[Cross-sectional study of iron level during pregnancy at the Mohamed V Military Training Hospital, Rabat]. / Etude transversale du statut martial au cours de la grossesse à l'Hôpital Militaire d'Instruction Mohamed V, Rabat.

Iron deficiency is the most widespread nutritional disorder. Anaemia during pregnancy is common in developing countries. The purpose of this study was to check iron levels during pregnancy by evaluating laboratory indicators of iron deficiency. Our study was conducted in the Department of Obstetrics and Gynaecology of the Mohamed V Military Training Hospital (MVMTH) and included 66 patients monitored during three trimesters of pregnancy. Biochemical tests including ferritin, serum iron, CRP and blood counts were performed. The average age of patients was 28.3 years, with a standard deviation of 5.2. The prevalence of iron deficiency was 15.2% (n = 10), 25.8% (n = 17) and 42.2% (n = 28) in the first, second and third trimester, respectively. Anemia progressed from 10% (n = 7), 24% (n = 16) to 42% (n = 28). ANOVA test was used to compare the means for the parameters serum ferritin and iron, hemoglobin and hematocrit within the three trimesters. This showed a significant difference with p = 0.001. This study highlights a high prevalence of iron deficiency during pregnancy, especially in the third trimester, that would justify a systematic iron supplementation.

Cytotoxicity of Particulate Matter PM10 Samples from Ouagadougou, Burkina Faso.

Particulate matter (PM) is one of the main air pollutants with 257,000 deaths per year in Africa. Studying their toxic mechanisms of action could provide a better understanding of their effects on the population health. The objective of this study was to describe the PM10 toxic mechanism of action collected in 3 districts of Ouagadougou. Once per month and per site between November 2015 and February 2016, PM10 was sampled for 24 hours using the MiniVol TAS (AirMetrics, Eugene, USA). The collected filters were then stored in Petri dishes at room temperature for in vitro toxicological studies using human pulmonary artery endothelial cells (HPAEC) at the Bordeaux INSERM-U1045 Cardio-thoracic Research Center. The three study districts were classified based on PM10 level (high, intermediate, and low, respectively, for districts 2, 3, and 4). PM10 induced a concentration-dependent decrease in cell viability. A significant decrease in cell viability was observed at 1 µg/cm2, 10 µg/cm2, and 25 µg/cm2 for, respectively, districts 2, 3, and 4. A significant increase in the production of reactive oxygen species (ROS) was observed at 10 µg/cm2 for district 2 versus 5 µg/cm2 and 1 µg/cm2 for districts 3 and 4, respectively. Finally, a significant production of IL-6 was recorded from 5 µg/cm2 for district 4 versus 10 µg/cm2 for districts 2 and 3. Consequently, Ouagadougou is subjected to PM10 pollution, which can induce a significant production of ROS and IL-6 to cause adverse effects on the health of the population.

An oral history of medical laboratory development in francophone West African countries.

BACKGROUND: Underdeveloped and underused medical laboratories in sub-Saharan Africa negatively affect the diagnosis and appropriate treatment of ailments. OBJECTIVE: We identified political, disease-related and socio-economic factors that have shaped the laboratory sector in Senegal, Mali and Burkina Faso to inform laboratory-strengthening programmes. METHODS: We searched peer-reviewed and grey literature from February 2015 to December 2018 on laboratory and health systems development from colonial times to the present and conducted in-depth interviews with 73 key informants involved in (inter)national health or laboratory policy, organisation, practice or training. This article depended on the key informants' accounts due to the paucity of literature on laboratory development in francophone West African countries. Literature and interview findings were triangulated and are presented chronologically. RESULTS: Until around 1990 there were a few disease-specific research laboratories; only the larger hospitals and district health facilities housed a rudimentary laboratory. The 1990s brought the advent of donor-dictated, vertical, endemic and epidemic disease programmes and laboratories. Despite decentralising from the national level to the regional and district levels, these vertical laboratory programmes biased national health resource allocation deleteriously neglecting the development of the horizontal, general-health laboratory. After the year 2000, the general-health laboratory system received more attention when, influenced by the World Health Organization, national networks and (sub-)directorates of laboratories were installed. CONCLUSION: To advance national general healthcare, as opposed to disease-specific healthcare, national laboratory directors and experts in general laboratory development should be consulted when national policies are made with potential laboratory donors.

[Management of a global health crisis: first COVID-19 disease feedback from Overseas and French-speaking countries medical biologists]. / Gestion d'une crise sanitaire mondiale : premiers retours d'expérience de biologistes médicaux d'Outre-mer et de francophonie face au COVID-19.

The French society of clinical biology "Biochemical markers of COVID-19" has set up a working group with the primary aim of reviewing, analyzing and monitoring the evolution of biological prescriptions according to the patient's care path and to look for markers of progression and severity of the disease. This study covers all public and private sectors of medical biology located in metropolitan and overseas France and also extends to the French-speaking world. This article presents the testimonies and data obtained for the "Overseas and French-speaking countries" sub-working group made up of 45 volunteer correspondents, located in 20 regions of the world. In view of the delayed spread of the SARS-CoV-2 virus, the overseas regions and the French-speaking regions have benefited from feedback from the first territories confronted with COVID-19. Thus, the entry of the virus or its spread in epidemic form could be avoided, thanks to the rapid closure of borders. The overseas territories depend very strongly on air and/or sea links with the metropolis or with the neighboring continent. The isolation of these countries is responsible for reagent supply difficulties and has necessitated emergency orders and the establishment of stocks lasting several months, in order to avoid shortages and maintain adequate patient care. In addition, in countries located in tropical or intertropical zones, the diagnosis of COVID-19 is complicated by the presence of various zoonoses (dengue, Zika, malaria, leptospirosis, etc.).

Analytical performance of eight rapid point-of-care tests routinely used for the detection of HBsAg in Burkina Faso: A cross-sectional study.

BACKGROUND: In limited resources countries, HBsAg-rapid diagnostic test (RDT) represents a good alternative for the diagnosis of hepatitis B virus (HBV) infection. Due to many factors that can influence their analytical performances, an evaluation with local biological samples before using on a large scale is recommended. OBJECTIVES: The aims of the study were: (i) to evaluate the analytical performance of eight commercial RDTs used in Burkina Faso for the detection of HBsAg using serum from blood donors, and (ii) to propose an algorithm using these RDTs based on their analytical performance. STUDY DESIGN: 109 HBsAg-positive and 216 HBsAg-negative samples were included in this evaluation. A modified version of the World Health Organization (WHO) algorithm for the detection of HBsAg was used as the gold standard. A pairwise combination of RDTs performance was done to choose the best diagnostic algorithm. RESULTS: All RDTs presented an excellent specificity (Sp) (≥99.0 %) except Accucare HBsAg® test. Sensitivity (Se) ranged from 90.8 % (95 % CI: 87.9-93.7) for Rapid Signal™ HBsAg to 92.8 % (95 % CI: 90.3-95.5) for SD BioLine® HBsAg and Artron® HBsAg. The pairwise combinations of the Se and Sp of RDTs showed no improvement in diagnostic performance. CONCLUSION: The RDTs evaluated in this study have good sensitivities and excellent specificities indicating their use in clinical practice and for HBV mass screening in Burkina Faso. However, their use should be monitored in the context of blood transfusion. Furthermore, according to our algorithm, each positive sample should be confirmed by another RDT of good Se.

A study to better understand under-utilization of laboratory tests for antenatal care in Senegal.

OBJECTIVE: To better understand factors contributing to underutilization of laboratory services for health care delivery in sub-Saharan Africa, we conducted a study in Senegalese Antenatal Care clinics (ANC) and laboratories to determine the extent of underutilization, contributing factors, and bottlenecks in the cascade of care from first ANC visit, test uptake, to availability of test results and appropriate clinical management. METHODS: At 16 health facilities, pregnant women attending for their first ANC visit were consecutively recruited and information was prospectively collected on the request, execution, results and clinical management of seven nationally recommended laboratory screening tests for normal pregnancy: hemoglobin concentration (Hb), syphilis serology, HIV serology, determination of proteinuria (PU), determination of blood group and Rhesus factor, Emmel test to detect sickle cell disease, and glycaemia. Health facility staff were interviewed on human resource capacity, management of the ANC and the laboratory, and availability and use of guidelines. RESULTS: Of 1246 ANC attendants, 400 (32%) had complete results. Completeness varied between facilities from 0-99%. In multilevel logistic regression analysis of women nested in facilities, complete uptake was lower if women started ANC later in pregnancy; very low in rural ANC attendants who ever delivered compared to urban primigravidae (OR 0.064; 95%CI 0.00-0.52); and higher if the facility routinely recommended all seven tests. In the cascade from test request to clinical management, the most frequent bottleneck was non-execution of requested tests, while unavailability of results for executed test was uncommon (<2%). Overall, of 525 abnormal test results 97(18%) had a record of adequate clinical management. CONCLUSION: Our study illustrates challenges to test uptake even when laboratory testing capacity is in place, with large differences between facilities, and underscores the importance of management, policy, and the importance of considering local context in order to improve service delivery to expectant mothers.

[Difficult immunofixation electrophoresis interpretation of serum proteins]. / Interprétation délicate de l'immunofixation des protéines sériques.

Immunofixation is currently very used in medical laboratories. The interpretation of the results is usually easy, but some cases raise interpretative problems. We here report two cases difficult to interpret. In the first case, we report a case of nonspecific precipitation of the protein on each track, in the second case we report a case of double monoclonal band on immunofixation electrophoresis. Reducing agent such as ß2-mercaptoethanol used in these two cases allowed to solve the problem and to make a diagnosis. A comparison between clinical radiological and laboratory test data is necessary before making a diagnosis of monoclonal immunoglobulin.

[Evolution of biochemical and hematological parameters in patients living with HIV/AIDS treated with antiretroviral therapy at the Aboubacar Sangoulé Lamizana General Camp Medical Center]. / Evolution des paramètres biochimiques et hématologiques chez les personnes vivant avec le VIH/SIDA sous traitement antirétroviral au Centre Médical du Camp General Aboubacar Sangoule Lamizana.

INTRODUCTION: This study aimed to evaluate the impact of treatment on biochemical and hematological parameters in HIV-positive patients followed up at the Aboubacar Sangoulé Lamizana General Camp Medical Center in Burkina Faso. METHODS: We conducted a retrospective study over the period January 2010-September 2015. The study only included HIV-positive patients treated with ART having undergone laboratory tests at treatment initiation (M0), at sixth month (M6), and at twelfth month (M12). RESULTS: Sex-ratio was 0.88 and the most affected age group was 45-55 years. The most prescribed treatments were triple combination therapies based on 2INTI + 1INNTI (74,5%), 2INTI+1 IP (14,9%). Viral load test was little requested. The rate of patients with normal laboratory tests showed a statistically significant regression between M0 (70%), and M6 (13%) (p<0.05). Severely immunocompromised patients showed a significant increase in average TCD4 lymphocytes value, ranging from 79,22 at M0 to 227.95 cells/mm3 at M12 (p<0.05). Anaemic patients showed a significant increase in the rate of mean haemoglobin levels from 10.5 g/dl at M0 to 12.53 g/dl at M12 (p<0.05). The analysis of biochemical parameters could not be performed because of a lack of data. CONCLUSION: The increase in the rate of TCD4 lymphocytes and in the rate of hemoglobin levels gives an indication of ART effectiveness and of patient's tolerance to treatment. Viral load test accessibility and an improvement in laboratory testing monitoring are essential.

Dengue Fever in Burkina Faso, 2016.

We report 1,327 probable cases of dengue in Burkina Faso in 2016. Of 35 serum samples tested by a trioplex test, 19 were confirmed dengue virus (DENV)‒positive: 11 DENV-2, 6 DENV-3, 2 nontypeable, and 1 DENV-2/DENV-3 co-infection. Molecular testing should be conducted to correctly identify causative agents in this complex infectious disease landscape.

Polymorphisme génétique des cytochromes p450: synthèse méthodiques des études primaires effectuées dans la population Africane

Il existe une grande variabilité interindividuelle de réponse aux médicaments, tant en terme d'efficacité que de toxicité. Pour comprendre cette variabilité, de multiples travaux de recherche sur le polymorphisme génétique des cytochromes P450 ont été menés de par le monde. Notre étude a pour but de faire le point des études réalisées en Afrique ayant porté sur le polymorphisme génétique des cytochromes P450 afin de recenser leurs variants alléliques susceptibles d'entrainer une variabilité interindividuelle de réponse aux médicaments.Il s'agissait d'une revue systématique des travaux de recherche qui ont porté sur le polymorphisme génétique des cytochromes P450. Elle a été réalisée au Burkina Faso à partir des articles publiés dans la base de données Pubmed et a concerné les populations africaines.Parmi les 1625 études primaires collectées dans la base de données Pubmed, 23 se sont intéressées aux populations africaines. Ces études ont été réalisées essentiellement dans la plupart des régions africaines sauf la partie centrale. Ces études primaires ont traité de la distribution des cytochromes P450 1A1, 1B1, 1A2, 2A6, 2B6, 2C8, 2C9, 2C19, 2D6 et 3A4. Les variants alléliques CYP 1A2*2, 1B1 (*2,*6), B6 (*6,*18,*20,*27), 2C8 (*2,*3), 2C9 (*2,*3,*5,*11), 2C19 (*2,*3), 2D6 (*4,*17,*29), 3A4*1B et 3A5*3 sont ceux susceptibles d'entrainer une anomalie de réponse aux médicaments. Cela montre la nécessité d'entreprendre des études spécifiques sur les populations africaines où on retrouve la plus grande variabilité génétique par rapport aux autres continents

Barriers to uptake of antenatal maternal screening tests in Senegal.

BACKGROUND: Evidence exists that selective antenatal maternal screening tests contribute to the reduction of maternal morbidity and mortality. However, data are lacking on coverage with the complete set of recommended tests. The study aimed to identify barriers to uptake of the complete set of tests recommended by the Ministry of Health in Senegal. METHODS: Data were collected in communities, antenatal care (ANC) clinics and the laboratories of 11 public health care facilities across Senegal. Mixed-methods included ethnography (observations and informal conversations), in-depth interviews and workshops at the health facilities; structured interviews with 283 women receiving antenatal tests ("women in the lab"); in-depth interviews with 81 women in communities who were pregnant or had recently delivered ("community women"). RESULTS: Only 13% of community women and 22% of women in the lab had received the complete set of tests. For various social, financial and antenatal care-related reasons 38% of community women who visited antenatal care facilities did not access a laboratory. The lowest test uptake was in women receiving antenatal care at health posts. Barriers at the laboratory level were the cost of the test, stock-outs of reagents, and broken equipment. Midwives were the main gatekeepers of the laboratory, not requesting (all) tests because of assumptions about women's financial problems and reliance on clinical symptoms. CONCLUSION: In Senegal, recommended antenatal maternal screening tests are substantially underutilized. Efforts to increase test uptake should include accessible testing guidelines, reducing the cost of tests, raising awareness about the reasons for tests, and making the complete test set in point-of-care format accessible in peripheral health posts. National and international antenatal care policies and programs should facilitate access to maternal screening tests as a contribution to reducing maternal and infant morbidity and mortality.

Practical recommendations for strengthening national and regional laboratory networks in Africa in the Global Health Security era.

The role of national health laboratories in support of public health response has expanded beyond laboratory testing to include a number of other core functions such as emergency response, training and outreach, communications, laboratory-based surveillance and data management. These functions can only be accomplished by an efficient and resilient national laboratory network that includes public health, reference, clinical and other laboratories. It is a primary responsibility of the national health laboratory in the Ministry of Health to develop and maintain the national laboratory network in the country. In this article, we present practical recommendations based on 17 years of network development experience for the development of effective national laboratory networks. These recommendations and examples of current laboratory networks, are provided to facilitate laboratory network development in other states. The development of resilient, integrated laboratory networks will enhance each state's public health system and is critical to the development of a robust national laboratory response network to meet global health security threats.

Reference ranges of cholesterol sub-fractions in random healthy adults in Ouagadougou, Burkina Faso.

In Burkina Faso, the values that serve as clinical chemistry reference ranges are those provided by European manufacturers' insert sheets based on reference of the Western population. However, studies conducted so far in some African countries reported significant differences in normal laboratory ranges compared with those of the industrialized world. The aim of this study was to determine reference values of cholesterol fractions in apparently normal adults in Burkina Faso that could be used to better assess the risks related to cardiovascular diseases. Study population was 279 healthy subjects aged from 15 to 50 years including 139 men and 140 women recruited at the Regional Center of Blood Transfusion of Ouagadougou, capital city of Burkina Faso (West Africa). Exclusion criteria based on history and clinical examination were used for defining reference individuals. The dual-step precipitation of HDL cholesterol sub-fractions using dextran sulfate was performed according to the procedure described by Hirano. The medians were calculated and reference values were determined at 2.5th and 97.5th percentiles. The median and upper ranges for total cholesterol, LDL cholesterol, total HDL cholesterol and HDL2 cholesterol were observed to be higher in women in comparison to men (p <0.05). These reference ranges were similar to those derived from other African countries but lower than those recorded in France and in USA. This underscores the need for such comprehensible establishment of reference values for limited resources countries. Our study provides the first cholesterol sub-fractions (HDL2 and HDL3) reference ranges for interpretation of laboratory results for cardiovascular risk management in Burkina Faso.

Implementation of a national external quality assessment program for medical laboratories in Burkina Faso: challenges, lessons learned, and perspectives.

OBJECTIVES: The National External Quality Assessment (NEQA) program of Burkina Faso is a proficiency testing program mandatory for all laboratories in the country since 2006. The program runs two cycles per year and covers all areas of laboratories. METHODS: All panels were validated by the expert committee before dispatch under optimal storage and transport conditions to participating laboratories along with report forms. RESULTS: Performance in the last 5 years varied by panel, with average annual performance of bacteriology panels for all laboratories rising from 75% in 2006 to 81% in 2010 and with a best average performance of 87% in 2007 and 2008. During the same period, malaria microscopy performance varied from 85% to 94%, with a best average performance of 94% in 2010; chemistry performance increased from 87% to 94%, with a best average annual performance of 97% in 2009. Hematology showed more variation in performance, ranging from 61% to 86%, with a best annual average performance of 90% in 2008. Average annual performance for immunology varied less between 2006 and 2010, recording 97%, 90%, and 95%. Except for malaria microscopy, annual performances for enrolled panels varied substantially from year to year, indicating some difficulty in maintaining consistency in quality. CONCLUSIONS: The main challenges of the NEQA program observed between 2006 to 2010 were funding, sourcing, and safe transportation of quality panels to all laboratories countrywide.

[National External Quality Assessment for medical biology laboratories in Burkina Faso: an overview of three years of activity]. / Contrôle national de qualité des laboratoires d'analyses de biologie médicale du Burkina Faso: bilan de trois années d'activités.

We report results of the National External Quality Assessment for (NEQA) laboratories in Burkina Faso, a country with limited resources located in West Africa whose epidemiology is dominated by infectious diseases. The national laboratory network consists of 160 laboratories including 40 private. The Government of Burkina Faso has adopted a national laboratory policy. One of the objectives of this policy is to improve the quality of laboratory results. One of the strategies to achieve this objective is the establishment of a NEQA. The NEQA is a panel testing also called proficiency testing. It is mandatory for all laboratories to participate to the NEQA. The NEQA is organized twice a year and covers all areas of laboratories (bacteriology-virology, biochemistry, hematology, parasitology and immunology). The review of three years of activity (2006-2008) shows the following results: (1) for microscopic examination of bacteria after Gram staining, the error rate decreased from 24.7% in 2006 to 13.1% in 2007 and 13% in 2008; (2) errors rate in reading slides for the microscopic diagnosis of malaria were 23.4%, 14.6% and 10.2% respectively in 2006, 2007 and 2008; (3) for biochemistry, the percentages of unsatisfactory results were respectively 12.5%, 14.8% and 13.8% in 2006, 2007 and 2008 for the overall parameters assessed. The analysis of the results generated by the laboratories during these three years shows a quality improvement. However, the NEQA should be strengthened through ongoing training and quality control of reagents and equipment.

A new strategy to improve the cost-effectiveness of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis testing of blood donations in sub-Saharan Africa: a pilot study in Burkina Faso.

BACKGROUND: In Africa where blood-borne agents are highly prevalent, cheaper and feasible alternative strategies for blood donations testing are specifically required. STUDY DESIGN AND METHODS: From May to August 2002, 500 blood donations from Burkina Faso were tested for hepatitis B surface antigen (HBsAg), human immunodeficiency virus (HIV), syphilis, and hepatitis C virus (HCV) according to two distinct strategies. The first strategy was a conventional simultaneous screening of these four blood-borne infectious agents on each blood donation by using single-marker assays. The second strategy was a sequential screening starting by HBsAg. HBsAg-nonreactive blood donations were then further tested for HIV. If nonreactive, they were further tested for syphilis. If nonreactive, they were finally assessed for HCV antibodies. The accuracy and cost-effectiveness of the two strategies were compared. RESULTS: By using the simultaneous strategy, the seroprevalences of HBsAg, HIV, syphilis, and HCV among blood donors in Ouagadougou were estimated to be 19.2, 9.8, 1.6, and 5.2%. No significant difference of HIV, syphilis, and HCV prevalence rates was observed by using the sequential strategy (9.2, 1.9, and 4.7%, respectively). Whatever the strategy used, 157 blood donations (31.4%) were found to be reactive for at least one transfusion-transmissible agent and were thus discarded. The sequential strategy allowed a cost decrease of euro 908.6, compared to the simultaneous strategy. Given that approximately there are 50,000 blood donations annually in Burkina Faso, the money savings reached potentially euro 90,860. CONCLUSIONS: In resource-limited settings, the implementation of a sequential strategy appears as a pragmatic solution to promote safe blood supply and ensure sustainability of the system.

[Causes of iron-deficiency anaemia in the internal medecine department of the national teaching hospital of Ouagadougou]. / Les étiologies des anémies ferriprives dans le service de médecine interne du centre hospitalier universitaire Yalgado-Ouédraogo de Ouagadougou.

This retrospective study in the internal medicine department of the national teaching hospital of Ouagadougou was conducted to identify the main causes of iron-deficiency anaemia. Among the 65 subjects meeting the inclusion and exclusion criteria, mean haemoglobin was 7.5 g/dl, with mean serum ferritin 8.9 microg/l among women and 15.5 microg/l among men. The most common cause was chronic blood loss, and hookworm was a major cause in 19.6% of cases. These results suggest the need for preventive measures against iron deficiency and for reinforcement of the fight against diseases producing fecal blood loss.