Knowledge, Attitudes, and Management of General Practitioners of the Hospital Districts of Ouagadougou about Migraine (Burkina Faso).

BACKGROUND: Migraine is a common neurological disorder characterized by severe headache attacks that may be debilitating. The objective of this study is to determine the knowledge and attitudes of general practitioners in the hospital districts of the city of Ouagadougou on migraine. METHODS: This cross-sectional study was carried out in hospital districts of Ouagadougou. The data were collected during three months from February 1 to April 30, 2020. RESULTS: The study included 116 general practitioners. Thirteen percent of them were suffering from migraine. All participants had previous experience with migraine diagnosis before the survey. Eighty percent of general practitioners had a good level of knowledge of ICDH-3 criteria (knowing 6-7 criteria). The most widely recognized IHS criteria were pulsatility quality (93.1%), photophobia or sonophobia (80.2%), and mild-to-moderate intensity (80%). Ninety-five (81.9%) general practitioners rarely ordered brain imaging. The most common acute treatments were nonsteroidal inflammatory drug (39.47%), paracetamol (44.74%), and derivate of ergot (3.95%). The most common preventive treatments were amitriptyline (27.8%), derivate of ergot (18.9%), and NSAID (16.7%). The majority of general practitioners (56.9%) have referred headache patients to a colleague or specialist. CONCLUSIONS: Our study found that diagnostic criteria and acute treatment of migraine were well known by the majority of general practitioners, in contrast of preventive treatment.

[Diabetes mellitus and high blood pressure over risk in HIV-infected people followed at Souro Sanou University Hospital Day Hospital, Bobo-Dioulasso 2018]. / Sur-risque de diabète sucré et d'hypertension artérielle chez les personnes infectées par le VIH suivies à l'hôpital de jour du CHU Souro Sanou, Bobo-Dioulasso, Burkina Faso, 2018.

BACKGROUND: Non-communicable diseases (NCDs) represent the leading causes of death worldwide. HIV also increases the risk of developing NCDs including diabetes mellitus and hypertension. METHODS: A cross-sectional study, based on an analysis of the cohort database of the day hospital of the Souro Sanou teaching hospital in Bobo-Dioulasso (Burkina Faso). Diabetes mellitus was defined by the undergoing of anti-diabetic treatment or two successive measurements of fasting blood sugar above 7mmol/l and high blood pressure by the undergoing of antihypertensive treatment or two successive measurements of blood pressure above 140/90mmHg. Comparison of the frequency of diabetes and hypertension in the people living with HIV/AIDS (PLWHA) population on antiretroviral therapy (ART) with that of the general population of Burkina Faso was made by indirect standardization according to age and gender. RESULTS: A total of 4259 patients including 3148 women (73.9%) were included in this study. The median age of the patients was 45 years (IQR: 38-52); the median body mass index (BMI) was 19.6kg/m2 (IQR: 15.4 - 22.7) and 48.3% of patients had a BMI≥25kg/m2. The median CD4 count was 590 cells/mm3 (IQR: 417-785). The median ART duration was 8.2 years (IQR: 4.7-11.2). The majority of patients (82.9%) were on treatment combinations consisting in 2 INTI+1 NNRTI. Prevalence of hypertension was 39.8%; it was statistically higher in men than in women (45.8% versus 37.8%). Prevalence of hypertension was 87.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population. Prevalence of diabetes mellitus was 7.3%. Diabetes mellitus was more common in men than in women (10.1% versus 6.3%; P<10-3). Prevalence of diabetes mellitus was 36.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population. CONCLUSION: Prevalence of diabetes mellitus and hypertension was higher among PLHWA undergoing ART than in the general population. Care for the PLHWA population should more widely include NCD treatment.

Depression and HIV: Epidemiological and clinical aspects at the Bamako University Hospital (Mali).

Depression plays an important role in clinical worsening, morbidity and mortality related to HIV/AIDS. To describe the epidemiological and clinical aspects of depressive disorders in people with HIV in Mali. This prospective study took place in the department of psychiatry and infectious diseases at the Bamako University Hospital from July 2004 through October, 2005 and included all HIV-positive antiretroviral-naive patients with depression, diagnosed according to ICD-10 criteria. The study included 84 HIV-positive patients with a depressive disorder; our total population of HIV-positive patients was 316 during the study period, for a prevalence rate of 26.7 % in this population. The mean age of these depressed patients was 36.7 ± 8.5 years (range: 20-57); 63.1% were women, 47.7% had not attended or at least not completed primary school; 66.6% were married, and 92.9% lived in urban areas. Sad mood, anxiety, and refusal to eat were reported by 27.7%, 10.9%, and 9.1%, respectively, as a reason for consultation. Depression was associated with an anxiety disorder in 33 (39.3%) and a delusional disorder in 14 (16.7%). Severe depression was associated with low BMI and at a CD4 count <200 cells/mm3. Depression was found at a high frequency in our study. Its detection, operational research about it, and improved management are recommended to improve the health of people living with HIV.

[Pathologies in internal medicine: concerning Burkina Faso]. / Les pathologies en medicine interne: Cas du Burkina Faso.

The objective of our study was to determining the epidemiological, diagnosis and evolutionary aspects of pathologies admitted for care in the service of internal medicine between January 1, 2007 to December 31, 2009. MATERIALS AND METHODS: A cross-sectional retrospective and descriptive study was conducted over three years, from the review of medical records of patients admitted to the Department of internal medicine of the Souro Sanou university hospital. RESULTS: Our study concerned 5362 patients. The average age had been 43.10 years old ±12.2. The sex ratio was 1.16: 1. The majority of our patients were from a low socio-economic background. HIV/AIDS had been the most frequent condition with the rate of admission of 24%, followed by cerebral vascular accidents with 8.6%. The recovery rate was of 53.9% and an overall mortality of 33.3%. This mortality had been dominated by infectious and parasitic diseases including HIV/AIDS with a rate of 27.8% of the overall mortality. Early mortality remains high with a rate of 37.4%. CONCLUSION: In spite of the epidemiological transition marked by the emergence of the cardio-metabolic diseases in the countries of the South, infection by HIV always constitutes the main pathology met in the Department of internal medicine of the Souro Sanou university hospital, it is responsible for a high mortality cause of mortality. The emphasis must be placed on early treatment and especially the communication for the change of behavior aiming at an early screening of the HIV. This would allow to reduce effectively the AIDS-related lethality to internal medicine.

L'objectif de notre étude était de déterminer les aspects épidémiologique, diagnostique et évolutif des pathologies prises en charge en hospitalisation dans le service de médecine interne du 1er janvier 2007 au 31 décembre 2009. MÉTHODES: nous avons mené une étude transversale rétrospective à visée descriptive sur trois ans, à partir de revue de dossiers médicaux de patients admis dans le service de médecine interne du Centre Hospitalier Universitaire Souro Sanou (CHU SS). RÉSULTATS: étaient concernés 5362 patients. L'âge moyen était de 43,10 ans ± 12,2, avec un sex- ratio de 1,16 :1. La majorité de nos patients avaient un faible niveau de vie socio-économique. L'infection par le VIH/SIDA était l'affection la plus fréquente avec un taux d'admission de 24%, suivi des AVC avec 8,6%. Le taux de guérison était de 53,9% et celui de la mortalité globale de 33,3%. Cette mortalité était dominée par maladies infectieuses notamment l'infection par le VIH/SIDA avec un taux de 27,8%. La mortalité précoce était de 37,4% (< 3 jours). CONCLUSION: malgré la transition épidémiologique marquée par l'émergence des maladies cardiométaboliques dans les pays du sud, l'infection par le VIH constitue toujours la principale pathologie rencontrée dans le service de médecine interne du CHUSS, elle est responsable d'une mortalité élevée. L'accent doit être mis sur le traitement précoce et surtout la communication pour le changement de comportement visant un dépistage précoce du VIH. Ceci permettrait de réduire efficacement la létalité li&e au sidia en médecine interne.

[Blood exposure accidents: Knowledge, attitudes and practices of nursing and midwifery students at the Bobo-Dioulasso teaching hospital (Burkina Faso)]. / Connaissances, attitudes et pratiques des élèves des formations paramédicales face aux accidents d'exposition au sang au CHU Sanou-Sourô de Bobo-Dioulasso (Burkina Faso).

Blood exposure accidents are the source of major risks of contamination of healthcare personnel. The objective of this study was to describe the knowledge of standard precautions, and the attitudes and practices of nursing and midwifery students in relation to this accidental exposure. This cross-sectional survey, conducted in November 2011, was based on voluntary anonymous questionnaires completed by students working in the medical ward of the Bobo-Dioulasso teaching hospital. Of the 275 students asked to participate, 219 (92.8%) completed the questionnaire: 138 (63,0%) were student nurses and 81 (37.0%) student midwives. Their mean age was 27.9 ± 5 years. Among them, 64 (29.1%) acknowledged accidental exposure to blood during treatment performed as part of their hospital work. Only 30 of these 64 cases were reported at the time. The standard precautions for the prevention of these accidents were known to 131 students (59.8%); 58.4% always wore gloves for invasive procedures; 74.9% reported that the syringe container was "always" or "often" used. The needles used were "always" or "often" recapped before disposal in only 39.1% of cases. Only 11.0% were fully vaccinated against hepatitis B. Blood exposure accidents were not uncommon among these students and their knowledge of the standard precautions and actions to take in case of an accident is insufficient. These data show the need for further training and awareness campaigns to improve these hospital practices.

Occurrence of natural Anopheles arabiensis swarms in an urban area of Bobo-Dioulasso City, Burkina Faso, West Africa.

The swarming behaviour of natural populations of Anopheles arabiensis was investigated by conducting transect surveys on 10 consecutive days, around dusk, from March to April and from September to October 2012 in Dioulassoba, a district of Bobo-Dioulasso city in Burkina Faso (West Africa). Swarms were observed outside, around identified larval breeding sites on the banks of the Houet River, as well as in the open-air courtyards found at the centre of many homes in the region. Swarms were found to occur in open sunlit spaces, mostly located above physical or visual cues somehow visually distinct from the surrounding area. Overall 67 and 78 swarms were observed, respectively, during the dry season (March-April) and the rainy season (September-October) of 2012, between 1.5m and 4.5m above the ground at their centre. 964 mosquitoes were collected and analysed from dry season swarms, of which most were male, and all were An. arabiensis, as were the few resting mosquitoes collected indoors. Larvae collected from breeding sites found on the banks of the Houet River mostly consisted of An. arabiensis and only a minority of Anopheles coluzzii (formerly identified as An. gambiae M form). Of 1694 mosquitoes analysed from 78 swarms in the rainy season collections, a few An. gambiae (formerly known as An. gambiae S form) males were identified, and the remainders were An. arabiensis. The majority of larvae collected during the wet season from the same breeding sites were identified as An. arabiensis followed by An. coluzzii and An. gambiae. The same pattern of species composition was observed in resting mosquitoes, though the proportion of An. arabiensis was less overwhelming. These data support the conclusion that An. arabiensis is the most prevalent species in this area, though the difference in species composition when using different population sampling techniques is noteworthy. Further studies are required for more detailed investigations of male dispersal, feeding behaviour and mating patterns in this urban setting.

[Retrospective study of cases of neuromeningeal cryptococcosis at the University Hospital of Bobo Dioulasso since accessibility to antiretroviral in Burkina Faso]. / Étude rétrospective des cas de cryptococcose neuroméningée au centre hospitalier universitaire de Bobo Dioulasso depuis l'accessibilité aux antirétroviraux au Burkina Faso.

AIMS OF THE STUDY: To study the prevalence of neuromeningeal cryptococcosis since the availability of antiretroviral drugs and to determine the epidemiological profiles, clinical and biological treatment of neuromeningeal cryptococcosis cases diagnosed in the service of parasitology and mycology of university hospital center of Bobo-Dioulasso from 2002 to 2010. PATIENTS, MATERIAL AND METHODS: We included all patients diagnosed with neuromeningeal cryptococcosis for which the presence of the fungi was observed on microscopic examination of cerebrospinal fluid after staining with Indian ink. Data were collected from the registers of the clinical service and from the laboratory of the university hospital center of Bobo Dioulasso. RESULTS: The prevalence of neuromeningeal cryptococcosis was 1.8% (61/5129). A decrease in the prevalence was observed from 2002 to 2010 (3.1%, to 0.2%). This decrease occurred even though the number of patients treated with antiretroviral drugs increase. Headaches were the predominant clinical signs (81.9%). The CD4 median count was 56/mm(3). All patients were successfully treated with fluconazole in relay to amphotericin B intravenous. Lethality rate is 27.8%. CONCLUSION: The overall prevalence of 1.8% of neuromeningeal cryptococcosis observed in this study was lower than that in previous studies in the same laboratory in 2001. The arrival of antiretroviral drugs could have contributed to the decline in the prevalence of neuromeningeal cryptococcosis in this study.

Prevalence case-control study of epilepsy in three Burkina Faso villages.

PURPOSE: To estimate the association between the prevalence of epilepsy and potential risk factors in three Burkina Faso villages. METHODS: Three villages were selected based on local reports of high numbers of epilepsy cases and pig-rearing practices. One person aged 7 or older was selected at random from all households of selected concessions for epilepsy screening and blood sampling. Epilepsy was confirmed by a physician using the ILAE definition. The cross-sectional associations between epilepsy and selected factors and seroresponse to the antigens of Taenia solium were estimated using a Bayesian hierarchical logistic regression. Prevalence odds ratios (POR) and their 95% Bayesian Credible Intervals (95% BCI) were estimated. RESULTS: Of 888 individuals interviewed, 39 of 70 screened positive were confirmed to have epilepsy for a lifetime prevalence of 4.5% (95% CI: 3.3; 6.0). The prevalence of epilepsy was associated with a positive reaction to cysticercosis Ag-ELISA serology (POR = 3.1, 95% BCI = 1.0; 8.3), past pork consumption (POR = 9.7, 95% BCI = 2.5; 37.9), and being salaried or a trader compared to a farmer or housewife (POR = 2.9, 95% BCI = 1.2; 6.4). DISCUSSION: Several factors were associated with prevalent epilepsy, with Ag-ELISA suggesting the presence of neurocysticercosis. The association between epilepsy and some occupations may reflect differences in local attitudes toward epilepsy and should be further explored.

[Acute bacterial meningitis with soluble antigen detected by latex particle agglutination tests at the Sourô-Sanou University Hospital of Bobo-Dioulasso (Burkina Faso)]. / Méningites bactériennes aiguës à recherche d'antigène soluble positive au CHU de Sourô-Sanou de Bobo-Dioulasso (Burkina Faso)

INTRODUCTION: Acute bacterial meningitis constitutes a major public health problem in Burkina Faso, in part because of its high lethality rate, estimated in 2004 at 17.5%. Failure to confirm suspected cases of meningitis results in overestimating reported cases and incorrectly treating false positives. The latex particle agglutination test is a diagnostic alternative that overcomes these limitations. OBJECTIVE: Determine the bacteriological and therapeutic profile as well as the course of cases of acute meningitis confirmed by the latex agglutination test at Sourô-Sanou University Hospital. METHODS: This prospective longitudinal study took place over a one-year period (2008 to 2009). Data were collected from clinical and laboratory records. The diagnosis of meningitis was confirmed by testing for specific soluble antigens in the spinal fluid. We used the Pastorex(™) Meningitis Kit for that purpose. The threshold of significance selected for our study was 0.05. RESULTS: In all, 457 samples of spinal fluid from patients with suspected acute bacterial meningitis were analyzed and the latex test was performed in 438 of these samples: 154 (35.2%) were positive. The average age of our cases confirmed by the latex test was 13.2 ± 4.2 years old. This test confirmed more cases than any other method of identification. The therapeutic strategy used from one to four treatment agents. Streptococcus pneumoniae was the most virulent and the most lethal pathogen, with a 64.7% lethality rate. CONCLUSION: The earliness of the consultation and the treatment of the bacterial meningitis seem to have a positive effect on the course of disease.

Interet des donnees cliniques dans le diagnostic de la meningite bacterienne aigue : experience du Burkina-Faso

La meningite bacterienne aigue (MBA) est une urgence medicale par ses complications potentielles; elle justifie un diagnostic et traitement precoces. La strategie nationale au Burkina Faso recommande une reference de tous les cas suspects au Centre Hospitalier Universitaire Souro Sanou; habilete a confirmer le diagnostic par analyse du liquide cephalo-rachidien. Methodes. Les auteurs; a travers une etude transversale et analytique; ont recherche les donnees epidemiocliniques des cas suspects referes; en vue de valider l'approche syndromique; dans l'orientation dudiagnostic de la meningite. La specificite; la sensibilite; et la valeur predictive positive des donnees cliniques ont ete determinees; par rapport a la confirmation apportee par la culture du LCR; selon les recommandations de STARD et de l'OMS. Resultats. Au total; 377 patients ont ete enregistres; soit un taux de 2;4; par rapport a l'ensemble des malades admis pendant la periode d'etude. La fievre (81;6) et la raideur de nuque (72;9) ont ete les observations cliniques les plus frequentes ; le bombement de la fontanelle (31;6) et les convulsions ( 23;1); etant l'apanage des patients pediatriques. La culture du liquide cephalorachidien (LCR) a ete positive chez 207 sujets (54;9) avec tableau clinique suggestif; et chez 97 patients sans triade symptomatique classique; meme si la fievre etait presente dans tous les cas (T. 38C). La specificite et la valeur predictive positive du tableau clinique etaient de 100dans la confirmation du diagnostic par la culture. Conclusion. Cette enquete montre la pertinence de l'examen clinique dans l'approche diagnostique de la MBA au niveau des centres de sante; tout en relevant le role determinant de la culture du LCR dans la confirmation de la pathologie

[Meningitis epidemic: assessment of surveillance and treatment of cases in the health centers of a Burkina Faso district]. / Épidémie de méningite: évaluation de la surveillance et du traitement des cas dans les formations sanitaires d'un district du Burkina Faso.

Meningococcal meningitis remains a periodical threat in the African meningitis belt. The countries concerned, such as Burkina Faso, provided guidelines for its surveillance, diagnosis, treatment, and prevention during outbreaks. The objective of this study is to assess the quality of the surveillance system and case management during an outbreak in Fada N'Gourma district. A retrospective study of the meningitis outbreak in 2007 was conducted by literature review and interviews of health caretakers across 27 health centers (CSPS) and three units in the regional hospital in the district.We reported all data available about surveillance and case management, and then we compared it with the guidelines of the Ministry of Health. The case definition and notification forms were available in all centers and units. During the outbreak, 861 cases were recorded, but only 89% was notified at the upper level and 87% of notification forms were available. The age is marked on all the forms, while the interval between the onset of symptoms and consultation is noted only in 90.7%. The forms were distributed weekly at the district level. Cerebrospinal fluid (CSF) Gram coloration was performed for a limited number of cases (150/349 samples, 42.9%); it showed Gram-negative diplococcus in 86%. Culture was performed for a limited number of patients (7 cases). According to the results of a central level laboratory study, the outbreak was due to Group A Neisseria meningitidis. The case management guidelines were available in all the centers and units which were supervised during the outbreak. Anti-biotherapy was appropriate in 93.6% of the cases. A shortage of antibiotics (free prepositioning) was observed in 7 centers (23.3%). The mortality rate was 3.5%. This assessment shows an under-notification of cases, despite the existence of a surveillance system and supervision, a weak laboratory contribution in germ identification, appropriate case management, and shortage of antibiotics during the outbreak. Management of a meningitis outbreak may become more efficient by improving the notification, the laboratory's capabilities, and the availability of drugs.

[Hematologic malignancies in internal medicine, University Hospital of Souro Sanou (Burkina Faso)]. / Place des hemopathies malignes en service de medecine interne du CHU Souro Sanou (Burkina Faso).

INTRODUCTION: Hematologic malignancies (HM) in internal medicine remain undocumented, both epidemiological aspects, diagnosis, therapeutic that evolutionary. An inventory of sites, will document these aspects, to identify highly lethal forms, and thus contribute to improving the management of HM in a hospital in a developing country. MATERIAL AND METHODS: A cross-sectional retrospective study referred to descriptive over two and a half years, from review of patients' medical records allowed an exhaustive census of 58 cases of HM admitted to the Department of Internal Medicine of University Hospital Souro Sanou (UHC SS). RESULTS: The first reason for consultation were abdominal tumor syndrome (63.7%). The average age of patients was 42 ± 19.7 years with extremes ranging from 16 to 87 years. The sex ratio was 1.42: 1. Hematological disturbances were strongly suspected anemia (89.2%), leukocytosis (64.3%) and thrombocytopenia (46.4%). The HM depending on cytology were dominated by lymphomas (48.2%) followed by chronic myeloid leukemia or 15.5%. Chemotherapy was undertaken in 63.7% of cases. Lethality was 23.1%, was significantly higher for acute leukemia 40% (p = 0.0012). HIV serology was positive in 3 patients among the 13 cases tested. CONCLUSION: This study provided a better understanding of HM epidemiology at the UHC SS in the department of internal medicine. It revealed a predominance of lymphomas with difficulties in the initiation of chemotherapy. Improving access to chemotherapy, and technical support enable a reduction in the fatality associated with HM in the department of internal medicine at UHC SS.

[Polyneuropathies in patients treated with HAART in Bobo-Dioulasso hospital, Burkina Faso]. / Les polyneuropathies chez les patients traités par les ARV au CHU de Bobo-Dioulasso, Burkina Faso.

Peripheral neuropathies (PN) represent the most common neurological manifestation in patients with HIV infection. Introduction of highly active antiretroviral therapy (HAART) had a significant impact on the epidemiology of HIV-associated neuropathies even in poor-resources countries. HIV-infected patients were followed up over a 2-years period from January 2002 to December 2003. PN was clinically diagnosed based on abnormalities of ankle reflexes or vibratory perception and if patients described pain, paresthesia or numbness. Electromyography was not performed in this study Among the 133 HIV-infected patients treated with HAART 31 patients (23 females and 8 males) with 38.8 of mean age were followed up for PN. 95.5% among them were HIV1-infected. According to the availability of the antiretroviral therapy, 9 patients were treated with protocol A including lamivudine + stavudine + nevirapine, 12 patients with protocol B including combination of stavudine + lamivudine + efavirenz, and 10 patients with protocol C with other combinations of antiretroviral therapies. Average CD4 cell count was 229.3/microl and 60% of the sample had < 200 CD4 cell counts at the time of diagnosis. PN occurred within 5.6 months from the institution of the HAART and 80% less than 3 months after the beginning of the treatment. Burning feet syndrome was found in 16.1% of the sample. 45.2% of polyneuropathies occurred in late stage of HIV infection (< 200 CD4/microl). The presence of PN was related to decreased CD4 cells counts and neurotoxic antiretroviral therapy Introduction of HAART has modified the course and the prognosis of HIV infection even in poor resources setting. The incidence of toxic neuropathies is increasing with longer patients' life expectancy and represents a major factor in treatment limitation and the neurological side effects of HAART should be well identified by physicians.

[Epidemiology of epilepsy in sub-Saharan Africa: a review]. / Epidémiologie de l'épilepsie en Afrique subsaharienne : une revue de la littérature.

Epilepsy is, above all tropical, moreover, very african in its frequency and gravity. Data on the prevalence of epilepsy shows it to be two or three times more prevalent in tropical zones than in industrialized countries in non tropical areas, however it is rare to find data on the incidence and prognosis of epilepsy in sub-Saharan Africa. It is difficult to determine the relative contribution of each of the causes of epilepsy. Only a few case-control studies have been carried out in sub-Saharan Africa. Infectious diseases, in particular parasitic diseases such as neurocysticercosis or cerebral malaria, seem to be the cause of the majority of the cases of epilepsy. However it is necessary to do additional epidemiological studies to determine the etiologies of epilepsy more precisely in sub-Saharan Africa.

[Cryptococcal meningitis in HIV-infected patients at Bobo-Dioulasso hospital (Burkina Faso)]. / La cryptococcose neuroméningée au cours de l'infection par le VIH au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

Cryptococcus neoformans is an important fungal pathogen in immunocompromised patients. A retrospective study was conducted to investigate the occurrence of Cryptococcus neoformans infection in patients admitted to Bobo-Dioulasso Hospital over a 3 year-period. During this period, cryptococcal meningo-encephalitis was diagnosed in 36 individuals. The median age of the patients under study was 34.25 years. There was a male preponderance (24 males/12 females) in our report. Typical presentations were persistent headaches (27 cases/36), neck stiffness (16/36), altered consciousness (14/36), fever (12/36) and convulsions (9/36). Oral candidiasis coexisted with cryptococcal meningitis in 7 patients. HIV serology was positive in all patients. At diagnosis, lymphocytes counts were < 1500/mm3 in 66.66% patients. CSF examination with India ink helped to the diagnosis of cryptococcosis in all cases. Cryptococcus neoformans was associated with Streptococcus pneumoniae in 4 patients. 15/36 patients died within 1 to 29 days after admission. High mortality was related to delayed diagnosis. Cryptococcal meningitis highly contributes to mortality in HIV-infected patients in Burkina Faso and it may occur in patients not severely immunocompromised patients. A need exists to improve strategies for clinical management of AIDS patients in poor African countries.

[Comparative study of neonatal bacterial meningitis in Lomé, Bobo-Dioulasso, Casablanca and Lyon]. / Analyse comparative des méningites bactériennes néonatales à Lomé, Bobo-Dioulasso, Casablanca et Lyon.

UNLABELLED: Bacterial meningitis in new-borns remains a serious event because of its high mortality and morbidity rates in Africa. OBJECTIVE: To identify the clinical and bacteriological epidemiology and the outcome of neonatal bacterial meningitis in three African cities. METHOD: We have analysed and compared three hospital studies done in humid tropical, Sahelian, and desert Africa with a European study. RESULTS: Compared with the European study this African study is characterized by a high mean frequency of neonatal meningitis (6 cases per year against 1.4), more important risk factors linked to pregnancy and childbirth (50% against 33%), high rates of death (61 to 68% against 5%) and sequelae (25 to 40% against 30%), rarity of Streptococcus agalactiae (7 to 15% against 38%) and absence of Listeria. Enterobacteriaceae were predominant both in African (50 to 68%) and European (43%) studies. E. coli appeared as the most frequent germ in both European and African studies and Salmonella as more frequent in Sub-Saharan Africa than in occidental countries. CONCLUSION: The epidemiological, bacteriological and evolutional aspects of the neonatal meningitis were identical in the three African cities. The African studies were different from the European only by their high incidence, the rarity of S. agalactiae and Listeria and the difficulties of bacterial diagnosis and management, all might explain the high rates of death and sequelae. An epidemiological survey and adequate antimicrobial therapy according to antibiotic susceptibility may improve the outcome.

[Guillain-Barré syndrome in HIV-infected patients at Bobo-Dioulasso Hospital (Burkina Faso)]. / Syndrome de Guillain-Barré chez les patients infectés par le VIH à Bobo-Dioulasso (Burkina Faso).

Neurological manifestations of human immunodeficiency virus (HIV) infection are frequent and several associated peripheral neuropathies have been recognized. Among them, Guillain-Barré syndrome (GBS) may occur either early or during the course of the illness. We present a prospective study of 32 consecutive cases of GBS managed over a 5-Year period at Bobo-Dioulasso Hospital where HIV prevalence reaches 20.1p.cent. Male gender predominated (24/32). GBS occurred during the dry season for 65.7p.cent of the patients. Prior infections were found in 84.4p.cent. The motor deficit was paraplegia or tetraplegia. Clinically, paraplegia was associated with transient urinary sphincteric involvement in 24 HIV-infected patients and 3 HIV negative patients. Facial nerve paralysis was found in 3 patients. Among the 32 patients with GBS, 27 were tested positive for HIV. Two patients were infected by HIV1 and HIV2. Cerebrospinal fluid examination showed albumin-cell dissociation and elevated albumin level in 75p.cent of the samples. Autonomic neuropathies were seen in 9 HIV-infected patients. The CD4 counts were above 200/mm3 in 10 among 18 HIV-infected patients. The clinical presentations were more severe in HIV-positive patients with a longer duration of symptoms. HIV-infected patients walked unaided within 51.1 days of peak paralysis. No fatal event occurred. This study indicates clearly that GBS in young adults is strongly associated with HIV infection and should be considered as an indicator of HIV infection in Black Africans. In the tropical context GBS should lead to HIV screening.

Epilepsy and traditional medicine in Bobo-Dioulasso (Burkina Faso).

OBJECTIVES: To contribute to a better knowledge of how epilepsy is perceived by traditional healers in Burkina Faso; what means they use to treat it, and how they think about modern treatment. MATERIAL AND METHODS: Individual interviews with 65 traditional healers chosen at random from members of the Reelwende Association. RESULTS: All traditional practitioners were of male gender. Most of them were above 50 years of age, and 75% had more than 10 years' experience. Epilepsy was considered to be contagious by 44% of the traditional practitioners, and hereditary according to 40% of them. Roughly, 15% of the healers think that the problem is localized in the head of a person and 7.8% think that they have worms in their head. Thirty-one per cent of them diagnose epilepsy if there is a combination of 'convulsions, sudden fall, dribbling and amnesia'. Another 15% require a combination of 'convulsions, amnesia and dribbling', the remaining 54% make the diagnosis based on one symptom or various combinations of two symptoms of 'grand mal' (generalized tonic clonic) seizures and most claim they have a treatment for it. For a quarter of them, therapeutic-means include concoctions of herbs or roots, baths and infusions. During the fit, 31% of the traditional practitioners think that nothing should be performed. According to 75% of them, traditional and modern treatments are complementary. CONCLUSION: Notwithstanding important differences in culture and religions (Muslim, Christian and Original), there is great similarity between the knowledge and beliefs about epilepsy reported from other parts of Africa and those presented by our study-group, suggesting an ancient origin of the concepts. Further study is needed to find out how other facets of epilepsy (e.g. complex partial seizures, absences) are perceived and how these are being treated. Ways need to be found to raise awareness about epilepsy without interfering with religious and cultural beliefs.

[New-onset seizures in patients with immunodeficiency virus infection in Bobo-Dioulasso Hospital (Burkina Faso)]. / Crises d'épilepsie d'apparition récente et infection par le VIH au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

Seizures are common in advanced stages of immunodeficiency virus (HIV) infection. HIV-infected outpatients and inpatients in the national hospital in Bobo-Dioulasso among whom seizures occurred had been recruited over four years. There were mainly male (30/13) with an average age of 35 years with extremes ranging from 22 to 60 years. New-onset generalised seizures occurred in all cases of cryptococcal meningitis or partial motor secondary generalised in 64% among patients with suspected cerebral toxoplasmosis due to the efficiency of the treatment of the antitoxoplasmic proof. Identified causes such as suspected cerebral toxoplasmosis (65%), suspected tuberculous meningitis (7%) as CSF culture is not available, cryptococcal meningitis (16%) were found in this study. In four cases among 43 patients, no identified causes could be determined. CD4 lymphocytes count which was available in 24 patients was under 200/41 in 74% of the cases. This study indicates clearly that seizures in young adults are strongly associated with focal brain lesions and cerebral toxoplasmosis is becoming an important cause of seizure in tropical area. This should imply a screening of toxoplasmosis with new-onset seizure in young people.