Undernutrition in children aged 0-59 months by region and over time: secondary analysis of the Burkina Faso 2012-2018 National Nutrition Surveys.

The global burden of undernutrition remains high, responsible for significant under-five mortality in resource-limited settings. Numerous sustainable development goals (SDGs) are linked to nutrition, and nationally representative nutrition surveillance is a key activity to track progress towards SDGs and guide efficient programmes. OBJECTIVES: The aim of this study is to look at spatial and temporal trends in undernutrition in children under 5 years age in Burkina Faso. SETTING: We used data from annual National Nutrition Surveys using Standardised Monitoring and Assessment of Relief and Transitions methodology (anthropometry, morbidity) over 7 years (2012-2018) in Burkina Faso. PARTICIPANTS: Children of under 5 years from households selected through systemic sampling at countrywide level. MAIN OUTCOME MEASURES: Prevalence of stunting (height-for-age z-score, <-2), underweight (weight-for-age z-score, <-2) and wasting (weight-for-height z-score, <-2) at regional and national. We used general linear mixed models, adjusted by age, survey year, sex, presence of fever and/or diarrhoea, and poverty index to quantify the risk of undernutrition over time and by region of residence. RESULTS: Between 2012 and 2018, decreases were observed overall in the prevalence of growth retardation (stunting) decreased from 33.0% (95% CI 32.3 to 33.8) in 2012 to 26.7% (95% CI 26.2 to 27.3) in 2018. Underweight reduced from 24.4% (95% CI 23.7 to 25.1) to 18.7% (95% CI 18.2 to 19.2) for the same period and wasting decreased from 10.8% (95% CI 10.3 to 11.3) in 2012 to 8.4% (95% CI 8.1 to 8.8) in 2018. However, there was substantial variation across the country, with increased risk of undernutrition in the regions of Sahel, East and Cascades primarily. High-risk regions were characterised by a lower poverty index and limited access to healthcare services. CONCLUSIONS: Our findings could inform national policymakers in refining and optimising resource allocation based on the identification of high-risk areas.

Intra renal epidermal cyst simulating a renal tumor: A case report.

Epidermoid cyst is an unusual and very rarely described lesion in the kidney. We report the case of a 45-year-old woman with no known pathological history who presented with right flank pain accompanied by macroscopic hematuria. The physical examination was unremarkable. The CT scan evoked a malignant tumor in front of a right renal mass with irregular contours. The patient underwent a total right nephrectomy. The nephrectomy specimen received for pathological examination showed macroscopically an encapsulated cystic mass of 4 cm long axis. The cyst lumen was occupied by solid brownish tissue debris. Histologically, the cystic wall was lined by a keratinizing squamous epithelium with accumulation of keratin lamellae in the cystic lumen. Anatomopathological examination concluded to the diagnosis of renal epidermoid cyst.

Characteristics of Obstetric and Iatrogenic Urogenital Fistulas in Burkina Faso: A Cross-Sectional Study.

OBJECTIVE: To compare the sociodemographic, clinical, and therapeutic characteristics of obstetric urogenital fistulas (OF) and iatrogenic urogenital fistulas (IF) treated in seven centers in Burkina Faso. Material and Methods. We carried out a cross-sectional study over a seven years' period (January 1, 2010 to December 31, 2016). We considered as iatrogenic all urogenital fistulas (UGF) occurred after elective caesarean section, gynecologic surgery (hysterectomy, myomectomy, and prolapse repair), or induced abortion. UGF following vaginal delivery after prolonged labor without obstetric maneuvers or caesarean section were considered as obstetric. UGF caused by other mechanisms (emergency caesarian section, congenital, and traumatic) were excluded from this study. The statistical analysis was carried out using version 14 of the STATA software. A logistic regression model was used to compare the two groups. RESULTS: 310 cases of UGF were included. IF accounted for 25.8% (n = 80) versus 74.2% (n = 230) for OF. The median age was 35 years for IF and 35.38 years for OF. The vesicovaginal fistulas were predominant (74.5%) in the two groups. All circumferential fistulas were found in the OF group. OF were frequently associated with residence in rural areas (OR = 1.8; CI = [1.05-3.1]), low level of education (OR = 5.4; CI = [2.3-12.9]), and a height under 158 cm (OR = 3.4 CI = [1.7-6.6]). Vaginal sclerosis was less common among IF (OR = 2.2; CI = [1-4.6]). The failure of surgical treatment after 3 months was more associated with OF (OR = 4.7; CI = [1.1-20.5]). CONCLUSION: OF were the most common, frequently affecting short women living in rural area and with low level of schooling. Fistulas were also more severe in the OF group. IF gave better results after surgical repair.

Primary malignant melanoma of the urethra in women: About a case.

Primary malignant melanoma of the urethra in women is a rare tumor with a poor prognosis. We report the case of a 48-year-old patient who consulted for a mass in the urethral meatus associated with symptoms of the lower urinary tract. The result of the biopsy of the mass revealed a malignant melanoma confirmed by immunohistochemistry. The extension workup was negative. She had a total cystectomy with lymph node dissection done. The one-year follow-up was without particularity.

Cost of pediatric hospitalizations in Burkina Faso: A cross-sectional study of children aged <5 years enrolled through an acute gastroenteritis surveillance program.

INTRODUCTION: Diarrheal illness is a leading cause of hospitalizations among children <5 years. We estimated the costs of inpatient care for rotavirus and all-cause acute gastroenteritis (AGE) in two Burkina Faso hospitals. METHODS: We conducted a cross-sectional study among children <5 years from December 2017 to June 2018 in one urban and one rural pediatric hospital. Costs were ascertained through caregiver interview and chart abstraction. Direct medical, non-medical, and indirect costs per child incurred are reported. Costs were stratified by rotavirus results. RESULTS: 211 children <5 years were included. AGE hospitalizations cost 161USD (IQR 117-239); 180USD (IQR 121-242) at the urban and 154USD (IQR 116-235) at the rural site. Direct medical costs were higher in the urban compared to the rural site (140USD (IQR 102-182) vs. 90USD (IQR 71-108), respectively). Direct non-medical costs were higher at the rural versus urban site (15USD (IQR 10, 15) vs. 11USD (IQR 5-20), respectively). Indirect costs were higher at the rural versus urban site (35USD (IQR 8-91) vs. 0USD (IQR 0-26), respectively). Rotavirus hospitalizations incurred less direct medical costs as compared to non-rotavirus hospitalizations at the rural site (79USD (IQR 64-103) vs. 95USD (IQR 80-118)). No other differences by rotavirus testing status were observed. The total median cost of a hospitalization incurred by households was 24USD (IQR 12-49) compared to 75USD for government (IQR 59-97). Direct medical costs for households were higher in the urban site (median 49USD (IQR 31-81) versus rural (median 14USD (IQR 8-25)). Households in the lowest wealth quintiles at the urban site expended 149% of their monthly income on the child's hospitalization, compared to 96% at the rural site. CONCLUSIONS: AGE hospitalization costs differed between the urban and rural hospitals and were most burdensome to the lowest income households. Rotavirus positivity was not associated with greater household costs.

Proposing standardised geographical indicators of physical access to emergency obstetric and newborn care in low-income and middle-income countries.

Emergency obstetric and newborn care (EmONC) can be life-saving in managing well-known complications during childbirth. However, suboptimal availability, accessibility, quality and utilisation of EmONC services hampered meeting Millennium Development Goal target 5A. Evaluation and modelling tools of health system performance and future potential can help countries to optimise their strategies towards reaching Sustainable Development Goal (SDG) 3: ensure healthy lives and promote well-being for all at all ages. The standard set of indicators for monitoring EmONC has been found useful for assessing quality and utilisation but does not account for travel time required to physically access health services. The increased use of geographical information systems, availability of free geographical modelling tools such as AccessMod and the quality of geographical data provide opportunities to complement the existing EmONC indicators by adding geographically explicit measurements. This paper proposes three additional EmONC indicators to the standard set for monitoring EmONC; two consider physical accessibility and a third addresses referral time from basic to comprehensive EmONC services. We provide examples to illustrate how the AccessMod tool can be used to measure these indicators, analyse service utilisation and propose options for the scaling-up of EmONC services. The additional indicators and analysis methods can supplement traditional EmONC assessments by informing approaches to improve timely access to achieve Universal Health Coverage and reach SDG 3.

Aspects morphométriques tomodensitométriques du pancréas chez l'adulte

But : Evaluer les variations morphométriques du pancréas à la tomodensitométrie. Sujets et méthode : il s'agissait d'une étude rétrospective sur une période de sept mois. L'étude concernait 110 sujets dont 55 hommes et 55 femmes sans antécédents d'affection ou de chirurgie abdominale. Nous étudiions pour chaque sujet le nombre de coupes ou le pancréas était visualisé, la forme générale du pancréas, la forme du pancréas à l'origine de l'artère mésentérique supérieure, la forme de la queue, la visibilité de la lobulation graisseuse et du conduit pancréatique principale. Nous mesurions l'angle formé par l'axe du corps et celui de la queue, la distance entre le bord antérieur du pancréas à la peau de la paroi abdominale ventrale, la distance entre le bord postérieur du pancréas à la peau de la paroi abdominale dorsale et les dimensions des différentes parties du pancréas. Résultats : Le pancréas était visualisé sur 35,43 coupes pour chaque sujet. Il avait une forme générale en « arc » à concavité postérieure dans 58 % des cas. A la naissance de l'artère mésentérique supérieure nous retrouvions une forme en arc à concavité postérieure dans 24 % des cas. La queue avait une forme classique dans 92,59% des coupes. Le conduit pancréatique principal était visible chez 37 sujets. La lobulation graisseuse était visible chez 31 sujets. L'angle moyen formé par l'axe du corps et celui de la queue était de 138 degré. La distance moyenne du bord antérieur du pancréas à la peau était de 76,86 mm chez les femmes ; et de 79,11 mm chez les hommes. La distance moyenne du bord postérieur du pancréas à la peau était de 123,87 mm chez les femmes ; et de 122,08 mm chez les hommes. Le diamètre moyen de la tête était de 22,8 mm chez les femmes ; et de 22,25 mm chez les hommes. Le diamètre moyen du corps était de 15,65 mm chez les femmes ; et de 15,69 mm chez les hommes. Le diamètre moyen de la queue était de 12,53 mm chez les femmes ; et de 12,35 mm chez les hommes. Conclusion : Nous retrouvons une forme générale du pancréas en « arc » ou en « s couchée ». Les dimensions chez les femmes sont plus élevées que chez les hommes mais la différence n'est pas significative. Il n'existe pas de corrélation entre le diamètre des différentes parties du pancréas et l'âge. Il existe une corrélation entre la lobulation graisseuse et l'âge

Impact and effectiveness of pentavalent rotavirus vaccine in children <5 years of age in Burkina Faso.

BACKGROUND: Burkina Faso was one of the first African nations to introduce pentavalent rotavirus vaccine (RV5, RotaTeq) into its national immunization program in October 2013. We describe the impact and effectiveness of rotavirus vaccine on acute gastroenteritis (AGE) hospitalizations among Burkinabe children. METHODS: Sentinel hospital-based surveillance for AGE was conducted at four hospitals during December 2013 - February 2017. Demographic, clinical, and vaccination information was collected and stool specimens were tested by EIA. Trends in rotavirus AGE hospitalizations and changes in the proportion of AGE hospitalizations due to rotavirus were examined at two sentinel sites from January 2014 - December 2016. Unconditional logistic regression models using data from all 4 surveillance sites were used to calculate vaccine effectiveness (VE, defined as 1-odds ratio) by comparing the odds of vaccination among rotavirus AGE (cases) and non-rotavirus AGE (controls) patients, controlling for age, season, hospital site and socioeconomic factors. RESULTS: The proportion of AGE hospitalizations that tested positive for rotavirus declined significantly among children <5 years of age, from 36% (154/422) in 2014 to 22% (71/323, 40% reduction, p < .01) in 2015 and 20% (61/298, 44% reduction, p < .01) in 2016. Among infants, the percentage of AGE admissions due to rotavirus fell significantly from 38% (94/250) in 2014 to 21% (32/153, 44% reduction, p < .01) in 2015 and 17% (26/149, 54% reduction, p < .01) in 2016. The adjusted VE for full 3-dose series of RV5 against rotavirus hospitalization was 58% (95% [CI], 10%, 81%) in children 6-11 months of age and 19% (-78%, 63%) in children ≥12 months. CONCLUSION: Rotavirus hospitalizations declined after introduction of pentavalent rotavirus vaccine in children, particularly among infants. RV5 significantly protected against severe rotavirus gastroenteritis in infants, but effectiveness decreased in older children.

[Acute scrotal swellings at Louga Regional Hospital, Senegal: epidemiologic, etiologic and therapeutic aspects]. / Les grosses bourses aiguës au centre hospitalier de Louga, Sénégal: aspects épidémiologiques, étiologiques et thérapeutiques.

INTRODUCTION: Acute scrotal swellings (ASS) are a common reason for emergency consultation. This study aims to determine the frequency of hospitalization for ASS at the Louga Amadou Sakhir Mbaye Regional Hospital, Senegal, to identify its clinical forms and to evaluate the care management. METHODS: This is a retrospective descriptive study involving 114 patients hospitalized for ASS at the Louga Amadou Sakhir Mbaye regional hospital, from May 2010 to August 2013. The variables studied were: the frequency of ASS among scrotal swellings and urological emergencies, age, consultation period, causes, treatment, post-treatment evolution and hospitalization length. RESULTS: During the study period, 356 scrotal swellings and 420 urological emergencies were recorded. Thus, 114 cases with ASS accounted for 32.0% of scrotal swellings and 27.1% of urological emergencies. The average age was 42.25 ± 25 years (5 months and 89 years represent the extremes). The median of consultation time was 4 days. The diagnosis at admission was: acute orchiepididymitis (n=66), ASS with abscess formation (n=18), suspicion of torsion of the spermatic cord (n=14), traumatic ASS (10 cases), strangulated inguinoscrotal hernia (06 cases). Treatment was exclusively medical in 66 cases (57.8 %). Surgical exploration, which was indicated in 48 patients, was performed in 45 of them (93.7%), three patients (6.2%) refused it. In total there were 9 cases with orchiectomies and 36 conservative procedures. The average length of stay in hospital was 3 ± 2 days. Eighty-one patients (71.0%) were hospitalized for at least 24 hours. They were divided into two groups: 42 surgical patients and 39 medical patients. No deaths were recorded. CONCLUSION: ASS are common in our hospital, people of all ages can be affected. They are dominated by ASS of infectious origin, torsion of the spermatic cord and scrotal trauma. Delayed consultation is often the rule, this may affect functional prognosis of the testicle.

Deforestation and the limited contribution of forests to rural livelihoods in West Africa: evidence from Burkina Faso and Ghana.

Forest degradation in West Africa is generally thought to have negative consequences on rural livelihoods but there is little overview of its effects in the region because the importance of forests to rural livelihoods has never been adequately quantified. Based on data from 1014 rural households across Burkina Faso and Ghana this paper attempts to fill this knowledge gap. We demonstrate that agricultural lands and the non-forest environment including parklands are considerably more valuable to poor as well as more well-off rural households than forests. Furthermore, product types supplied by the non-forest environment are almost identical with those from forests. Accordingly, forest clearance/degradation is profitable for and, hence, probably performed by rural people at large. We attribute rural people's high reliance on non-forest versus forest resources to the two countries' restrictive and inequitable forest policies which must be reformed to promote effective forest conservation, e.g., to mitigate climate change.