Screening for Hepatitis B in partners and children of women positive for surface antigen, Burkina Faso.

Objective: To evaluate the implementation of a screening strategy for the partners and children of pregnant women with hepatitis B virus (HBV) attending antenatal care. Methods: We identified pregnant women positive for HBV surface antigen (HBsAg) at antenatal consultation in Ouagadougou, Burkina Faso. At post-test counselling, women were advised to disclose their HBV status to partners and to encourage their partner and children to be screened for HBsAg. We used multivariable logistic regression to explore factors associated with uptake of screening and HBsAg positivity among family members. Findings: Of 1000 HBsAg-positive women, 436/1000 partners and 215/1281 children were screened. HBsAg was detected in 55 (12.6%) partners and 24 (11.2%) children. After adjusting for confounders, uptake of screening was higher in partners who were married, who attended the woman's first post-test consultation and to whom the woman had disclosed her HBV status. In children, HBsAg positivity was associated with being born before the introduction of infant hepatitis B vaccination in Burkina Faso (not significant in the multivariable analysis), having a mother positive for HBV e-antigen (adjusted OR: 8.57; 95% CI: 2.49-29.48) or having a mother with HBV DNA level ≥ 200 000 IU/mL (OR: 6.83; 95% CI: 1.61-29.00). Conclusion: In low-income countries, the antenatal consultation provides a cost-effective opportunity to identify HBV-infected household contacts and link them to care. Children born before the introduction of infant hepatitis B vaccination and whose mother has higher viral load or infectivity should be a priority for testing and linkage to care.

Timely completion of childhood vaccination and its predictors in Burkina Faso.

BACKGROUND: Despite important progress in global vaccination coverage, many countries are still facing preventable disease outbreaks. Timely vaccination is important in getting adequate protection against disease. In light of the paucity of relevant literature, this study investigated the timely completion of childhood routine immunization and identified factors associated with timely vaccination in Burkina Faso. METHODS: We extracted data on child vaccination and other child characteristics from a household survey conducted across 24 districts in 2017. We extracted data on health system characteristics from a parallel facility survey. We applied a Kaplan-Meier time-to-event analysis to estimate timely vaccination coverage defined as the proportion of children that received a given vaccine in the period between three days before and 28 days after the recommended age. We used a Cox proportional hazard model with mixed effects to identify factors associated with timely vaccination. RESULTS: In total, 3,138 children aged between 16 and 36 months who could present an immunization booklet were included in the study.The main finding is the existence of an important gap showing that timely vaccination coverage was lower than vaccination coverage. More specifically,this gap ranged from 16% for BCG to 43% for Penta 3. In addition, region and distance between the household and the nearest health facility were the main factors associated with timely full vaccination coverage and specifically for Penta3, MCV1 and MCV2. CONCLUSIONS: This study highlights that timely vaccination coverage remains substantially lower than vaccination coverage. Timeliness of vaccination should therefore be considered as a metric to assess the status of immunization in a country. Geographical accessibility continues to represent a major barrier to timely vaccination, calling for specific interventions on both supply-side (e.g. outreach activities) and demand-side (e.g. vouchers or community-based interventions for vaccination) to counteract its negative effect.

Glycaemic Variability and Hyperglycaemia as Prognostic Markers of Major Cardiovascular Events in Diabetic Patients Hospitalised in Cardiology Intensive Care Unit for Acute Heart Failure.

(1) Background: Hyperglycaemia and hypoglycaemia are both emerging risk factors for cardiovascular disease. Nevertheless, the potential effect of glycaemic variability (GV) on mid-term major cardiovascular events (MACE) in diabetic patients presenting with acute heart failure (AHF) remains unclear. This study investigates the prognostic value of GV in diabetic patients presenting with acute heart failure (AHF). (2) Methods: this was an observational study including consecutive patients with diabetes and AHF between January 2015 and November 2016. GV was calculated using standard deviation of glycaemia values during initial hospitalisation in the intensive cardiac care unit. MACE, including recurrent AHF, new-onset myocardial infarction, ischaemic stroke and cardiac death, were recorded. The predictive effects of GV on patient outcomes were analysed with respect to baseline characteristics and cardiac status. (3) Results: In total, 392 patients with diabetes and AHF were enrolled. During follow-up (median (interquartile range) 29 (6−51) months), MACE occurred in 227 patients (57.9%). In total, 92 patients died of cardiac causes (23.5%), 107 were hospitalised for heart failure (27.3%), 19 had new-onset myocardial infarction (4.8%) and 9 (2.3%) had an ischaemic stroke. Multivariable logistic regression analysis showed that GV > 50 mg/dL (2.70 mmol/L), age > 75 years, reduced left ventricular ejection fraction (LVEF < 30%) and female gender were independent predictors of MACE: hazard ratios (HR) of 3.16 (2.25−4.43; p < 0.001), 1.54 (1.14−2.08; p = 0.005), 1.47 (1.06−2.07; p = 0.02) and 1.43 (1.05−1.94; p = 0.03), respectively. (4) Conclusions: among other well-known factors of HF, a GV cut-off value of >50 mg/dL was the strongest independent predictive factor for mid-term MACE in patients with diabetes and AHF.

Modelling factors associated with therapeutic inertia in hypertensive patients: Analysis using repeated data from a hospital registry in West Africa.

The proportion of poorly controlled hypertensives still remains high in the general African population. This is largely due to therapeutic inertia (TI), defined as the failure to intensify or modify treatment in a patient with poorly controlled blood pressure (BP). The objective of this study was to identify the determinants of TI. We conducted a retrospective cohort study from March 2012 to February 2014 of hypertensive patients followed during 4 medical visits. The TI score was the number of visits with TI divided by the number of visits where a therapeutic change was indicated. A random-effects logistic model was used to identify the determinants of TI. A total of 200 subjects were included, with a mean age of 57.98 years and 67% men. The TI score was measured at 85.57% (confidence interval [CI] 95% = [82.41-88.92]). Measured individual heterogeneity was significantly significant (0.78). Three factors were associated with treatment inertia, namely the number of antihypertensive drugs (odd ratios [OR] = 1.27; CI = [1.02-1.58]), the time between consultations (OR = 0.94; CI = [0.91-0.97]), and treatment noncompliance (OR = 15.18; CI = [3.13-73.70]). The random-effects model performed better in predicting high-risk patients with TI than the classical logistic model (P value < .001). Our study showed a high TI score in patients followed in cardiology in Burkina Faso. Reduction of the TI score through targeted interventions is necessary to better control hypertension in our cohort patients.

Dynamic prediction models for graft failure in paediatric kidney transplantation.

BACKGROUND: Several models have been proposed to predict kidney graft failure in adult recipients but none in younger recipients. Our objective was to propose a dynamic prediction model for graft failure in young kidney transplant recipients. METHODS: We included 793 kidney transplant recipients waitlisted before the age of 18 years who received a first kidney transplantation before the age of 21 years in France in 2002-13 and survived >90 days with a functioning graft. We used a Cox model including baseline predictors only (sex, age at transplant, primary kidney disease, dialysis duration, donor type and age, human leucocyte antigen matching, cytomegalovirus serostatus, cold ischaemia time and delayed graft function) and two joint models also accounting for post-transplant estimated glomerular filtration rate (eGFR) trajectory. Predictive performances were evaluated using a cross-validated area under the curve (AUC) and R2 curves. RESULTS: When predicting the risk of graft failure from any time within the first 7 years after paediatric kidney transplantation, the predictions for the following 3 or 5 years were accurate and much better with the joint models than with the Cox model (AUC ranged from 0.83 to 0.91 for the joint models versus 0.56 to 0.64 for the Cox model). CONCLUSION: Accounting for post-transplant eGFR trajectory strongly increased the accuracy of graft failure prediction in young kidney transplant recipients.

Risk Factors of Early Kidney Graft Transplantectomy.

BACKGROUND: Kidney allograft explant in the first month after transplant is a major concern for medicosurgical teams specialized in kidney transplantation and unacceptable graft loss in the current shortage. The aim of our study was to evaluate the risk factors of early kidney graft explant. METHODS: We retrospectively analyzed all adult kidney transplantations performed at our center from January 2006 to December 2011. Recipient, donor, and transplant characteristics were collected, as well as operating data and early postoperative complications. Univariate and multivariate logistic regression models were used to determine risk factors of early renal allograft explant. RESULTS: From a total of 707 kidney transplantations, 28 transplantectomies were performed in the first month following transplantation (3.96%). The average delay in days ± SD was 7.6 ± 10. Eighty-six percent of transplantectomies were due to vascular complications. In multivariate analysis, obesity (odds ratio [OR] = 9.6; 95% confidence interval [CI], 1.63-56.5; P = .0007), range of transplantation (OR = 36.89; 95%CI, 5.5-245; P = .0006), intraoperative complications (OR = 3.99; 95%CI, 1.22-13; P = .026), and early postoperative vascular complications (OR = 85.15; 95%CI, 23.6-306; P < .0001) were independent risk factors. Neither donors nor graft characteristics were significant. CONCLUSIONS: Early renal graft transplantectomies are rare but account for 50% of renal graft loss in the first year. Because obesity, perioperative complications, and early vascular complications are independent factors associated with early transplantectomies, their prevention should be based on meticulous surgery during organ procurement, implantation of the kidney, and on the rehabilitation of future recipients.

Risk prediction models for graft failure in kidney transplantation: a systematic review.

Risk prediction models are useful for identifying kidney recipients at high risk of graft failure, thus optimizing clinical care. Our objective was to systematically review the models that have been recently developed and validated to predict graft failure in kidney transplantation recipients. We used PubMed and Scopus to search for English, German and French language articles published in 2005-15. We selected studies that developed and validated a new risk prediction model for graft failure after kidney transplantation, or validated an existing model with or without updating the model. Data on recipient characteristics and predictors, as well as modelling and validation methods were extracted. In total, 39 articles met the inclusion criteria. Of these, 34 developed and validated a new risk prediction model and 5 validated an existing one with or without updating the model. The most frequently predicted outcome was graft failure, defined as dialysis, re-transplantation or death with functioning graft. Most studies used the Cox model. There was substantial variability in predictors used. In total, 25 studies used predictors measured at transplantation only, and 14 studies used predictors also measured after transplantation. Discrimination performance was reported in 87% of studies, while calibration was reported in 56%. Performance indicators were estimated using both internal and external validation in 13 studies, and using external validation only in 6 studies. Several prediction models for kidney graft failure in adults have been published. Our study highlights the need to better account for competing risks when applicable in such studies, and to adequately account for post-transplant measures of predictors in studies aiming at improving monitoring of kidney transplant recipients.

Age-Dependent Risk of Graft Failure in Young Kidney Transplant Recipients.

BACKGROUND: The risk of graft failure in young kidney transplant recipients has been found to increase during adolescence and early adulthood. However, this question has not been addressed outside the United States so far. Our objective was to investigate whether the hazard of graft failure also increases during this age period in France irrespective of age at transplantation. METHODS: Data of all first kidney transplantation performed before 30 years of age between 1993 and 2012 were extracted from the French kidney transplant database. The hazard of graft failure was estimated at each current age using a 2-stage modelling approach that accounted for both age at transplantation and time since transplantation. Hazard ratios comparing the risk of graft failure during adolescence or early adulthood to other periods were estimated from time-dependent Cox models. RESULTS: A total of 5983 renal transplant recipients were included. The risk of graft failure was found to increase around the age of 13 years until the age of 21 years, and decrease thereafter. Results from the Cox model indicated that the hazard of graft failure during the age period 13 to 23 years was almost twice as high as than during the age period 0 to 12 years, and 25% higher than after 23 years. CONCLUSIONS: Among first kidney transplant recipients younger than 30 years in France, those currently in adolescence or early adulthood have the highest risk of graft failure.

Factors associated with very early neonatal mortality in Burkina Faso: A matched case-control study.

OBJECTIVE: To identify the risk factors associated with very early neonatal death in Burkina Faso. METHODS: A matched case-control study including newborns born between May 2009 and April 2010. Cases comprised newborns that died within 24hours of birth, whereas controls were those of a similar birth weight to the cases who survived the first 24hours. Potential risk factors related to mothers, neonates, and healthcare provision were assessed from medical records and via interviews. Conditional logistic regression was used to estimate odds ratios. RESULTS: Data from 470 cases and 470 controls were analyzed. Multivariate analysis showed that Apgar score at 4-7 or 1-3 (aOR 6.27; 95% CI, 3.10-12.68 and aOR 72.26; 95% CI, 14.07-371.26, respectively); bradycardia at the last heart sound recorded before delivery (aOR 5.72; 95% CI, 1.42-23.03); inadequacy or lack of prenatal care (aOR 2.39; 95% CI, 1.15-4.97); resuscitation of newborns (aOR 2.07; 95% CI, 1.01-4.27); and referral of the newborn (aOR 5.29; 95% CI, 1.44-19.43) were associated with increased odds of neonatal mortality. However, being a primigravid mother (aOR 0.51; 95% CI, 0.29-0.89) was associated with decreased odds of neonatal mortality. CONCLUSION: Very early neonatal mortality is closely related to the condition of the newborn at birth, the monitoring of the pregnancy, and medical procedures.