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.

Quality of antenatal care and obstetrical coverage in rural Burkina Faso.

Improving maternal health is one of the Millennium Development Goals of the United Nations. Despite the efforts to promote maternal and neonatal care to achieve this goal, the use of delivery care remains below expectations in Burkina Faso. This situation raises the question of the quality of care offered in maternity wards. The aim of this study was to identify primary healthcare facility and antenatal care characteristics predictive of an assisted delivery in rural Burkina Faso. A cross-sectional study was carried out in Gnagna province (North-East Burkina Faso) in November 2003. The operational capacities of health facilities were assessed, and a non-participating observation of the antenatal care (ANC) procedure was undertaken to evaluate their quality. Scores were established to summarize the information gathered. The rate of professional childbirth (obstetrical coverage) was derived from the number of childbirths registered in the health facility compared to the size of the population. The established scores were related to the obstetrical coverage using non-parametric tests (Kendall). In total, 17 health facilities were visited, and 81 antenatal consultations were observed. Insufficiencies were observed at all steps of ANC (mean total score for the quality of ANC=10.3 +/- 3.0, ranging from 6 to 16, out of a maximum of 20). Health facilities are poorly equipped, and the availability of qualified staff remained low (mean total score for the provision of care was 22.9 +/- 4.2, ranging from 14 to 33). However, these scores were not significantly related to the rate of professional childbirth (tau Kendall=0.27: p=0.14 and 0.01, p=0.93 respectively). The ability of the primary health centres to provide good antenatal care remains low in rural Burkina Faso. The key factors involved in the limited use of professional childbirth relating to maternal health services may be the quality of ANC.

Etiology and prophylaxis of helminthiasis in sheep in Burkina Faso.

Helminths of "Mossi" sheep from traditional livestock were investigated at three different seasons (humid, cold dry, and hot dry seasons) in the village of Donsin from the central land of Burkina Faso. Three prophylaxis plans using Fenbendazole were tested. Primary parasites identified were: Oesophagostomum sp., Trichostrongylus sp., and Haemonchus contortus. These parasites were noticed mainly during the rainy season with mean egg per gram (epg) numbers of 500 +/- 141.42 in August-September, at the end of the rainy season. At this same period, hematocrit (22%) and body weights (17 kg of live weight) (LW) were low. These values progressively increased to reach their highest levels (32% and 27 kg of LW respectively) in February. The prophylactic plan consisting of two treatments with oral drench of 5 mg/kg LW of Fenbendazole turned out to be the most efficacious and the most economical.