance of family planning, while taking into account their sociodemographic characteristics (age, parity, ethnic background, living environment).


Assuntos
Serviços de Planejamento Familiar , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Adolescente , Adulto , Burkina Faso , Demografia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Medição de Risco , Fatores Sociológicos , Adulto Jovem
2.
Stud Health Technol Inform ; 272: 159-162, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32604625

RESUMO

The successful introduction of ICTs into medical practice is a key factor in improving the performance of any health system for both patients and healthcare professionals. In Burkina Faso, many hospital information systems (HIS) have been developed and are already widely used in large health centers with proven efficiency. To improve the quality of patient care, these hospital information systems should exchange information. Interoperability is one of the privileged ways to improve the integration of different systems because nowadays a HIS is no longer just a single monolithic software system, which is run on a single machine. This paper presents a semantic interoperability architecture, which is based on a mediation approach. The mediator implements local domain ontologies for each HIS, a knowledge base, and a referential ontology which is used as a semantic repository and web services.


Assuntos
Sistemas de Informação Hospitalar , Burkina Faso , Humanos , Bases de Conhecimento , Semântica , Software
3.
BMC Infect Dis ; 20(1): 449, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590942

RESUMO

BACKGROUND: This study aimed to assess the pharmacokinetic profile of 150 mg rifabutin (RBT) taken every other day (every 48 h) versus 300 mg RBT taken every other day (E.O.D), both in combination with lopinavir/ritonavir (LPV/r), in adult patients with human immunodeficiency virus (HIV) and tuberculosis (TB) co-infection. METHODS: This is a two-arm, open-label, pharmacokinetic, randomised study conducted in Burkina Faso between May 2013 and December 2015. Enrolled patients were randomised to receive either 150 mg RBT EOD (arm A, 9 subjects) or 300 mg RBT EOD (arm B, 7 subjects), both associated with LPV/r taken twice daily. RBT plasma concentrations were evaluated after 2 weeks of combined HIV and TB treatment. Samples were collected just before drug ingestion and at 1, 2, 3, 4, 6, 8, and 12 h after drug ingestion to measure plasma drug concentration using an HPLC-MS/MS assay. RESULTS: The Cmax and AUC0-12h medians in arm A (Cmax = 296 ng/mL, IQR: 205-45; AUC0-12h = 2528 ng.h/mL, IQR: 1684-2735) were lower than those in arm B (Cmax = 600 ng/mL, IQR: 403-717; AUC0-12h = 4042.5 ng.h/mL, IQR: 3469-5761), with a statistically significant difference in AUC0-12h (p = 0.044) but not in Cmax (p = 0.313). No significant differences were observed in Tmax (3 h versus 4 h). Five patients had a Cmax below the plasma therapeutic limit (< 300 ng/mL) in the 150 mg RBT arm, while the Cmax was above this threshold for all patients in the 300 mg RBT arm. Additionally, at 48 h after drug ingestion, all patients had a mycobacterial minimum inhibitory concentration (MIC) above the limit (> 64 ng/mL) in the 300 mg RBT arm, while 4/9 patients had such values in the 150 mg RBT arm. CONCLUSION: This study confirmed that the 150 mg dose of rifabutin ingested EOD in combination with LPV/r is inadequate and could lead to selection of rifamycin-resistant mycobacteria. TRIAL REGISTRATION: PACTR201310000629390, 28th October 2013.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antibióticos Antituberculose/administração & dosagem , Antibióticos Antituberculose/uso terapêutico , Coinfecção/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , Lopinavir/uso terapêutico , Rifabutina/administração & dosagem , Rifabutina/uso terapêutico , Ritonavir/uso terapêutico , Tuberculose/tratamento farmacológico , Adulto , Antibióticos Antituberculose/efeitos adversos , Antibióticos Antituberculose/sangue , Burkina Faso , Cromatografia Líquida de Alta Pressão , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Testes de Sensibilidade Microbiana , Projetos Piloto , Distribuição Aleatória , Rifabutina/efeitos adversos , Rifabutina/sangue , Espectrometria de Massas em Tandem
4.
Ann Parasitol ; 66(2): 251-254, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32592548

RESUMO

Ouagadougou, the capital city of Burkina Faso, was recognized as a focus of zoonotic cutaneous leishmaniosis in April 2000. Leishmania major was the only strain isolated in this focus. We conducted a prospective study to detect L. major in rodents, animals which are described as reservoir of the parasite. Rodents were caught in five city areas from November 2005 to October 2006. Giemsa stained smears were realized from the cutaneous lesions when present after macroscopic examination of external lesions. The spleen of each rodent was sterilely removed and split into 3 parts for microscopic examination of smears, culture on NNN media and PCR, respectively. A total of 101 rodents belonging to 9 genera were trapped. All the direct examinations and cultures were negative. By using PCR of lesions and spleen samples, three animals were found infected by L. major: one out of 24 (4.2%) Mastomys natalensis; one out of 8 (12.5%) Taterillus sp. and one out of three Cricetomys gambianus. This is the first detection of L. major in rodent species in Burkina Faso. Further studies are needed to confirm their role as reservoirs of L. major.


Assuntos
Reservatórios de Doenças , Leishmania major , Leishmaniose Cutânea , Reação em Cadeia da Polimerase , Doenças dos Roedores , Roedores , Animais , Burkina Faso , Reservatórios de Doenças/parasitologia , Leishmania major/genética , Leishmaniose Cutânea/diagnóstico , Estudos Prospectivos , Doenças dos Roedores/parasitologia , Roedores/parasitologia , Baço/parasitologia
5.
PLoS Negl Trop Dis ; 14(6): e0008305, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32520930

RESUMO

BACKGROUND: The dengue virus is endemic in many low- and middle-income countries. In Burkina Faso, the proportion of fevers that could be due to dengue is growing. In 2013, a dengue epidemic spread there, followed by other seasonal outbreaks. Dengue is often confused with malaria, and health workers are not trained to distinguish between them. Three training videos using different narrative genres were tested with nursing students from two institutions in Ouagadougou: journalistic, dramatic and animated video. The study aimed to determine if video is an effective knowledge transfer tool, if narrative genre plays a role in knowledge acquisition, and which narrative elements are the most appreciated. METHODOLOGY: A mixed method research design was used. The relative effectiveness of the videos was verified through a quasi-experimental quantitative component with a comparison group and post-test measurements. A qualitative component identified participants' perceptions regarding the three videos. Data were drawn from a knowledge test (n = 482), three focus groups with health professionals' students (n = 46), and individual interviews with health professionals (n = 10). Descriptive statistics and single-factor variance analysis were produced. A thematic analysis was used to analyse qualitative data. PRINCIPAL FINDINGS: Results showed that all three videos led to significant rates of knowledge improvement when compared with the comparison group (p <0.05): 12.31% for the journalistic video, 20.58% for the dramatic video, and 18.91% for the animated video. The dramatic and animated videos produced a significantly higher increase in knowledge than did the journalistic video (with respectively 8.27% (p = 0.003) and 6.59% (p = 0.029) and can be considered equivalent with a difference of 1.68% (p = 0.895). Thematic analysis also revealed that these two videos were considered to be better knowledge transfer tools. Four key aspects are important to consider for a video to be effective: 1) transmitting information in a narrative form, 2) choosing good communicators, 3) creating a visual instrument that reinforces the message and 4) adapting the message to the local context. CONCLUSIONS: Video has proven to be an effective and appreciated knowledge transfer and training tool for health professionals, but the narrative genre of the videos can influence knowledge acquisition. The production of other videos should be considered for training or updating health professionals and their narrative genre taken into consideration. The actual context of constant circulation of new diseases, such as COVID-19, reaffirms the need to train health professionals.


Assuntos
Recursos Audiovisuais , Pessoal de Saúde/educação , Narração , Burkina Faso , Dengue/diagnóstico , Erros de Diagnóstico/prevenção & controle , Grupos Focais , Humanos , Disseminação de Informação/métodos , Capacitação em Serviço , Conhecimento
6.
Sci Total Environ ; 729: 139053, 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32498181

RESUMO

West African populations are exposed to the longest and harshest dust storms on the planet, the Saharan sand and dust storms (SDS). Nonetheless, little is known about the effects of the severe storms on early-life health in West Africa. This study investigated the association of the risk of neonatal mortality, an indicator of the population's early-life health, with potential prenatal and neonatal exposure to the Saharan SDS. Data on 30,552 under-five children from Burkina Faso's 1993, 2003, and 2010 demographic and health surveys were matched to the particulate matters (PM) and terrestrial air temperature and precipitation forecasts. Exposure to dust events was measured by the number of days with average PM10 and PM2.5 concentrations above a series of threshold. Intensity-dependent patterns of associations between neonatal mortality and both prenatal and birth month exposure to dust events were identified. There was no association if average daily PM10 and PM2.5 levels were <60 and 30 µg/m3, respectively. However, strong associations, which increase almost linearly with the intensity of exposure, were identified when daily PM10 and PM2.5 levels ranged from 70 to 150 and from 40 to 70 µg/m3, respectively. At the higher PM levels, the association for the gestation period decreased, but that for the birth month remained mostly unresponsive to changes in the PM levels. Larger associations were identified when siblings were compared.


Assuntos
Mortalidade Infantil , África do Norte , Poluentes Atmosféricos , Burkina Faso , Poeira , Humanos , Lactente , Recém-Nascido , Material Particulado , Areia
7.
PLoS One ; 15(5): e0231819, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32401773

RESUMO

INTRODUCTION: The proliferation of cell phone ownership in Sub-Saharan Africa (SSA) presents the opportunity to collect public health indicators at a lower cost compared to face-to-face (FTF) surveys. This analysis assesses the equivalence of modern contraceptive prevalence estimates between a nationally representative FTF survey and a cell phone survey using random digit dialing (RDD) among women of reproductive age in Burkina Faso. METHODS: We analyzed data from two surveys conducted in Burkina Faso between December 2017 and May 2018. The FTF survey conducted by Performance Monitoring and Accountability (PMA2020) comprised a nationally representative sample of 3,556 women of reproductive age (15-49 years). The RDD survey was conducted using computer-assisted telephone interviewing and included 2,379 women of reproductive age. RESULTS: Compared to FTF respondents, women in the RDD sample were younger, were more likely to have a secondary degree and to speak French. RDD respondents were more likely to report using modern contraceptive use (40%) compared to FTF respondents (26%) and the difference remained unchanged after applying post-stratification weights to the RDD sample (39%). This difference surpassed the equivalence margin of 4%. The RDD sample also produced higher estimates of contraceptive use than the subsample of women who owned a phone in the FTF sample (32%). After adjusting for women's sociodemographic factors, the odds of contraceptive use were 1.9 times higher (95% CI: 1.6-2.2) in the RDD survey compared to the FTF survey and 1.6 times higher (95% CI: 1.3-1.8) compared to FTF phone owners. CONCLUSIONS: Modern contraceptive prevalence in Burkina Faso is over-estimated when using a cell phone RDD survey, even after adjusting for a number of sociodemographic factors. Further research should explore causes of differential estimates of modern contraceptive use by survey modes.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Adolescente , Adulto , Burkina Faso , Feminino , Humanos , Pessoa de Meia-Idade , Saúde Pública , Adulto Jovem
8.
PLoS One ; 15(5): e0232681, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32407336

RESUMO

In West Africa, long and complex livestock value chains connect producers mostly in the Sahel with consumption basins in urban areas and the coast. Regional livestock trade is highly informal and, despite recent efforts to understand animal movement patterns in the region, remains largely unrecorded. Using CILSS' database on intraregional livestock trade, we built yearly and overall weighted networks of animal movements between markets. We mapped and characterized the trade networks, identified market communities, key markets and their roles. Additionally, we compared the observed network properties with null-model generated ensembles. Most movements corresponded to cattle, were made by vehicle, and originated in Burkina Faso. We found that live animals in the central and eastern trade basins flow through well-defined, long distance trade corridors where markets tend to trade in a disassortive way with others in their proximity. Modularity-based communities indicated that both national and cross-border trade groups exist. The network's degree and link distributions followed a log-normal or a power-law distribution, and key markets located primarily in urban centers and near borders serve as hubs that give peripheral markets access to the regional network. The null model ensembles could not reproduce the observed higher-level properties, particularly the propinquity and highly negative assortativity, suggesting that other possibly spatial factors shape the structure of regional live animal trade. Our findings support eliminating cross-border impediments and improving the condition of the regional road network, which limit intraregional trade of and contribute to the high prices of food products in West Africa. Although with limitations, our study sheds light on the abstruse structure of regional livestock trade, and the role of trade communities and markets in West Africa.


Assuntos
Comércio , Gado , África Ocidental , Animais , Burkina Faso , Bovinos , Emigração e Imigração , Gado/fisiologia
9.
J Glob Health ; 10(1): 010422, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32426122

RESUMO

Background: The primary cause of death in Burkina Faso is lower respiratory tract infections, accounting for 1 in 7 deaths. The Ministry of Health is building surveillance for severe acute respiratory infections (SARI) in four districts. This study sought to determine the catchment area of the Boussé district hospital and to describe disease burden of individuals hospitalized for SARI. Methods: Data were collected from hospital log books to identify individuals with a SARI diagnosis during 2015 and 2016. Residence of SARI patients was recorded to determine the catchment area of the hospital. Population data were used to estimate SARI incidence rates. Results: Investigators reviewed logs for 3034 hospital admissions; 885 SARI cases were identified. Five communes were identified as the hospital catchment area, with 770 SARI patients residing in these communes. The SARI incidence rate (IR) for all ages was 136 (95% confidence interval (CI) = 115, 161) and 266 (95% CI = 236, 300) cases per 100 000 population for 2015 and 2016, respectively. Children <1 (RI = 1111 cases per 100 000, 95% CI = 1047, 1178, and RI = 2425 cases per 100 000, 95% CI = 2330, 2524) and adults ≥65 years old (RI = 377 cases per 100 000, 95% CI = 341, 417, and RI = 816 cases per 100 000, 95% CI = 762, 874) had the highest burden of disease for 2015 and 2016, respectively. Conclusion: Our analysis found high rates of SARI, especially among children <1 year of age, and marked variation in incidence between the years studied. These baseline data and the method developed will be useful for the new SARI surveillance system.


Assuntos
Área Programática de Saúde , Hospitais de Distrito/estatística & dados numéricos , Vigilância da População , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/terapia , Adolescente , Adulto , Idoso , Burkina Faso/epidemiologia , Criança , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
Sante Publique ; HS1(S1): 113-122, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32374090

RESUMO

INTRODUCTION: The WHO and UNICEF have declared exclusive breast-feeding one of the essential tools in the fight against neonatal mortality. Both international bodies finalized a 40-hour training program to provide counseling in feeding, to teach a body of care-givers to bring qualified assistance to the breast-feeding mothers and to help them to overcome their difficulties. However, in the field and in maternities such as those where the study took place (Boucle du Mouhoun region in the northwest of Burkina Faso), although technical recommendations are generally adopted and respected, exclusive breastfeeding makes it difficult for mothers to find their way. The aim of this study is to examine the blockages existing at the maternity ward and in families which prevent the practice of exclusive breastfeeding from becoming widespread. A qualitative approach was used through open interviews with various socio-professional medical categories and community members. METHOD: Fourteen observations were made in the families. Twenty-four observations were made on the care of the newborn at home. Thirty-eight interviews with health and administrative staff and nine interviews with healers using traditional knowledge were also conducted. RESULTS: The results show that exclusive breastfeeding is complicated to implement particularly in rural areas because of the use of medicinal plants in the form of washing and gavage. Moreover, the information is not given to mothers of families at the appropriate time. CONCLUSION: In conclusion, we suggest that maternities be thought out and designed in partnership with the health workers who use them.


Assuntos
Aleitamento Materno , Aconselhamento , Conhecimentos, Atitudes e Prática em Saúde , Mães/psicologia , Burkina Faso , Feminino , Pessoal de Saúde , Humanos , Recém-Nascido , Entrevistas como Assunto , Gravidez
11.
PLoS One ; 15(4): e0230340, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32236118

RESUMO

CONTEXT: The person-centred approach (PCA) is a promising avenue for care improvement. However, health professionals in Burkina Faso (hereafter referred to as caregivers) seem unprepared for taking into consideration patients' preferences and values in the context of healthcare provision. OBJECTIVE: To understand the meaning attributed to PCA in the Burkina Faso context of care and to identify the challenges related to its adoption from the perspective of caregivers and women service users (hereafter referred to as patients). METHODS: An ethnographic qualitative research design was used in this study. We conducted 31 semi-directed interviews with caregivers and patients from Koudougou (Burkina Faso) healthcare facilities. We also carried out direct observation of consultations. Data thematic analyses are based on the person-centred approach analysis framework. RESULTS: According to the caregivers and patients interviewed, the PCA in maternal and child healthcare in Burkina Faso includes the following five components used in our analytical framework: i) pregnancy follow-up consultations extend beyond examining physical health issues (biopsychosocial component), ii) healthcare professionals' mood affects the caregiver-patient relationship as well as care delivery (the healthcare professional as a person), iii) patients expect to be well received, listened to, and respected (the patient as a person), iv) healthcare professionals first acknowledge that both themselves and patients have power, rights but also responsibilities (sharing power, rights and responsibilities of professionals and patients), and v) healthcare professionals who are open to involving patients in decision-making about their care and patients asking to have a say in the organization of services (therapeutic alliance). Implementing each of these themes comes with challenges, such as i) talking about health problems in the presence of other women, especially those related to sexuality, even though they are common to parturient women (biopsychosocial component); ii) offering psychotherapy to healthcare professionals (healthcare professional as a person); iii) taking into consideration patients' cultural and linguistic differences (the patient as a person); iv) raising awareness among patients about their right to ask questions and healthcare professionals' duty to answer them (sharing power, and rights and responsibilities of professionals and patients); v) accepting the presence of birth attendants while avoiding traditional practices that are contrary to scientific recommendations (therapeutic alliance). CONCLUSION: Despite some context-specific particularities, the PCA is not new in the context of health care in Burkina Faso. However, its implementation can pose a number of challenges. There is a need to train healthcare professionals with a view to being sensitive to these particularities. This may also require organizational adjustments so as to create the physical and sociocultural environments that are conducive to taking into account the patient's perspective.


Assuntos
Pessoal de Saúde/psicologia , Serviços de Saúde Materno-Infantil/tendências , Assistência Centrada no Paciente/tendências , Relações Profissional-Paciente , Burkina Faso , Pessoal de Saúde/educação , Humanos , Pesquisa Qualitativa , Encaminhamento e Consulta
12.
PLoS One ; 15(4): e0232115, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32339192

RESUMO

Crop diseases are responsible for considerable yield losses worldwide and particularly in sub-Saharan Africa. To implement efficient disease control measures, detection of the pathogens and understanding pathogen spatio-temporal dynamics is crucial and requires the use of molecular detection tools, especially to distinguish different pathogens causing more or less similar symptoms. We report here the design a new molecular diagnostic tool able to simultaneously detect five bacterial taxa causing important diseases on rice in Africa: (1) Pseudomonas fuscovaginae, (2) Xanthomonas oryzae, (3) Burkholderia glumae and Burkholderia gladioli, (4) Sphingomonas and (5) Pantoea species. This new detection tool consists of a multiplex PCR, which is cost effective and easily applicable. Validation of the method is presented through its application on a global collection of bacterial strains. Moreover, sensitivity assessment for the detection of all five bacteria is reported to be at 0.5 ng DNA by µl. As a proof of concept, we applied the new molecular detection method to a set of 256 rice leaves collected from 16 fields in two irrigated areas in western Burkina Faso. Our results show high levels of Sphingomonas spp. (up to 100% of tested samples in one field), with significant variation in the incidence between the two sampled sites. Xanthomonas oryzae incidence levels were mostly congruent with bacterial leaf streak (BLS) and bacterial leaf blight (BLB) symptom observations in the field. Low levels of Pantoea spp. were found while none of the 256 analysed samples was positive for Burkholderia or Pseudomonas fuscovaginae. Finally, many samples (up to 37.5% in one studied field) were positive for more than one bacterium (co-infection). Documenting co-infection levels are important because of their drastic consequences on epidemiology, evolution of pathogen populations and yield losses. The newly designed multiplex PCR for multiple bacterial pathogens of rice is a significant improvement for disease monitoring in the field, thus contributing to efficient disease control and food safety.


Assuntos
Burkholderia/genética , Coinfecção/diagnóstico , DNA Bacteriano/análise , Reação em Cadeia da Polimerase Multiplex/métodos , Oryza/microbiologia , Doenças das Plantas/microbiologia , Pseudomonas/genética , Xanthomonas/genética , Burkholderia/isolamento & purificação , Burkholderia/patogenicidade , Burkina Faso/epidemiologia , Coinfecção/epidemiologia , Coinfecção/genética , DNA Bacteriano/genética , Incidência , Pseudomonas/isolamento & purificação , Pseudomonas/patogenicidade , Xanthomonas/isolamento & purificação , Xanthomonas/patogenicidade
13.
Value Health ; 23(3): 300-308, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32197725

RESUMO

OBJECTIVES: The reduction and removal of user fees for essential care services have recently become a key instrument to advance universal health coverage in sub-Saharan Africa, but no evidence exists on its cost-effectiveness. We aimed to address this gap by estimating the cost-effectiveness of 2 user-fee exemption interventions in Burkina Faso between 2007 and 2015: the national 80% user-fee reduction policy for delivery care services and the user-fee removal pilot (ie, the complete [100%] user-fee removal for delivery care) in the Sahel region. METHODS: We built a single decision tree to evaluate the cost-effectiveness of the 2 study interventions and the baseline. The decision tree was populated with an own impact evaluation and the best available epidemiological evidence. RESULTS: Relative to the baseline, both the national 80% user-fee reduction policy and the user-fee removal pilot are highly cost-effective, with incremental cost-effectiveness ratios of $210.22 and $252.51 per disability-adjusted life-year averted, respectively. Relative to the national 80% user-fee reduction policy, the user-fee removal pilot entails an incremental cost-effectiveness ratio of $309.74 per disability-adjusted life-year averted. CONCLUSIONS: Our study suggests that it is worthwhile for Burkina Faso to move from an 80% reduction to the complete removal of user fees for delivery care. Local analyses should be done to identify whether it is worthwhile to implement user-fee exemptions in other sub-Saharan African countries.


Assuntos
Parto Obstétrico/economia , Honorários e Preços , Custos de Cuidados de Saúde , Gastos em Saúde , Acesso aos Serviços de Saúde/economia , Serviços de Saúde Materna/economia , Burkina Faso , Redução de Custos , Análise Custo-Benefício , Feminino , Humanos , Modelos Econômicos , Formulação de Políticas , Gravidez
14.
BMC Med Genet ; 21(1): 55, 2020 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-32188413

RESUMO

BACKGROUND: Glutathione S-transferases play a key role in the detoxification of persistent oxidative stress products which are one of several risks factors that may be associated with many types of disease processes such as cancer, diabetes, and hypertension. In the present study, we characterize the null genotypes of GSTM1 and GSTT1 in order to investigate the association between them and the risk of developing essential hypertension. METHODS: We conducted a case-control study in Burkina Faso, including 245 subjects with essential hypertension as case and 269 control subjects with normal blood pressure. Presence of the GSTT1 and GSTM1 was determined using conventional multiplex polymerase chain reaction followed by gel electrophoresis analysis. Biochemical parameters were measured using chemistry analyzer CYANExpert 130. RESULTS: Chi-squared test shows that GSTT1-null (OR = 1.82; p = 0.001) and GSTM1-active/GSTT1-null genotypes (OR = 2.33; p <  0.001) were significantly higher in cases than controls; the differences were not significant for GSTM1-null, GSTM1-null/GSTT1-active and GSTM1-null/GSTT1-null (p > 0.05). Multinomial logistic regression revealed that age ≥ 50 years, central obesity, family history of hypertension, obesity, alcohol intake and GSTT1 deletion were in decreasing order independent risk factors for essential hypertension. Analysis by gender, BMI and alcohol showed that association of GSTT1-null with risk of essential hypertension seems to be significant when BMI < 30 Kg/m2, in non-smokers and in alcohol users (all OR ≥ 1.77; p ≤ 0.008). Concerning GSTT1, GSTM1 and cardiovascular risk markers levels in hypertensive group, we found that subjects with GSTT1-null genotype had higher waist circumference and higher HDL cholesterol level than those with GSTT1-active (all p <  0.005), subjects with GSTM1-null genotype had lower triglyceride than those with GSTM1-active (p = 0.02) and subjects with the double deletion GSTM1-null/GSTT1-null had higher body mass index, higher waist circumference and higher HDL cholesterol than those with GSTM1-active/GSTT1-active genotype (all p = 0.01). CONCLUSION: Our results confirm that GSTT1-null genotype is significantly associated with risk of developing essential hypertension in Burkinabe, especially when BMI < 30 Kg/m2, in non-smokers and in alcohol users, and it showed that the double deletion GSTM1-null/GSTT1-null genotypes may influence body lipids repartition.


Assuntos
Hipertensão Essencial/genética , Glutationa Transferase/genética , Polimorfismo Genético , Deleção de Sequência , Adulto , Consumo de Bebidas Alcoólicas/sangue , Consumo de Bebidas Alcoólicas/epidemiologia , Índice de Massa Corporal , Burkina Faso/epidemiologia , Estudos de Casos e Controles , Hipertensão Essencial/sangue , Hipertensão Essencial/epidemiologia , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Lipídeos/sangue , Mutação com Perda de Função , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fumar/sangue , Fumar/epidemiologia
15.
BMC Public Health ; 20(1): 254, 2020 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-32075630

RESUMO

BACKGROUND: Meningococcal serogroup A conjugate vaccine (MACV) was introduced in 2017 into the routine childhood immunization schedule (at 15-18 months of age) in Burkina Faso to help reduce meningococcal meningitis burden. MACV was scheduled to be co-administered with the second dose of measles-containing vaccine (MCV2), a vaccine already in the national schedule. One year following the introduction of MACV, an assessment was conducted to qualitatively examine health workers' perceptions of MACV introduction, identify barriers to uptake, and explore opportunities to improve coverage. METHODS: Twelve in-depth interviews were conducted with different cadres of health workers in four purposively selected districts in Burkina Faso. Districts were selected to include urban and rural areas as well as high and low MCV2 coverage areas. Respondents included health workers at the following levels: regional health managers (n = 4), district health managers (n = 4), and frontline healthcare providers (n = 4). All interviews were recorded, transcribed, and thematically analyzed using qualitative content analysis. RESULTS: Four themes emerged around supply and health systems barriers, demand-related barriers, specific challenges related to MACV and MCV2 co-administration, and motivations and efforts to improve vaccination coverage. Supply and health systems barriers included aging cold chain equipment, staff shortages, overworked and poorly trained staff, insufficient supplies and financial resources, and challenges with implementing community outreach activities. Health workers largely viewed MACV introduction as a source of motivation for caregivers to bring their children for the 15- to 18-month visit. However, they also pointed to demand barriers, including cultural practices that sometimes discourage vaccination, misconceptions about vaccines, and religious beliefs. Challenges in co-administering MACV and MCV2 were mainly related to reluctance among health workers to open multi-dose vials unless enough children were present to avoid wastage. CONCLUSIONS: To improve effective administration of vaccines in the second-year of life, adequate operational and programmatic planning, training, communication, and monitoring are necessary. Moreover, clear policy communication is needed to help ensure that health workers do not refrain from opening multi-dose vials for small numbers of children.


Assuntos
Atitude do Pessoal de Saúde , Programas de Imunização/organização & administração , Meningite Meningocócica/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Neisseria meningitidis Sorogrupo A , Burkina Faso , Humanos , Esquemas de Imunização , Lactente , Vacinas Conjugadas
16.
Lancet Infect Dis ; 20(5): 585-597, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32032566

RESUMO

BACKGROUND: PRIMVAC is a VAR2CSA-derived placental malaria vaccine candidate aiming to prevent serious clinical outcomes of Plasmodium falciparum infection during pregnancy. We assessed the safety and immunogenicity of PRIMVAC adjuvanted with Alhydrogel or glucopyranosyl lipid adjuvant in stable emulsion (GLA-SE) in French and Burkinabe women who were not pregnant. METHODS: This first-in-human, randomised, double-blind, placebo-controlled, dose escalation trial was done in two staggered phases, a phase 1A trial in 18-35-year-old women who were malaria naive in a hospital in France and a subsequent phase 1B trial in women who were naturally exposed to P falciparum and nulligravid in the clinical site of a research centre in Burkina Faso. Volunteers were recruited into four sequential cohorts receiving PRIMVAC intramuscularly at day 0, 28, and 56: two cohorts in France receiving 20 µg or 50 µg of PRIMVAC and then two in Burkina Faso receiving 50 µg or 100 µg of PRIMVAC. Volunteers were randomly assigned (1:1) to two groups (PRIMVAC adjuvanted with either Alhydrogel or GLA-SE) in France and randomly assigned (2:2:1) to three groups (PRIMVAC adjuvanted with either Alhydrogel, GLA-SE, or placebo) in Burkina Faso. Randomisation was centralised, using stratification by cohort and blocks of variable size, and syringes were masked by opaque labels. The primary endpoint was the proportion of participants with any grade 3 or higher adverse reaction to vaccination up until day 35. Safety at later time points as well as humoral and cellular immunogenicity were assessed in secondary endpoints. This trial is registered with ClinicalTrials.gov, NCT02658253. FINDINGS: Between April 19, 2016, and July 13, 2017, 68 women (18 in France, 50 in Burkina Faso) of 101 assessed for eligibility were included. No serious adverse event related to the vaccine occurred. PRIMVAC antibody titres increased with each dose and seroconversion was observed in all women vaccinated with PRIMVAC (n=57). PRIMVAC antibody titres reached a peak (geometric mean 11 843·0, optical density [OD] 1·0, 95% CI 7559·8-18 552·9 with 100 µg dose and GLA-SE) 1 week after the third vaccination (day 63). Compared with Alhydrogel, GLA-SE tended to improve the PRIMVAC antibody response (geometric mean 2163·5, OD 1·0, 95% CI 1315·7-3557·7 with 100 µg dose and Alhydrogel at day 63). 1 year after the last vaccination, 20 (71%) of 28 women who were vaccinated with PRIMVAC/Alhydrogel and 26 (93%) of 28 women who were vaccinated with PRIMVAC/GLA-SE still had anti-PRIMVAC antibodies, although antibody magnitude was markedly lower (452·4, OD 1·0, 95% CI 321·8-636·1 with 100 µg dose and GLA-SE). These antibodies reacted with native homologous VAR2CSA expressed by NF54-CSA infected erythrocytes (fold change from baseline at day 63 with 100 µg dose and GLA-SE: 10·74, 95% CI 8·36-13·79). Limited cross-recognition, restricted to sera collected from women that received the 100 µg PRIMVAC dose, was observed against heterologous VAR2CSA variants expressed by FCR3-CSA (fold change from baseline at day 63: 1·49, 95% CI 1·19-1·88) and 7G8-CSA infected erythrocytes (1·2, 1·08-1·34). INTERPRETATION: PRIMVAC adjuvanted with Alhydrogel or GLA-SE had an acceptable safety profile, was immunogenic, and induced functional antibodies reacting with the homologous VAR2CSA variant expressed by NF54-CSA infected erythrocytes. Cross-reactivity against heterologous VAR2CSA variants was limited and only observed in the higher dose group. An alternate schedule of immunisation, antigen dose, and combinations with other VAR2CSA-based vaccines are envisaged to improve the cross-reactivity against heterologous VAR2CSA variants. FUNDING: Bundesministerium für Bildung und Forschung, through Kreditanstalt für Wiederaufbau, Germany; Inserm, and Institut National de Transfusion Sanguine, France; Irish Aid, Department of Foreign Affairs and Trade, Ireland.


Assuntos
Adjuvantes Imunológicos/administração & dosagem , Hidróxido de Alumínio/imunologia , Glucosídeos/imunologia , Lipídeo A/imunologia , Vacinas Antimaláricas/imunologia , Malária Falciparum/imunologia , Adolescente , Adulto , Formação de Anticorpos/imunologia , Burkina Faso , Método Duplo-Cego , Feminino , França , Humanos , Imunização/métodos , Imunogenicidade da Vacina/imunologia , Plasmodium falciparum/imunologia , Vacinação/métodos , Adulto Jovem
17.
Bull Cancer ; 107(3): 328-332, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32059813

RESUMO

INTRODUCTION: Dermatofibrosarcoma (DFS) is a common dermic sarcoma. It is a local malignant tumor occurring in young adults. The recurrence potential justifies an R0-type surgery with a three centimeters margin. We report our experience of the management of locally advanced DFS by resection and reconstructive surgery. METHODS: It is an ongoing descriptive study spanned from June 2005 to December 2018. We included all DFS cases treated by curative resection and reconstruction. A total of eight cases of DFS among 108 soft tissue sarcomas were studied. All patients were males. The mean age was 41.8 years [32-60]. Carcinologic results, cosmetic results, and outcomes were analyzed. RESULTS: R0-type resection was performed in six cases. In two cases, the resection was R1-type and resulted in amputation. In four cases, it was an iterative surgery. Average desease duration was 4 years [1-8]. Reconstructive surgery was needed for wound closure in six cases. Wounds healed in 28 days [18-90]. Outcomes showed hyperchromic keloid scars (N=2) at the trunk localization. CONCLUSION: DFS is a common cancer with a good outcome if managed earliest. Delayed diagnoses and inadequate first-time surgery led to tumor extension and recurrences. Locally advanced tumors management needs extensive resections and reconstructive surgery. In addition to surgery, Imatinib and radiotherapy improve outcomes, but are not available in our context.


Assuntos
Dermatofibrossarcoma/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Países em Desenvolvimento , Neoplasias Cutâneas/cirurgia , Adulto , Burkina Faso/epidemiologia , Dermatofibrossarcoma/epidemiologia , Dermatofibrossarcoma/patologia , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Países em Desenvolvimento/estatística & dados numéricos , Humanos , Queloide/etiologia , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Fotografação , Complicações Pós-Operatórias/etiologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos , Cicatrização
18.
BMC Public Health ; 20(1): 149, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005220

RESUMO

BACKGROUND: The global poverty profile shows that Africa and Asia bear the highest burden of multidimensional child poverty. Child survival and development therefore depend on socioeconomic and environmental factors that surround a child.The aim of this paper is to measure multidimensional child poverty and underpin what drives it among children aged 5 to 18 years in a resource poor region of Burkina Faso. METHODS: Using primary data collected from a cross sectional study of 722 households in the Mouhoun region of Burkina Faso, the Alkire-Foster methodology was applied to estimate and decompose child poverty among children aged 5-18 years. Seven broad dimensions guided by the child poverty literature, data availability and the country's SDGs were used. A binary logistic regression model was applied to identify drivers of multidimensional child poverty in the region. RESULTS: The highest prevalence of deprivations were recorded in water and sanitation (91%), information and leisure (89%) followed by education (83%). Interestingly, at k = 3 (the sum of weighted indicators that a child must be deprived to be considered multidimensionally poor), about 97% of children are deprived in at least three of the seven dimensions. At k = 4 to k = 6, between 88.7 and 30.9% of children were equally classified as suffering from multidimensional poverty. The odds of multidimensional poverty were reduced in children who belonged to households with a formally educated mother (OR = 0.49) or stable sources of income (OR = 0.31, OR = 0.33). The results equally revealed that being an adolescent (OR = 0.67), residing in the urban area of Boromo (OR = 0.13) and rural area of Safané (OR = 0.61) reduced the odds of child poverty. On the other hand, child poverty was highest among children from the rural area of Yé (OR = 2.74), polygamous households (OR = 1.47, OR = 5.57 and OR = 1.96), households with an adult head suffering from a longstanding illness (OR = 1.61), households with debts (OR = 1.01) and households with above five number of children/woman (OR = 1.49). CONCLUSION: Child poverty is best determined by using a multidimensional approach that involves an interplay of indicators and dimensions, bearing in mind its causation.


Assuntos
Pobreza/estatística & dados numéricos , Adolescente , Burkina Faso , Criança , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Humanos , Masculino , Fatores de Risco
19.
Malar J ; 19(1): 8, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906948

RESUMO

BACKGROUND: Artemisinin-based combination therapy (ACT) is recommended to improve malaria treatment efficacy and limit drug-resistant parasites selection in malaria endemic areas. 5 years after they were adopted, the efficacy and safety of artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ), the first-line treatments for uncomplicated malaria were assessed in Burkina Faso. METHODS: In total, 440 children with uncomplicated Plasmodium falciparum malaria were randomized to receive either AL or ASAQ for 3 days and were followed up weekly for 42 days. Blood samples were collected to investigate the ex vivo susceptibility of P. falciparum isolates to lumefantrine, dihydroartemisinin (the active metabolite of artemisinin derivatives) and monodesethylamodiaquine (the active metabolite of amodiaquine). The modified isotopic micro test technique was used to determine the 50% inhibitory concentration (IC50) values. Primary endpoints were the risks of treatment failure at days 42. RESULTS: Out of the 440 patients enrolled, 420 (95.5%) completed the 42 days follow up. The results showed a significantly higher PCR unadjusted cure rate in ASAQ arm (71.0%) than that in the AL arm (49.8%) on day 42, and this trend was similar after correction by PCR, with ASAQ performing better (98.1%) than AL (91.1%). Overall adverse events incidence was low and not significantly different between the two treatment arms. Ex vivo results showed that 6.4% P. falciparum isolates were resistant to monodesthylamodiaquine. The coupled in vivo/ex vivo analysis showed increased IC50 values for lumefantrine and monodesethylamodiaquine at day of recurrent parasitaemia compared to baseline values while for artesunate, IC50 values remained stable at baseline and after treatment failure (p > 0.05). CONCLUSION: These findings provide substantial evidence that AL and ASAQ are highly efficacious for the treatment of uncomplicated malaria in children in Burkina Faso. However, the result of P. falciparum susceptibility to the partner drugs advocates the need to regularly replicate such surveillance studies. This would be particularly indicated when amodiaquine is associated in seasonal malaria chemoprophylaxis (SMC) mass drug administration in children under 5 years in Burkina Faso. Trial registration clinicaltrials, NCT00808951. Registered 05 December 2008,https://clinicaltrials.gov/ct2/show/NCT00808951?cond=NCT00808951&rank=1.


Assuntos
Amodiaquina/uso terapêutico , Combinação Arteméter e Lumefantrina/uso terapêutico , Artemisininas/uso terapêutico , Quimioterapia Combinada/métodos , Malária Falciparum/tratamento farmacológico , Adolescente , Amodiaquina/administração & dosagem , Amodiaquina/análogos & derivados , Antimaláricos/uso terapêutico , Combinação Arteméter e Lumefantrina/administração & dosagem , Artemisininas/administração & dosagem , Artesunato/uso terapêutico , Burkina Faso , Criança , Pré-Escolar , Combinação de Medicamentos , Feminino , Humanos , Lactente , Concentração Inibidora 50 , Lumefantrina/uso terapêutico , Masculino , Administração Massiva de Medicamentos , Plasmodium falciparum/efeitos dos fármacos , Plasmodium falciparum/isolamento & purificação , Falha de Tratamento , Resultado do Tratamento
20.
Artigo em Inglês | MEDLINE | ID: mdl-31936308

RESUMO

Burkina Faso has recently implemented an additional strategy, the free healthcare policy, to further improve maternal and child health. This policy targets children under five who bear the brunt of the malaria scourge. The effects of the free-of-charge healthcare were previously assessed in women but not in children. The present study aims at filling this gap by assessing the effect of this policy in children under five with a focus on the induced spatial and temporal changes in malaria morbidity. We used a Bayesian spatiotemporal negative binomial model to investigate the space-time variation in malaria incidence in relation to the implementation of the policy. The analysis relied on malaria routine surveillance data extracted from the national health data repository and spanning the period from January 2013 to December 2018. The model was adjusted for meteorological and contextual confounders. We found that the number of presumed and confirmed malaria cases per 1000 children per month increased between 2013 and 2018. We further found that the implementation of the free healthcare policy was significantly associated with a two-fold increase in the number of tested and confirmed malaria cases compared with the period before the policy rollout. This effect was, however, heterogeneous across the health districts. We attributed the rise in malaria incidence following the policy rollout to an increased use of health services combined with an increased availability of rapid tests and a higher compliance to the "test and treat" policy. The observed heterogeneity in the policy effect was attributed to parallel control interventions, some of which were rolled out at different paces and scales. Our findings call for a sustained and reinforced effort to test all suspected cases so that, alongside an improved case treatment, the true picture of the malaria scourge in children under five emerges clearly (see the hippopotamus almost entirely).


Assuntos
Assistência à Saúde/estatística & dados numéricos , Notificação de Doenças/estatística & dados numéricos , Malária/epidemiologia , Animais , Teorema de Bayes , Burkina Faso/epidemiologia , Pré-Escolar , Assistência à Saúde/economia , Assistência à Saúde/normas , Notificação de Doenças/normas , Feminino , Política de Saúde , Humanos , Incidência , Lactente , Masculino , Modelos Estatísticos
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