[Factors associated with the satisfaction of prescribers of blood products in Burkina Faso]. / Facteurs associés à la satisfaction des prescripteurs de produits sanguins labiles au Burkina Faso.

BACKGROUND: The National Blood Transfusion Centre, unique operator of blood transfusion in Burkina Faso is engaged into the quality process according to ISO 9001. Therefore, the assessment of customer satisfaction is a main part of its system. Our study conceives "customer satisfaction" as dependant to the perceived service quality based on SERVQUAL model. OBJECTIVES: To identify factors associated with the satisfaction of blood products prescribers in order to help decision-makers for continuous improvement of services. MATERIAL AND METHODS: We conducted a cross-sectional survey among prescribers of blood components in Ouagadougou, between February 27 and April 30, 2015. We used an anonymous self-administered questionnaire, including 13 items associated to the 5 dimensions of SERVQUAL model. The different satisfaction gaps were calculated and linear regression was used to determine statistical associations with a significance level of 5%. RESULTS: The return rate was 94.5% about the 256 questionnaires distributed. A total of 30% of respondents were satisfied to very satisfied. The overall global gap of satisfaction was -5.74. The product delivery time, the efficacy and safety of blood products, the medical and clinical support, the pro-activity of the communication, the management of blood products reservation and the satisfaction of needs in blood products were the factors associated with the prescribers' satisfaction. CONCLUSION: This first study in blood transfusion services in our context was been useful to assess customer satisfaction and identify the main axes on which targeting priority actions in order to effectively use available resources.

[Role of quality control for improvement of blood components in the Regional Blood Centre of Ouagadougou in Burkina Faso, 2014]. / Apports du contrôle qualité produits finis dans l'amélioration de la qualité des produits sanguins labiles au Centre régional de transfusion sanguine de Ouagadougou (Burkina Faso), 2014.

OBJECTIVES: In Burkina Faso, blood components must comply with national standards. Then, all Transfusion services must implement a quality control process to ensure compliance. Our study aims to establish the main characteristics of blood components of the regional transfusion center of Ouagadougou, and evaluate the capability of this center to improve its manufacturing process. METHODS: We conducted from marsh to December 2014 a pre-post study, assessing blood components' characteristics before and after the implementation of a six months' improvement plan. The assessed parameters were: volume, hematocrit (Ht) and hemoglobin (Hb) levels in RBCs; volume and the number of platelets in PPCs; and volume and concentration of clotting factor VIII in fresh frozen plasma (FFP), respectively. Three hundred and twelve RBCs and 280 PCs were randomly selected for the first series of controls, and 215 RBCs, 54 PCs and 60 FFP were selected for the second series of controls. We compared the mean values of the components parameters and the overall non-compliance rates for each series. RESULTS: The average Hb level of RBCs was respectively 47.8±8.9g and 54.7±7.2g in the first and second series compare to a standard of≥40g. Non-compliance rates of Hb level decreased significantly from 17.6% to 1.4%. For PCs units, the mean number of platelets was 0.14±0.10×1011 and 0.30±0.15×1011 in the first and second period compare to a standard of 0.5×1011. Non-compliance rates for platelets number were high 97.1% and 72.2%. CONCLUSION: The study demonstrates that only RBCs complied with national standards. The study also demonstrates the capability of CRTSO to improve blood components' processing even if for PCs and FFP, NC rates remain high. QC must be maintained and expanded to the others regional blood centers of the country.

[Implementation of hemovigilance in Sub-Saharan Africa]. / Mise en place de l'hémovigilance en Afrique subsaharienne.

PURPOSE OF THE STUDY: Hemovigilance being an essential part of blood transfusion safety, many countries have set legislation for its organization and its establishment. In Sub-Saharan Africa, where transfusion practice is facing many challenges, hemovigilance does not always appear as a priority. Nevertheless, in 2000, Burkina Faso decided to reorganize its blood transfusion system according to the World Health Organisation recommendations and other international standards. A national blood transfusion center and regional blood transfusion centers were created. From 2005 to 2009, a hemovigilance pilot project was conducted by the regional blood transfusion center of Bobo-Dioulasso. METHODS: The implementation of this hemovigilance project included the following steps: training of medical and paramedical personnel of the health facilities provided with blood and blood products by the regional blood transfusion center, distribution of post transfusion and hemovigilance forms, and the creation of a hemovigilance and transfusion committee. RESULTS: During the period 2005-2009, 34,729 blood products were distributed for 23,478 patients. The return rate of the post-transfusion and hemovigilance forms (number of files completed partially or completely and returned to the regional blood transfusion center compared to the number of units distributed) raised from 83.1 to 94.8%, the rate of traceability (rate of forms returned to the regional blood transfusion center and totally completed) raised from 71.6 to 91.6%, and the concordance between the patient for which the blood was delivered and the patient transfused moved from 92.9 to 98.0%. The notification rate of transfusion incidents raised from 1.1 to 16.1 per 1000 units transfused during that period. CONCLUSION: The implementation of a hemovigilance system is possible in the Sub-Sahara African countries. This constitutes a major element in the improvement of different steps of transfusion safety. The implementation of a hemovigilance system requires negotiations between transfusion centers and the hospital personnel, and should be facilitated by the official regulation on blood transfusion practices.

[The transfusion center, the blood donor and the given blood in francophone African countries]. / Le centre de transfusion, le donneur de sang et le sang donné dans les pays d'Afrique francophone.

In subsaharan Africa, knowledge of the organization and methods of transfusion centers, as well as blood donor characteristics, is essential in choosing strategies to improve transfusion practices and the security of blood products on this Continent. The present study was based on a analysis led in partnership with the transfusion of seven francophone African countries (Burkina-Faso, Cameroon, Congo, Ivory Cost, Mali, Niger, and Rwanda). The results showed that withstanding significant progress has been realized in the organization and safety, but much remains to be undertaken over the years to come in order to improve the organization of the centers, the providing of blood products and the infectious and immunohematologic safety. This evolution, for the moment, is limited by the financial resources, insufficient training of personnel and cultural obstacles, but will necessarily pass through the pursuit of conjugated efforts of the scientific, international and local communities.

[Lack of knowledge among blood donors in Burkina Faso (West Africa); potential obstacle to transfusion security]. / Faible niveau de connaissances des donneurs de sang au Burkina Faso; une entrave potentielle à la sécurité transfusionnelle.

BACKGROUND: The measures recommended to reduce TTD include clinical selection of donors, based on a standardized questionnaire which aims to find out antecedents and behaviours predicting transmitted diseases within donors. The effectiveness of this measure is well established in the industrialized countries where the level of education of the population may support a greater receptivity of donors about this procedure. What is happening in developing one? AIM: This study was carried out to assess knowledge attitude and behaviours among blood donors regarding blood and transfusion safety in Burkina Faso. METHODS: A cross sectional study was carried out in the blood bank of the teaching hospital of Ouagadougou. In addition to the routine questionnaire, 544 included blood donors were subjected to additional questions seeking to specify their behaviours, knowledge and attitude towards TTD diseases and screening. RESULTS: Donors were from 16 to 57 years of age (mean age : 28+/-7.9 years). The majority of donors were male (71.2%). Family donors represent 52% and first time donors 55%. About 30.8% were illiterate or of primary school level. A percentage of 14.4 donate to access HIV testing and 30.7% will donate blood immediately to check any contamination in case of exposure. There was no difference between donors having been informed about their HIV status in the past and the other donors regarding HIV, HBs Ag and VHC results. CONCLUSIONS: This study suggests that there is some great need for donors' education on transfusion safety. There is also need for staff training in donors' management.

HBs antigen in children with suspicion of HIV infection.

In order to evaluate the prevalence rate of HBs antigen in children with a suspicion of HIV infection, 103 children were tested for HBs antigen and HIV. The mean age of the children was 2 years. The prevalence of HBs antigen was 39.8 per cent in children and the HIV ELISA test was positive in 57.7 per cent. A correlation was found between carrier of HBs antigen and HIV ELISA positivity (p = 0.04, RR = 1.46; 1.06 < RR < 2.02). There was a high prevalence of HBs antigen in children with a suspicion of HIV infection. This calls for the promotion of antenal screening for HIV and HBV along with immunization against hepatitis B in newborns in our setting.

[HIV infection and hepatitis B co-infection: survey of prevalence in pregnant women in Bobo Dioulasso, Burkina Faso]. / Co-infection hépatite B et VIH: enquête de préevalence chez les femmes enceintes à Bobo Dioulasso, Burkina Faso.

We carried out this study to assess the prevalence of co-infection with hepatitis B and HIV-1 in african pregnant women. Nine hundred and seventeen pregnant women attending two antenatal clinics in Bobo Dioulasso, Burkina Faso, were included. The characteristics of the women were the following: a mean age of 26 years and 83.5% married; a mean gravidity and para of 4 and 3 respectively and a mean gestational age of 27 weeks of amenorrhea. Then sera were drawn to be tested for both hepatitis B and HIV-1. Sera tested positive for HIV-1 at ELISA were confirmed by Western Blot. Ninety eight women (10.7%) were Ag HBs carriers of whose 18.2% were positive for Ag HBe, 66.7% anti-HBe positive and 95.6% anti-HBc positive. The HIV-1 prevalence rate was 5.9%. Eight women were positive for both Ag HBs and HIV-1, giving a co-infection rate of 0.88%. The co-infection rate by hepatitis B and HIV-1 is very low in pregnant women in Bobo Dioulasso despite a high prevalence of these two infections.

Stabilization of HIV infection rates in urban Burkina Faso, 1995-1999.

The objectives of this study were to monitor the trends of the HIV epidemic between 1995 and 1999 among pregnant women in Bobo-Dioulasso, the second largest town of Burkina Faso, and to discuss the possible effect of preventive interventions (condom availability) on sexual transmission of HIV in this context. Age-specific trends in HIV prevalence obtained from sentinel surveillance programme were analysed. Among antenatal clinic attendees, HIV prevalence was 7.5% (n=401) in 1995, 10% (n=200) in 1996, 7.6% (n=448) in 1997, 8.4% (n=642) in 1998 and 5.3% (n=716) in 1999 without demonstrated temporal trend (P=0.12). The average number of condoms available per person (aged 15-49 years) per year increased from 0.6 in 1992 to 5.7 in 1995 and 6.0 in 1999. Anonymous surveys are less subject to selection bias and suggest a stabilization of the HIV prevalence around 7.3% in Bobo-Dioulasso. Distribution of condoms could explain at least, partly, this stabilization of the HIV epidemic.

[HBs antigen carrier state in pregnant women in Bobo Dioulasso (Burkina Faso)]. / Portage de l'antigène HBs chez les femmes enceintes a Bobo-Dioulasso (Burkina Faso).

The aim of this study was to evaluate the prevalence rate and the risk factors for the carriage of hepatitis B markers in pregnant women in Bobo Dioulasso, Burkina Faso. Out of 917 pregnant women recruited during antenatal care, 98 (10.7%) were HBs antigen positive. Among these ones, 18.2% carded HBe antigen, 66.7% antiHBe antibodies and 95.6% antiHBc antibodies. Two risk factors were identified: maternal age of 23 and 28 (RR = 2.33, chi2 =12.21, p = 0.005) and widowage (Fisher test RR = 6.43, p = 0.0016). This high prevalence of HBs antigen calls for systematic screening for hepatitis B during antenatal care along with an immunization policy toward women of reproductive age and newborns.

Serological diagnosis of human immuno-deficiency virus in Burkina Faso: reliable, practical strategies using less expensive commercial test kits.

Reported are the results of a cross-sectional survey in Burkina Faso to identify reliable, practical strategies for the serological diagnosis of HIV-1 and/or HIV-2 infections, using less-expensive commercial test kits in various combinations, as an alternative to the conventional Western blot (WB) test, which costs US$ 60. Serum samples, collected from blood donors, patients with acquired immunodeficiency syndrome (AIDS) and pregnant women, were tested between December 1995 and January 1997. Twelve commercial test kits were available: five Mixt enzyme-linked immunosorbent assays (ELISA), three Mixt rapid tests, and four additional tests including monospecific HIV-1 and HIV-2 ELISA. The reference strategy utilized a combination of one ELISA or one rapid test with WB, and was conducted following WHO criteria. A total of 768 serum samples were tested; 35 were indeterminate and excluded from the analysis. Seroprevalence of HIV in the remaining 733 sera was found to be 37.5% (95% confidence interval: 34.0-41.1). All the ELISA tests showed 100% sensitivity, but their specificities ranged from 81.4% to 100%. GLA (Genelavia Mixt) had the highest positive delta value, while ICE HIV-1.0.2 (ICE) produced the most distinct negative results. Among the rapid tests, COM (CombAIDS-RS) achieved 100% sensitivity and SPO (HIV Spot) 100% specificity. Various combinations of commercial tests, according to recommended WHO strategies I, II, III, gave excellent results when ICE was included in the sequence. The best combination of tests for strategy II, which achieved 100% sensitivity and specificity, was to use ICE and COM, the cost of which was US$ 2.10, compared with US$ 55.60 for the corresponding conventional strategy. For strategy III, the best combination, which achieved 100% sensitivity and specificity, was to use ICE, ZYG (Enzygnost Anti HIV-1/HIV-2 Plus) and COM, the cost of which was US$ 2.90 (19.2 times lower than the corresponding strategy requiring WB). No rapid test combination showed 100% sensitivity and specificity. Our results indicate that the serodiagnosis of HIV in Burkina Faso is possible by using reliable, less-expensive strategies which do not require Western blot testing. Moreover, there is a choice of strategies for laboratories working with or without an ELISA chain.

Evaluation of a quantitative determination of CD4 and CD8 molecules as an alternative to CD4+ and CD8+ T lymphocyte counts in Africans.

In the developed word, monitoring HIV-infected patients is routinely determined by CD4+ T lymphocyte absolute counts. The reference procedure, flow cytometry, is expensive, requires sophisticated instrumentation and operators with specific training. Due to these limitations, CD4 counting is often unavailable in developing countries. The Capcellia assay is an enzyme-linked immunoassay for quantitative determination of CD4 and CD8 molecules. We evaluated this method in West Africa on blood samples collected from 39 HIV-uninfected and 44 HIV-infected adult subjects. CD4 concentration ranges were determined according to the clinical stages of the disease. We then studied the relationship between the two methods in the HIV-infected patients. The Spearman's rank correlation was 0.61 (95% confidence interval: 0.38-0.76, P < 0.0001). Nevertheless, determination of limits of agreement revealed discrepancies between the two methods, especially for CD4 counts > 0.4 x 10(9)/l, which are discussed. We conclude that the Capcellia assay is a convenient means to determine the immunodepression level where flow cytometric instrumentation is unavailable, and can be complementary to CD4 T lymphocyte enumeration.

[Prevention of wasting and opportunistic infections in HIV-infected patients in West Africa: a realistic and necessary strategy before antiretroviral treatment]. / Prévention de la dénutrition et des infections opportunistes chez lespatients infectés par le VIH en Afrique de l'Ouest: une démarche réaliste, nécessaire, préalabe aux antirétroviraux.

The medical inequalities between countries of the North and South (infrastructure, drug availability, medical techniques) are particularly marked in terms of the challenge posed by HIV infection. We propose a strategy for monitoring adult patients in West Africa that is appropriate to the situation in the field and to economic constraints. The aim of this strategy is to increase the quality of life and the life expectancy of HIV-infected adults and to prevent the overcrowding of hospital departments with patients in the terminal phase of AIDS. We analyzed the biological and clinical spectrum of HIV infection before the onset of the diseases that define AIDS (excluding pulmonary tuberculosis). We found that it was particularly important to diagnose B-stage diseases early, especially atypical chronic cutaneous and mucous diseases. Careful analysis of data from a routine hemogram (total lymphocyte count 2500/ml; paradoxical eosinopenia), even in the absence of a CD4 lymphocyte count, should also enable clinicians from a wide variety of health structures to identify the HIV-infected patients most likely to benefit from more detailed clinical follow up, prophylaxis of opportunistic infections using cotrimoxazole, nutritional checkups and prevention of wasting. Cachexia is the most common AIDS-associated disease in West African patients. It involves an overall decrease in calorific intake, diarrhea, immune system activation, an increase in TNFalpha production and greater energy expenditure when resting. Recent nutritional studies have shown that it is vital to optimize the calorific intake of HIV-infected patients presenting with chronic diarrhea, before the onset of severe immune deficiency, to prevent wasting. So, spontaneous calorific intake should de routinely determined in HIV-infected patients and an optimal diet provided. Specific training in nutrition is required for doctors and nurses, as is consideration of the logistic organization required to provide nutritional support to HIV-infected adults. Despite the large number of individuals infected and the lack of sophisticated paraclinical facilities, we feel that it is possible to establish rational management "a minima" of HIV infection in West Africa, whilst waiting for antiretroviral drugs to become more widely available. This strategy could be of direct benefit to patients without swallowing up the financial resources of the health system in expensive biological follow up. Such basic management is also required before the new antiretroviral drugs become widely available. Research should be carried out in parallel in several reference centers in West Africa to determine the most effective associations of antiretroviral drugs and the optimal timing of treatment during the course of infection and to assess the potential side effects of these drugs in HIV patients exposed to recurrent antigenic stimulation by a wide diversity of pathogens.

A proposal for basic management of HIV disease in west Africa: use of clinical staging and haemogram data.

Our objective was to propose a strategy to screen HIV-infected African people for biological immunodeficiency easily. In a cross-sectional study, we analysed the patterns of diseases and of CD4 counts among 266 HIV-infected adults. Peripheral facial paralysis and chronic cutaneo-mucous diseases were the earlier B-stage diseases. Pulmonary tuberculosis was close to B-stage diseases, and chronic diarrhoea was borderline between B and C stages. Cachexia was the most frequent C-stage symptom (47.8%). Ninety per cent of CDC-C stage people had CD4 counts below 350/microliter, whereas only 75% had CD4 counts below 200/microliter. Regression analysis identified the lymphocyte count, clinical stage and platelet count as predictors of CD4 count below 350/microliter. A simple score (lymphocyte count < or = 2500/microliter and clinical stage > or = B) is proposed to determine this CD4 threshold (positive predictive value: 83%) and to determine those patients needing treatment to prevent wasting and opportunistic infections.

PIP: Findings are presented from a cross-sectional study conducted in 1995 in Bobo-Dioulasso, Burkina Faso, in which the patterns of diseases and CD4 counts among 266 HIV-infected adults of mean age 33 years were analyzed. The bioclinical spectrum of subjects' HIV disease is described and a simple alternative proposed to CD4 enumeration for screening and monitoring HIV-infected Africans. Dermatological symptoms and diarrhea were the most frequent signs associated with B-stage disease, while cachexia and digestive candidosis were the most frequent AIDS-defining diseases (ADD). Peripheral facial paralysis and cutaneo-mucous diseases were associated with weak immune deficiency. Pulmonary tuberculosis (TB) was close to B-stage diseases, and chronic diarrhea was borderline between B and C stages. Cachexia was the most frequent C-stage symptom (47.8%). 90% of CDC C-stage subjects had CD4 counts of less than 350 per mcl, while only 75% had CD4 counts under 200/mcl. Regression analysis identified the lymphocyte count, clinical stage, and platelet count as predictors of CD4 count below 350/mcl. A lymphocyte count of less than or equal to 2500/mcl and clinical stage of B or higher is proposed to determine the CD4 threshold and to determine those patients in need of treatment to prevent wasting and opportunistic infections.