Low attendance in cervical cancer screening, geographical disparities and sociodemographic determinants of screening uptake among adult women in Burkina Faso : results from the first nationwide population-based survey.

OBJECTIVE: To explore the level, geographical disparities and sociodemographic determinants of cervical cancer screening uptake among adult women in Burkina Faso by using data from the first national population-based survey. METHODS: This was a cross-sectional secondary analysis of primary data obtained by the 2013 World Health Organization (WHO) Stepwise Approach to Surveillance survey conducted in Burkina Faso. All 13 Burkinabè regions, with their different rates of urbanization, were surveyed. Lifetime cervical cancer screening uptake was explored. We included 2293 adult women for analyses and performed Student's t, chi-square and Fisher's exact tests, and logistic regression. RESULTS: Only 6.2% (95% CI: 5.3-7.3) of women had ever been screened for cervical cancer. For two regions ("Centre" and "Hauts-Bassins"), the pooled frequency was 16.6% (95% CI: 13.5-20.1) while in the other eleven regions it was significantly lower, 3.3% (95% CI: 2.5-4.2). In urban and rural areas, the respective frequencies for the screening uptake were 18.5% and 2.8% (p < 0.001), and in educated and un-educated women, frequencies were 27.7% and 3.3% (p < 0.001) respectively. The sociodemographic factors associated with screening uptake were being educated (adjusted odd-ratio [aOR] = 4.3; 95% CI: 2.8-6.7), urban residence (aOR = 3.8, 95% CI: 2.5-5.8) and having an occupation providing income (aOR = 3.1, 95% CI: 1.8-5.4). CONCLUSION: There was a significantly wide range in screening uptake between Burkina Faso regions, and the overall national as well as the region-specific levels were far below the WHO's target for cervical cancer elimination. Cervical cancer interventions should be tailored specifically for Burkinabè women with different educational levels, and prevention strategies based on community engagement integrating psychosocial considerations could be helpful.

Coûts médicaux des accouchements et des césariennes au Burkina Faso: une évaluation nationale

Dans le cadre des politiques publiques d'accès aux soins de santé maternelle, les centres de santé offrent des prestations aux populations et sont ensuite remboursés par l'État sans qu'on sache ce que représentent ces coûts. Les objectifs de cette étude étaient de déterminer les coûts réels des accouchements au Burkina Faso. C'est une enquête transversale conduite entre juin et août 2014 dans tous les hôpitaux, centres médicaux et deux centres de santé de base par commune. Les coûts médicaux réels incluaient l'acte, les médicaments et consommables, les examens paracliniques et l'hospitalisation. Au total 949 femmes de 544 centres de santé publics ont été analysées. L'échantillon comprenait 579 accouchements eutociques, 202 dystociques et 168 césariennes. Au niveau national, le coût médical réel moyen était de 3 180 (±1 255), 13 305 (± 6 865) et 55 830 (±14 800) FCFA respectivement pour un accouchement eutocique, dystocique et une césarienne. Quel que soit le type d'accouchement, les médicaments et consommables représentaient plus de la moitié des coûts. Le coût médical moyen variait selon la région sanitaire, le type d'accouchement et le type de formation sanitaire (p<0,001). Ces résultats suggèrent qu'un remboursement forfaitaire, selon le type de prestation, doit tenir compte du niveau de soins

Facteurs associés aux décès des patients atteints de tuberculose pulmonaire au service de pneumo phtisiologie du Centre hospitalier universitaire Yalgado Ouédraogo de Ouagadougou, Burkina Faso : étude cas témoin

La tuberculose (TB) reste l'une des maladies transmissibles causant le plus de décès dans le monde. elle figure désormais au même titre que le Vih parmi les principales causes de décès dans le monde. le rapport 2015 de l'oMS décrit un total plus élevé de nouveaux cas de tuberculose (9,6 millions) que les années précédentes dont 6 millions (63%) ont été notifiés et 1,5 million de décès enregistrés (1,1 million de personnes Vih-négatives et 0,4 million personnes Vih-positives). l'afrique est le continent qui présente le taux d'incidence le plus élevé : 281 cas pour 100 000 habitants. les résultats des études menées montrent des niveaux de mortalités variables, le rôle favorisant de la co-infection au Vih, ainsi que du faible niveau socio-économique. Très peu d'études ont cependant exploré les facteurs de risque de décès des patients tuberculeux dans le contexte de la relative disponibilité des traitements antirétroviraux (TaRV). notre étude vise à identifier les facteurs de risque de décès des patients tuberculeux dans un contexte de disponibilité et d'accessibilité élargies aux TaRV au Burkina Faso. l'objectif de notre étude était d'identifier les facteurs de risque de décès des patients atteints de tuberculose pulmonaire dans le service de pneumo phtisiologie du Chu-Yo, de ouagadougou, Burkina Faso. une étude cas-témoin a été menée au service de pneumo phtisiologie du Chu-Yo, de ouagadougou, Burkina Faso, s'appuyant sur les données de 2011 à 2015. les cas de décès ont été identifiés à travers la revue des dessiers et registres d'hospitalisation. Ce groupe de cas de décès a été comparé à un groupe témoin constitué d'un nombre égal de malades adultes choisis parmi les malades également atteints de tuberculose pulmonaire à microscopie positive(TPM+) hospitalisés au cours de la même période et qui sont sortis vivants du service. les facteurs de risque ont été identifiés à partir d'une régression logistique simple en utilisant le logiciel stata version 13. au total, 54 cas de décès et 54 témoins ont été inclus dans l'analyse. l'analyse multi variée a identifié comme facteurs de risque de décès des patients atteints de TPM+ : le sexe masculin (oRa= 3,81 ; p= 0,04), l'absence de vaccination par le BCg (oRa= 15,34 ; p= 0,03), la co-infection par le Vih (oRa= 9,04 ; p= 0,002), la présence de comorbidités (oRa= 19,99 ; p= 0,000) et l'anorexie (oRa= 8,14 ; p= 0,000). les résultats de notre étude montrent que la co-infection par le Vih demeure un des facteurs de mauvais pronostic pour les malades atteints de la tuberculose à microscopie positive en dépit d'une plus grande disponibilité des aRVs. la vaccination par le BCg a aussi un effet protecteur contre le décès

Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries.

OBJECTIVE: To assess the risks of uterine rupture, maternal and perinatal outcomes associated with a trial of labour (TOL) after one previous caesarean were compared with having an elective repeated caesarean section (ERCS) without labour in low-resource settings. DESIGN: A prospective 4-year observational study. SETTING: Senegal and Mali. SAMPLE: A cohort of 9712 women with one previous caesarean delivery. METHODS: Maternal and perinatal outcomes were compared between 8083 women who underwent a TOL and 1629 women who had an ERCS. Perinatal and maternal outcomes were then stratified according to the presence or absence of risk factors associated with vaginal birth after caesarean section. These outcomes were adjusted on maternal, perinatal and institutional characteristics. MAIN OUTCOME MEASURES: The risks of uterine rupture, maternal complication and perinatal mortality associated with TOL after one previous caesarean as compared with ERCS, RESULTS: The risks of hospital-based maternal complication [adjusted odds ratio (OR) 1.52; 95% CI 1.09-2.13; P = 0.013] and perinatal mortality (adjusted OR 4.53; 95% CI 2.30-9.92; P < 0.001) were significantly higher in women with a TOL compared with women who had an ERCS. However, when restricted to low-risk women, these differences were not significant (adjusted OR 0.90, 95% CI 0.55-1.46, P = 0.68, and adjusted OR 1.13; 95% CI 0.75-1.86; P = 0.53, for each outcome, respectively). Uterine rupture occurred in 25 (0.64%) of 3885 low-risk women compared with 70 (1.66%) of 4198 women with unfavourable risk factors. CONCLUSION: Low-risk women have no increased risk of maternal complications or perinatal mortality compared with women with one or more unfavourable factors. TWEETABLE ABSTRACT: Low-risk women have a lower risk of maternal complications or perinatal mortality compared with high-risk women.

[Why people delay seeking care after a positive HIV test: a qualitative study in Burkina]. / La déperdition entre les postes de dépistage et de prise en charge des personnes vivant avec le VIH-sida au Burkina Faso : une approche qualitative.

UNLABELLED: Delayed care-seeking occurs when a person who received a positive HIV serology test result does not immediately seek medical treatment for this HIV infection. It has serious consequences for patient survival. This study aims to analyze the factors leading to delayed care-seeking in this circumstance. METHODOLOGY: Applying a qualitative approach, we conducted individual interviews and focus groups in 9 community-based organizations of people living with HIV and AIDS in Burkina Faso. In total, 112 people including 70 HIV-positive patients, 30 healthcare providers, and 12 people leaving the laboratory after an HIV test, were interviewed. A thematic content analysis identified the factors that delayed care-seeking. RESULTS: Several factors explain the delay in seeking care. The weight of the negative representations of HIV and AIDS, its impact on those diagnosed with them, and fear of stigmatization (especially by family members) are major factors in delayed care. The poor quality of pre- and post-test counseling is another factor. This study also shows that financial barriers remain important in this delay. CONCLUSION: These findings suggest that earlier HIV care may be possible through efforts to reduce stigma, removal of financial barriers, and improvement of the quality of pre- and post-test counseling in mobile-device strategies and during large-scale testing campaigns.

[Prevalence of albuminuria in children from 5 to 15 years in the town of Kaya (Burkina Faso)]. / Prevalence de l'albuminurie chez des enfants de 5 a 15 ans de la ville de Kaya (Burkina Faso).

INTRODUCTION: Albuminuria, an important marker of kidney damage, is still insufficiently studied in sub-Saharan Africa. The aim of this study is to describe the epidemiology of albuminuria in the town of Kaya in Burkina Faso. METHODS: We conducted a cross-sectional study in the town of Kaya. Simple random sampling was done. It concerned all households with children 5-15 years old of urban area of the town of Kaya. Selected children or their parents were interviewed. Anthropometric measurements and urinary samples were performed. RESULTS: Two hundred six children (113 girls and 93 boys) participated in the study. Albuminuria was found in 18 children whether 8.7% of cases. The mean systolic and diastolic blood pressures of children with albuminuria (107.2 ± 13.6 and 74.7 ± 11.4 mm Hg) were not significantly different from those of children without albuminuria (110.3 ± 14 and 73.1 ± 11.5 mmHg). Sociodemographic factors were not associated with the occurrence of albuminuria in children. DISCUSSION: The prevalence of albuminuria in the strip involved nearly a tenth of children, which is important. CONCLUSION: The results of this study are a first population database of kidney disease in the country. The study should be completed by the identification of cases of persistent albuminuria in this population.

INTRODUCTION: L'albuminurie, important marqueur d'atteinte rénale, est encore insuffisamment étudiée en Afrique subsaharienne. Par la présente étude, nous voulons connaître l'épidémiologie de l'albuminurie dans la ville de Kaya au Burkina Faso. MÉTHODES: Nous avons mené une étude transversale dans la ville de Kaya. Un échantillonnage aléatoire simple a été effectué à partir d'une base de sondage constituée par l'ensemble des ménages ayant des enfants de 5 à 15 ans du milieu urbain de la ville de Kaya. Les enfants sélectionnés ou leurs parents ont été interviewés. Les mesures anthropométriques et des prélèvements urinaires ont été effectués. RÉSULTATS: Deux cent six enfants (113 filles et 93 garçons) ont participé à l'étude. L'albuminurie a été trouvée chez 18 enfants soit 8,7% des cas. Les moyennes des pressions artérielles systolique et diastolique des enfants avec albuminurie (107,2±13,6 et 74,7±11,4 mm Hg) n'étaient pas significativement différentes de celles des enfants sans albuminurie (110,3±14 et 73,1±11,5 mm Hg). Les facteurs sociodémographiques n'étaient pas associés à la survenue de l'albuminurie chez l'enfant. DISCUSSION: La prévalence de l'albuminurie à la bandelette a concerné près d'un dixième des enfants, ce qui est important. CONCLUSION: Les résultats de cette étude constituent pour le pays une première base de données en population sur la maladie rénale. L'étude doit être complétée par l'identification des cas d'albuminurie persistante dans cette population.

[Health staff workload in a context of user fees exemption policy for health care in Burkina Faso and Niger]. / La charge de travail des agents de santé dans un contexte de gratuité des soins au Burkina Faso et au Niger.

User fees exemption policy supported by NGOs in Burkina Faso and Niger resulted in a higher utilization of health services in primary health care facilities. We conducted a survey in 2 health districts in Burkina Faso and Niger in 2011. The study objective was to assess whether the higher utilization associated with the user fees exemption policy, may result in an overload for health staff at the front line in health facilities. The WHO's recommended WISN method was used to compute a ratio of actual/required staff using a comparative study with 4 control facilities and 4 intervention sites where the user fees exemption policy was provided by local NGOs in both countries. Overall, 8 primary health facilities both in Burkina Faso and Niger were involved. In Burkina Faso, the ratio was ≥1 in all facilities both control and intervention, i.e. a sufficient staff in facilities. In Niger, 3 out of the 4 intervention facilities in Keita district were found to have a ratio ≤1, i.e. understaffed. In the 4 control facilities, the staff was sufficient with a ratio ≥1. In Burkina Faso, the actual number of staff in facilities appeared enough to face the higher utilization of health services that may follow the user fees exemption policy supported by local NGOs unlike Niger where we found that the actual number of staff was insufficient to face a possible higher utilization resulting from the same policy in intervention facilities.

[Hepatitis B vaccination status and associated factors among health care workers in Burkina Faso]. / Statut vaccinal contre le virus de l'hépatite B et facteurs associés parmi le personnel de santé au Burkina Faso.

INTRODUCTION: The purpose of this study was to evaluate anti-HBV vaccination status and factors associated with vaccination against HBV among health care workers in Burkina Faso. METHODS: In August and September 2010, we conducted a cross-sectional study on health care workers having practiced in a health facility for at least three months. Data were collected using a self-administered questionnaire. Blood samples were collected from consenting participants to search for anti-HBs antibodies, markers of immune status. RESULTS: A total of 452 health care workers were surveyed. Among the respondents, 47.7 % had received at least one dose of HBV vaccine. The full immunization coverage against HBV was estimated at 10.9 %. Factors associated with vaccination status were age (p = 0.005), occupation (p = 0.005), and seniority in the profession (p = 0.001). Anti-HBs was found in 61.6 % of respondents, with significant differences (p = 0.01) between subjects who received at least one dose of vaccine (76.7 %) and those who reported never having been vaccinated (50.3 %). CONCLUSION: Hepatitis B vaccination coverage among health care workers is low in Burkina Faso, hence the need to promote vaccination against HBV in health facilities.

[Self-disclosure of a HIV-positive serostatus: factors favoring disclosure and consequences for persons living with HIV/AIDS in Burkina Faso]. / Partage de l'information sur le statut sérologique VIH positif : facteurs associés et conséquences pour les personnes vivant avec le VIH/sida au Burkina Faso.

UNLABELLED: Disclosure of HIV-serostatus remains a way to avoid sexual transmission of HIV because it allows partners to take the necessary protective measures, e.g. use of condoms. Disclosure is nevertheless difficult due to the discrimination associated with HIV. The objective of this study was to analyze factors leading to self-disclosure of HIV-positive status within a sample of persons of both sexes attending different healthcare services in Burkina Faso. METHODOLOGY: Cross-sectional study conducted by interviewing 740 patients in 26 healthcare services. Univariate (Chi(2) test) and multivariate (logistic regression) analyses were performed. The significance level was 5%. Qualitative data on factors associated with self-disclosure of HIV-positive status were analyzed. RESULTS: The majority of the patients (81.4%) informed at least one person who was very often a close relative (descendant, ascendant and sibling) or the partner. At multivariate analysis, HIV-serostatus was associated with using antiretroviral treatment, (OR=0.40, 95% CI: 0.3-0.7, P<0.001), known HIV-serostatus for at least one year (OR=0.6; 95% CI: 0.4-0.9), living in couple (2.3; 95% CI: 1.4-3.8). CONCLUSION: In a context limiting HIV testing due to the fear of social stigma, these results appear to be in favor of the Voluntary Counseling Testing model with a focus on the couple and/or families.

Determinants and causes of mortality in HIV-infected patients receiving antiretroviral therapy in Burkina Faso: a five-year retrospective cohort study.

In this study, we investigated the causes of death and the factors associated with mortality in a cohort of patients receiving highly active antiretroviral therapy (HAART) in Burkina Faso, an African country with limited resources. This retrospective cohort study included patients aged 15 years and older who started HAART for the first time between January 2003 and December 2008 in 14 health districts. We used survival analyses, including the Kaplan-Meier method, to examine potential predictors of death and two Cox proportional hazard models to estimate hazard ratios for death, first from baseline covariates and then from time-dependent covariates. A total of 6641 patients initiated HAART during this period; of these, 5608 were included in the analysis. By the end of the study period, 4310 of those patients were still receiving HAART, 690 had died, 207 had been transferred and 401 were lost to follow-up. The median duration of follow-up was 23.2 months [interquartile range (IQR): 12.4-36.9], and the overall incidence of mortality was 6 per 100 person-years. The clinical stage, CD4 count, body mass index (BMI), haemoglobin level, HAART regimen, gender, age, profession and year of initiation were the primary risk factors associated with death. In the multivariate analysis, BMI, clinical stage, treatment regimen and CD4 count remained significantly associated with death. The most frequent causes of death were wasting syndrome, tuberculosis and anaemia. This result highlights the already advanced stage of immunodeficiency among patients in Burkina Faso when they start HAART. Testing patients for HIV and starting antiretroviral therapy earlier are necessary to further reduce the mortality of patients living with HIV. This study provides a solid evidence base with which future evaluations of HAART in Burkina Faso can be compared.

Short-term and long-term outcomes following DOTS-based treatment for tuberculosis patients in Burkina Faso.

A cross-sectional study was initiated in Burkina Faso's National Tuberculosis Programme to confirm successful treatment results within 3 months of completing treatment and to characterise longer-term outcomes 12-24 months after completion. The sample (n = 278) included 91 patients who had completed treatment 0-3 months earlier ('short-term' sample) and 187 patients who had completed treatment 12-24 months earlier ('long-term' sample). All sputum specimens from the short-term sample were confirmed as negative. In the long-term sample, among 154 patients with available information, 13 (8%) had died, 24 were not traced, and 117 (76%) were interviewed and had sputum examinations, of which 2 (2%) were smear-positive. Recording of successful treatment outcomes shows good validity.

Une étude transversale a été conduite sur le Programme National Tuberculose du Burkina Faso afin de confirmer les résultats du traitement avec succès dans les 3 mois après l'achèvement du traitement et caractériser les résultats à long terme du traitement 12­24 mois après l'achèvement du traitement. L'échantillon (n = 278) comptait 91 patients ayant terminé le traitement 0­3 mois plus tôt (échantillon du court terme) et 187 patients ayant terminé le traitement 12­24 mois avant l'enquête (échantillon du long terme). Tous les frottis de crachat de l'échantillon du court terme ont été confirmés négatifs. Dans l'échantillon du long terme, parmi 154 patients dont les informations étaient disponibles, 13 (8%) étaient décédés, 24 n'ont pas été interviewés et 117 (76%) ont été interviewés et subi des examens de crachats, révélant 2 patients (2%) à frottis positif. L'enregistrement des résultats du traitement avec succès montre une bonne validité.

En el marco del Programa Nacional contra la Tuberculosis de Burkina Faso se llevó a cabo un estudio transversal, con el fin de confirmar los resultados de tratamiento exitoso, hasta 3 meses después de haber completado la pauta terapéutica y de caracterizar los desenlaces clínicos a largo plazo, 12 meses y 24 meses después de la compleción. Conformaron la muestra (n = 278) 91 pacientes que habían completado el tratamiento como máximo 3 meses antes, en el subgrupo 'de corto plazo', y 187 pacientes que habían completado el tratamiento entre 12 y 24 meses antes, en el subgrupo 'de largo plazo'. En la rama de corto plazo se confirmó la negatividad de todas las muestras de esputo. En el subgrupo de largo plazo se obtuvo información acerca de 154 pacientes, de los cuales 13 (8%) habían fallecido, 24 no participaron a los entrevistas y 117 (76%) respondieron entrevistas y aportaron muestras de esputo; de estos pacientes examinados, dos pacientes (2%) presentaron una baciloscopia positiva. Se confirmó la validez del registro de los desenlaces terapéuticos favorables.

User fees and access to ARV treatment for persons living with HIV/AIDS: implementation and challenges in Burkina Faso, a limited-resource country.

Access to antiretroviral (ARV) treatment remains a crucial problem for patients living with HIV/AIDS (PLWHA) in limited-resources countries. Some African countries have adopted the principle of providing ARV free of charge, but Burkina Faso opted for a direct out-of-pocket payment at the point of care delivery, with subsidized payments and mechanisms for the poorest populations to receive these services free of charge. Our objectives were to determine the proportion of PLWHA who pay for ARV and to identify the factors associated with ARV access in Burkina Faso. A cross-sectional study was performed in 13 public health facilities, 10 Nongovernmental Organizations and association health facilities, and three faith-based health facilities. In each facility, 20 outpatients receiving ARV were interviewed during a routine clinic visit. A multivariate analysis by logistic regression was performed. Among the expected 520 patients receiving ARV, 499 (96.0%) were surveyed. The majority of patients (79%) did not pay for their ARV treatment, thereby limiting cost recovery from patient payments. In a multivariate analysis, level of education and income were associated with free access to ARV. Patients with no education more frequently received free ARV than those who had received some level of education (OR 2.7, 95% CI [1.3-5.6]). Patients without any income or with less than US$10 per month were more likely to receive free ARV (OR 2.6 [95% CI 1.3-5.2]) than those who earned more than US$10 per month. However, 16% of patients without any income and 21% of those without employment paid for ARV, and the costs of drugs for opportunistic infections, food, and transport remained a burden for 85%, 91%, and 74%, respectively, of those who did not pay for ARV. Free access to a minimum care package for every PLWHA would enhance access to ARV.

Mycobacterium tuberculosis drug-resistance in previously treated patients in Ouagadougou, Burkina Faso.

BACKGROUND: Tuberculosis drug-resistance becomes common in sub-Saharan Africa; however, very few data are available in Burkina Faso. The aim of this study is to assess the acquired resistance of Mycobacterium tuberculosis complex strains identified in TB patients to four first-line drugs in Ouagadougou. METHODS: One hundred and ten (110) pulmonary tuberculosis patients with acid-fast bacilli-positive sputum and in situation of failure, relapse, or treatment abandonment were included in the study. Ninety six strains, including 92 (95.8%) M. tuberculosis and 4 (4.2%) M. africanum, were isolated from the sputum samples of these patients. Their drug susceptibility testing was performed using the proportion method. The first-line drugs tested were isoniazid (INH), streptomycin (STR), ethambutol (EMB), and rifampicin (RIF). RESULTS: The overall drug-resistance rate of M. tuberculosis was 67.4% (n=60), including 3.4% to one drug, 18% to two, 10.1% to three, and 35.9% to four drugs. The resistance to INH, RIF, EMB, and STR were 67.4%, 51.7%, 50.6%, and 44.9%, respectively. Two strains of M. africanum were resistant to all drugs. Forty-six (51.7%) strains were multidrug-resistant (resistant to at least INH and RIF). CONCLUSIONS: In previously treated patients, the level of resistance of M. tuberculosis complex to commonly used anti-tuberculosis drugs is very high in Ouagadougou. Our results showed that multidrug-resistant tuberculosis could be a public health problem in Burkina Faso.

Drug Resistance of Mycobacterium tuberculosis Complex among Newly Diagnosed Tuberculosis Cases in Burkina Faso

BACKGROUND:In Burkina Faso; there is no recent data about the level of drug resistance in Mycobacterium tuberculosis strains among newly diagnosed tuberculosis cases. OBJECTIVE: To provide an update of the primary drug resistance of mycobacterium tuberculosis among patients in Burkina faso. METHODS: Mycobacterium strains were identified in 323 newly diagnosed tuberculosis patients between April 2005 and September 2006; and their susceptibility to isoniazid; rifampicin; streptomycin; and ethambutol was determined according to the proportions method. Among these patients; 243 accepted voluntarily to be tested for antibodies to HIV. RESULTS: The age range of the patients was 11 and 75 years and included 221 (68.4) males and 102 (21.6) females. The isolates included 314 (97.2) M. tuberculosis; eight (0.3) M. africanum and one M. bovis. Thirty-nine (12.4) of the M. tuberculosis strains were resistant; with 7.3resistant to one drug; 2.9to two drugs; 0.3to three drugs and 1.9to four drugs. In total 3.2of the isolates were multidrug-resistant (MDR). One isolate of M. africanum was resistant to all drugs while the single strain of M. bovis was sensitive to all the drugs. Among the 243 patients tested for HIV 77 were positive. However; there was no relationship between drug resistance and gender; age group or HIV serostatus of the patients. CONCLUSION: The resistance rate of M. tuberculosis strains to all the four drugs tested (12.4) and the rate of MDR (3.2) are high. These results demand an increased effort by the National Tuberculosis Program to limit the spread of MDR strains of tuberculosis

Mycobacterium tuberculosis Drug-Resistance in Previously Treated Patients in Ouagadougou; Burkina Faso

Background: Tuberculosis drug-resistance becomes common in sub-Saharan Africa; however; very few data are available in Burkina Faso. The aim of this study is to assess the acquired resistance of Mycobacterium tuberculosis complex strains identified in TB patients to four first-line drugs in Ouagadougou. Methods: One hundred and ten (110) pulmonary tuberculosis patients with acid-fast bacilli-positive sputum and in situation of failure; relapse; or treatment abandonment were included in the study. Ninety six strains; including 92 (95.8) M. tuberculosis and 4 (4.2) M. africanum; were isolated from the sputum samples of these patients. Their drug susceptibility testing was performed using the proportion method. The first-line drugs tested were isoniazid (INH); streptomycin (STR); ethambutol (EMB); and rifampicin (RIF). Results: The overall drug-resistance rate of M. tuberculosis was 67.4(n=60); including 3.4to one drug; 18to two; 10.1to three; and 35.9to four drugs. The resistance to INH; RIF; EMB; and STR were 67.4; 51.7; 50.6; and 44.9; respectively. Two strains of M. africanum were resistant to all drugs. Forty-six (51.7) strains were multidrug-resistant (resistant to at least INH and RIF). Conclusions: In previously treated patients; the level of resistance of M. tuberculosis complex to commonly used anti-tuberculosis drugs is very high in Ouagadougou. Our results showed that multidrug-resistant tuberculosis could be a public health problem in Burkina Faso

[Evaluation of the acid-fast bacilli gradations before and after treatment of the expectorations by sodium hypochlorite [corrected] in the tuberculosis diagnosis]. / Evaluation de la densité bacillaire avant et après traitement des expectorations par l'hypochlorite de sodium dans le diagnostic de la tuberculose.

To assess the impact of the sputum samples treatment by sodium hypochloride (NaOCl) 5% on the acid-fast bacilli (AFB) gradations in the tuberculosis diagnosis, 516 sputum samples were collected in 244 patients. The sputum smears made before and after expectorations treatment with NaOCl 5%, were stained by Ziehl-Neelsen hot method. The values obtained from the two microscopic readings were compared by using the chi2 test of McNemar. The statistical significance was set at p < 0.05. The results obtained before using NaOCl 5% showed that 357 samples were negative, while 41 were AFB scanty (gradation 1-9), 28, 40 and 50 were positive 1+, 2+ and 3+. After treatment, among 357 AFB negative expectorations, 14 (3.9%) were AFB-positive, while the AFB gradation increased for 77 (48.4%) in the 159 positive specimens. The two microscopic readings differ significantly (p = 0.001). The application of the process on a routine basis in the laboratory will require a reorganization of the tasks in order to give back the results to the patients in time. It is necessary to take into account the aspect of the samples.

Drug resistance of Mycobacterium tuberculosis complex among newly diagnosed tuberculosis cases in Burkina Faso.

BACKGROUND: In Burkina Faso, there is no recent data about the level of drug resistance in Mycobacterium tuberculosis strains among newly diagnosed tuberculosis cases. OBJECTIVE: To provide an update of the primary drug resistance of mycobacterium tuberculosis among patients in Burkina faso. METHODS: Mycobacterium strains were identified in 323 newly diagnosed tuberculosis patients between April 2005 and September 2006, and their susceptibility to isoniazid, rifampicin, streptomycin, and ethambutol was determined according to the proportions method. Among these patients, 243 accepted voluntarily to be tested for antibodies to HIV. RESULTS: The age range of the patients was 11 and 75 years and included 221 (68.4%) males and 102 (21.6%) females. The isolates included 314 (97.2%) M. tuberculosis, eight (0.3%) M. africanum and one M. bovis. Thirty-nine (12.4%) of the M. tuberculosis strains were resistant, with 7.3% resistant to one drug, 2.9% to two drugs, 0.3% to three drugs and 1.9% to four drugs. In total 3.2% of the isolates were multidrug-resistant (MDR). One isolate of M. africanum was resistant to all drugs while the single strain of M. bovis was sensitive to all the drugs. Among the 243 patients tested for HIV 77 were positive. However, there was no relationship between drug resistance and gender, age group or HIV serostatus of the patients. CONCLUSION: The resistance rate of M. tuberculosis strains to all the four drugs tested (12.4%) and the rate of MDR (3.2%) are high. These results demand an increased effort by the National Tuberculosis Program to limit the spread of MDR strains of tuberculosis.

Insulin Growth Factor-I in Protein-Energy Malnutrition during Rehabilitation in Two Nutritional Rehabilitation Centres in Burkina Faso.

Objective. To investigate the relationship between IGF-I and the nutritional status of West-African children hospitalised for nutritional rehabilitation. Patients and methods. A cohort study was performed in two centres for nutritional rehabilitation and education (CREN) in Burkina Faso. Children were followed and the anthropometric data as well as the capillary blood samples were taken on the 7th and on the 14th days after their admission. IGF-I levels were determined from dried blood spots on filter paper on IGF-I RIA, after separation of the IGF-I from its binding proteins, using Sep-Pak chromatography. Results. A total of 59 children was included in the cohort. The IGF-I mean geometric values (SD) were 6.3 (1.4) mug/L on admission, 8.6 (1.8) mug/L at day 7 and 13.6 (2.0) mug/L at day 14. The differences between these values were statistically significant (P < .001). There is a significant correlation between the changes of IGF-I with the change of weight for height Z-score (P = .01). Conclusion. These results suggest that IGF-I can be considered as a potential marker to follow the nutritional status of children admitted in hospital for protein and energy malnutrition.

Reference values of IGF-I in children from birth to 5 years of age, in Burkina Faso, using blood samples on filter paper.

OBJECTIVES: The aims of this study were to validate the use of filter paper to measure insulin-like growth factor-I (IGF-I) and to establish normal levels of IGF-I in children appearing healthy, from birth to 5 years of age in an African population. METHODS: We determined IGF-I from blood collected on filter paper. We validated this method by comparing the IGF-I values from dried blood spots on filter paper (kept at 4 degrees C and ambient temperature) and from serum among 13 children under 5. IGF-I were measured by the classical IGF-I RIA, after separation of the IGF-I from its binding proteins, using Sep-Pak chromatography. To establish normal levels of IGF-I, we conducted a cross-sectional study and collected blood samples with filter paper among 360 children in Ouagadougou (Burkina Faso). RESULTS: IGF-I determined from dried blood spots on filter paper were in good agreement with IGF-I levels obtained from blood serum, whether the filter papers were kept at 4 degrees C or at ambient temperature. The results of IGF-I-levels in apparently healthy children showed that geometric mean IGF-I ranged from 27 microg/l in boys younger than five months to 31 microg/l in 5-year-old boys. In girls, mean IGF-I ranged from 29 microg/l for girls younger than five months to 45 microg/l at the age of 5. From birth to 24 months, IGF-I decreased by 0.32+/-0.08 microg/l/month in boys and by 0.27+/-0.06 microg/l/month in girls and these decreases were not significantly different (p=0.95). After the age of 24 months, there was an increase in IGF-I of 4.9+/-1.3 microg/l/year in boys and of 8.4+/-0.8 microg/l/year in girls. This increase was indeed significantly different (p<0.001). CONCLUSIONS: Reference values of IGF-I for African boys and girls were determined. They will be used for endocrine evaluations and nutritional monitoring.