Current status of digital health interventions in the health system in Burkina Faso.

BACKGROUND: Digital health is being used as an accelerator to improve the traditional healthcare system, aiding countries in achieving their sustainable development goals. Burkina Faso aims to harmonize its digital health interventions to guide its digital health strategy for the coming years. The current assessment represents upstream work to steer the development of this strategic plan. METHODS: This was a quantitative, descriptive study conducted between September 2022 and April 2023. It involved a two-part survey: a self-administered questionnaire distributed to healthcare information managers in facilities, and direct interviews conducted with software developers. This was complemented by a documentary review of the country's strategic and standards documents on digital transformation. RESULTS: Burkina Faso possesses a relatively comprehensive collection of governance documents pertaining to digital transformation. The study identified a total of 35 digital health interventions. Analysis showed that 89% of funding originated from technical and financial partners as well as the private sector. While the use of open-source technologies for the development of the applications, software, or platforms used to implement these digital health interventions is well established (77%), there remains a deficiency in the integration of data from different platforms. Furthermore, the classification of digital health interventions revealed an uneven distribution between the different elements across domains: the health system, the classification of digital health interventions (DHI), and the subsystems of the National Health Information System (NHIS). Most digital health intervention projects are still in the pilot phase (66%), with isolated electronic patient record initiatives remaining incomplete. Within the public sector, these records typically take the form of electronic registers or isolated specialty records in a hospital. Within the private sector, tool implementation varies based on expressed needs. Challenges persist in adhering to interoperability norms and standards during tool design, with minimal utilization of the data generated by the implemented tools. CONCLUSION: This study provides an insightful overview of the digital health environment in Burkina Faso and highlights significant challenges regarding intervention strategies. The findings serve as a foundational resource for developing the digital health strategic plan. By addressing the identified shortcomings, this plan will provide a framework for guiding future digital health initiatives effectively.

Bioaccumulation and trophic transfer of mercury and selenium in african sub-tropical fluvial reservoirs food webs (Burkina Faso).

The bioaccumulation and biomagnification of mercury (Hg) and selenium (Se) were investigated in sub-tropical freshwater food webs from Burkina Faso, West Africa, a region where very few ecosystem studies on contaminants have been performed. During the 2010 rainy season, samples of water, sediment, fish, zooplankton, and mollusks were collected from three water reservoirs and analysed for total Hg (THg), methylmercury (MeHg), and total Se (TSe). Ratios of δ13C and δ15N were measured to determine food web structures and patterns of contaminant accumulation and transfer to fish. Food chain lengths (FCLs) were calculated using mean δ15N of all primary consumer taxa collected as the site-specific baseline. We report relatively low concentrations of THg and TSe in most fish. We also found in all studied reservoirs short food chain lengths, ranging from 3.3 to 3.7, with most fish relying on a mixture of pelagic and littoral sources for their diet. Mercury was biomagnified in fish food webs with an enrichment factor ranging from 2.9 to 6.5 for THg and from 2.9 to 6.6 for MeHg. However, there was no evidence of selenium biomagnification in these food webs. An inverse relationship was observed between adjusted δ15N and log-transformed Se:Hg ratios, indicating that Se has a lesser protective effect in top predators, which are also the most contaminated animals with respect to MeHg. Trophic position, carbon source, and fish total length were the factors best explaining Hg concentration in fish. In a broader comparison of our study sites with literature data for other African lakes, the THg biomagnification rate was positively correlated with FCL. We conclude that these reservoir systems from tropical Western Africa have low Hg biomagnification associated with short food chains. This finding may partly explain low concentrations of Hg commonly reported in fish from this area.

Mercury, arsenic and selenium concentrations in water and fish from sub-Saharan semi-arid freshwater reservoirs (Burkina Faso).

Despite intensive mining activities in Burkina Faso, little is known on the environmental impacts of metals and metalloids potentially released from these activities. Water samples and 334 fish from 10 reservoirs were taken in order to evaluate the extent of mercury (Hg), selenium (Se) and arsenic (As) contamination in aquatic systems and their potential health risk for humans and wildlife, taking into account their antagonistic interactions. Water and fish levels of these elements were relatively low and did not reveal an important impact of gold mining activities. Water temperature and conductivity were the key factors associated with higher levels of MeHg. Higher sulfate content was reported in sites with more particulate Hg, As and Se, suggesting anthropogenic origin of metal(loid) inputs in water reservoirs. Metal(loid) concentrations in fish were low and ranged from 0.002 to 0.607 µg/g wet weight (w.w.) for Hg, 0.023 to 0.672 for Se and 0.039 to 0.42 for As. These levels are similar or slightly higher than those reported in many other studies from Africa. Nevertheless, more than 70% of piscivore fish exceeded the threshold for wildlife protection for MeHg. Further, a traditional risk analysis performed ignoring Se antagonism indicated that these piscivores should be consumed by humans with caution. However, when taking into account the antagonistic effect of Se on Hg toxicity, up to 99% of all fish could be protected from Hg toxicity by their Se content. When considering both As/Se and Se/Hg antagonism, 83% instead the 99% of fish should be considered safe for consumption. Fish Se and As concentrations did not pose potential risk for both animals and humans. Overall, these reservoirs were relatively unaffected by As, Se and Hg contamination despite the rising gold mining activities. Further, considering antagonistic effects of As, Se and Hg may help refine consumption advisories.

Effects of various cooking methods and food components on bioaccessibility of mercury from fish.

Fish consumption is the main source of human exposure to mercury. Studies from specific human populations have reported Hg levels lower than those modeled from consumption data. These discrepancies between expected and measured Hg levels may be explained by differences in dietary habits such as cooking methods and food components on fish Hg bioavailability. We assessed the effects of three cooking methods (no cooking, frying and boiling) and of the co-ingestion of selected food items (tea, coffee and corn starch) on Hg bioaccessibility in three fish species (tuna, shark and mackerel) containing between 1 and 4 µg/g dry weight of Hg. We used in vitro techniques simulating human digestion and each experiment was repeated three times with at least three different individuals for each fish species. For all fish species, Hg concentrations (dry weight) in boiled fish were slightly but not significantly higher than those in fried or raw fish. Boiling and frying reduced Hg bioaccessibility by 40% and 60%, respectively, compared to raw fish Hg bioaccessibility. Black coffee as well as green and black tea significantly reduced raw fish Hg bioaccessibility by 50-60%, whereas, corn starch did not. The combined effect of cooking and addition of tea or coffee led to very low levels of Hg bioaccessibility. This study suggests that Hg bioaccessibilty from fish can be modified by cooking and by the co-ingestion of tea and coffee. These results should be further validated in vitro with different fish species before proceeding with in vivo approaches using animal models.