Incidence, prevalence, and mortality of type 1 diabetes in children and youth in Burkina Faso 2013-2022.

AIM: There are no data on type 1 diabetes (T1D) incidence and prevalence in Burkina Faso. We aimed to determine these in persons aged <25 years (y) since the implementation of Life for a Child (LFAC) program in 2013. PATIENTS AND METHODS: Data were collected from the prospective program register. Diagnosis of T1D was clinical, based on presentation, abrupt onset of symptomatic hyperglycemia, need for insulin replacement therapy from diagnosis, and no suggestion of other diabetes types. RESULTS: We diagnosed 312 cases of T1D <25y in 2013-2022. Male-to-female ratio was 1:1. T1D incidence <25y per 100,000 population/year increased from 0.08 (CI 95% 0.07-0.60) in 2013 to 0.34 (CI 95% 0.26-0.45) in 2022 (p=0.002). Incidence <15y/y rose from 0.04 (CI 95% 0.01-0.10) to 0.27 (CI 95% 0.18-0.38) per 100,000/year in 2013 and 2022, respectively (p < 0.002). Prevalence per 100,000 population <25y was 0.27 (CI 95% 0.19-0.37) in 2013 and rose to 1.76 (CI 95% 1.546-1.99) in 2022 (p<0.0001). Mortality rate was 20 (CI 95% 13-29.6) per 1,000-person y. CONCLUSIONS: There is a low but sharply rising T1D incidence and prevalence rates in children and youth in Burkina Faso since LFAC program implementation. It is very likely this is partly due to improved case detection. Mortality remains substantial.

Comparison of regular with NPH insulin vs. premix insulin in children and adolescents with type 1 diabetes in a resources-limited setting: a retrospective data analysis.

OBJECTIVES: Few studies addressed the efficacy of human insulin regimens (mostly premix insulin) used in many low-and-middle income countries on glycemic control of children and adolescents with diabetes. The aim of this study was to assess the efficacy of the premix insulin on the glycated hemoglobin (HbA1c) in comparison to the regular with NPH insulin scheme. METHODS: A retrospective study was carried out from January 2020 to September 2022 on patients with type 1 diabetes aged below 18 years followed in Burkina Life For A Child program. They were categorized into three groups, on regular with NPH insulin (Group A), on premix insulin (Group B) and on regular with premix insulin (Group C). Outcome was analyzed based on HbA1c level. RESULTS: Sixty-eight patients with a mean age of 15.38 ± 2.26 years and the sex ratio (M/W) 0.94 were studied. There were 14 in Group A, 20 in Group B, and 34 patients in Group C. The mean HbA1c value in the corresponding insulin regimen was 12.8 ± 1.39%, 9.87 ± 2.18%, and 10.66 ± 2.1%, respectively. Glycemic control was better in Groups B and C than Group A (p<0.05) but there was no difference between groups B and C. CONCLUSIONS: Our results indicate that the use of premix insulin gives a better glycemic control than NPH insulin. However, further prospective study of these insulin regimens with a strengthening education strategy and glycemic control by continuous glucose monitoring and HbA1c is required to corroborate these preliminary findings.

The "Walking Estimated Limitation Stated by History" (WELSH) visual tool is applicable and accurate to determine walking capacity, even in people with low literacy level.

Determination of the self-reported walking capacity by interview or standardized questionnaire is important. However, the existing questionnaires require the patient to be able to read and write in a specific language. We recently proposed the WELSH (Walking Estimated Limitation Stated by History) tool to be administrable to illiterate people. The main objective was to assess the applicability of WELSH tool in the community and in a large group. We performed a prospective study in the city of Bobo-Dioulasso in Burkina Faso during June 2020. We recruited 630 interviewers among medical students. They were trained to administer the WELSH, and to conduct a 6-minute walk test. We performed a Pearson's "r" correlation between the WELSH and maximal walking distance (MWD). Of the 1723 participants available for the analysis, 757 (43.9%: 41.6-46.3) never went to school or attended only elementary school. The percentage of questionnaires with participant filling-in errors corrected by the investigator decreased with the decrease in educational level (p<0.001). The average WELSH score was 53 ± 22 and the average MWD was 383 ±142 meters. The Spearman correlation coefficient between the WELSH score and the MWD was r = 0.567 (p<0.001). Correlations ranged from 0.291 to 0.576 in males and females, (all p values < 0.05) and in different levels of education, with the highest coefficients found in illiterate people. The WELSH is feasible on the community by a wide variety of interviewers. It correlates with the MWD estimated by the 6-minutes' walk test even for people with little or no schooling.

The walking estimated limitation stated by history (WELSH): a visual tool to self-reported walking impairment in a predominantly illiterate population.

BACKGROUND: The prevalence of cardiovascular diseases is increasing in low-income countries. Various questionnaires to estimate walking capacity in patients are available in multiple languages but they are not suitable for illiterate patients. OBJECTIVE: The walking estimated limitation stated by history (WELSH) tool aims at rating individual walking disability using only drawings and four items. METHODS: A six-month prospective study was performed on new patients referred to the Department of Cardiology at the Centre Hospitalier Universitaire Sourô Sanou in Bobo-Dioulasso, Burkina Faso. We administered the WELSH tool after a short oral presentation in the patient's language or dialect. Thereafter, patients performed a six-minute walking test in the hospital corridor under the supervision of a nurse who was blinded to the results of the WELSH score. We performed a step-by-step multilinear regression analysis to determine the factors predicting maximal walking distance (MWD). RESULTS: There were 40 female and 10 male patients in this study. Their ages ranged from 54.8 ± 10.7 years. Only 32% of the patients had attended primary school. Most patients were classified as stage I to III of the New York Heart Association (NYHA) classification. The objective measurement of MWD during a six-minute walking test showed no association with the subjects' educational level, body mass index, NYHA stage or gender, but a significant correlation with the WELSH scores. The Spearman r-value for the WELSH score-to-MWD relationship was 0.605 (p < 0.001). CONCLUSIONS: The WELSH tool is feasible and correlated with measured MWD in a population of predominantly illiterate patients.

[Electrocardiography coupled with transthoracic echocardiography at rest in the diagnosis of cardiac impairments in type 2 diabetics: lessons learned from a cross-sectional case series in Burkina Faso]. / Electrocardiographie couplé à l'échocardiographie transthoracique de repos dans le diagnostic des atteintes cardiaques chez le diabétique de type 2: les enseignements d'une série transversale au Burkina Faso.

Diabetes is a powerful independent cardiovascular risk factor. The aim of this study is to describe the electrocardiographic and echocardiographic abnormalities observed in patients with type 2 diabetes treated in the Department of Medicine at the University Hospital in Bobo-Dioulasso. We conducted a descriptive cross-sectional study of all patients with type 2 diabetes who gave consent from April to September 2014. We gathered clinical data from all the patients. They, moreover, underwent electrocardiography and doppler echocardiography. A total of 155 diabetics were investigated. The average age of patients was 55 years (IQR: 47-64) with a female predominance (sex ratio 0.5). Electrocardiographic abnormalities included repolarization abnormalities (31%) and atrial rhythm disorders (16,12%). Echocardiographic examination showed left ventricular hypertrophy (LVH) in 20,64% of cases. Left atrium was dilated in 14.19% of cases, LV was dilated in 1.3% of cases. Abnormal left ventricular ejection fraction was detected in 3.87% of cases. Nosological entities included hypertensive heart disease in 27 cases (54%), ischemic heart disease in 19 cases (38%), dilated cardiomyopathy in 2 cases (4%) and diabetic cardiomyopathy in 2 cases (4%). Heart failure was detected in 22 cases (44%) independently from cardiac impairment. Electrocardiographic and echocardiographic abnormalities are frequent in type 2 diabetes population at the University Hospital in Bobo-Dioulasso. Improved cooperation between cardiologists and diabetologists as well as the establishment of adequate technical screening equipment would be prerequisite for better cardiac risk stratification in this population.

Knowledge and practice concerning swallowing disorders in hemiplegic patients among nurses of Bobo-Dioulasso urban primary health care centers in Burkina Faso.

INTRODUCTION: The quality of management of swallowing disorders (SD) from admission onwards influences the patients' nutritional status and their prognosis. Neurological diseases are the main causes of SD, affecting one in three patients with hemiplegia (Hp). In Burkina Faso (BF), primary health care center (PHCC) nurses are the first to manage these patients, but there are no data related to their management of SD. The study aimed to assess knowledge and practices regarding SD in Hp among PHCC nurses in Bobo-Dioulasso, a main center for care of Hp in BF. METHODS: This cross-sectional study was performed August 1-September 15 2014. Subjects underwent a standardized survey to determine their knowledge and practices concerning SD in Hp. RESULTS: Of 125 nurses surveyed (83.3% of the targeted workers), 82.4% had experience of caring for Hp. The role of the central nervous system in cases of Hp and SD was recognized by 56.8% of nurses; 42.3% knew that SD can cause aspiration, and 36.0% were aware of rescue techniques to use when aspiration occurs; 39.2% correctly assessed the impact on nutritional status of SD. Knowledge in this area was better among respondents who recently completed training school. 65.6% and 1.6% respectively knew about the impact of posture and the texture of food on the ability to swallow. Among the 103 nurses with experience of treating Hp, 68.0% considered clinical interview the best way to detect SD, and 30.1% did not give the patient advice in this area. In multivariate analysis, detection of SD was associated with good knowledge of the value of voice disorders (OR = 3.5, 95% CI = 1.4-8.1; p = 0.005). CONCLUSION: Few nurses had been warned of the connection between Hp and SD, which are classic issues and potential complications. Practices varied, but most were not in accord with what are recognized as good strategies for SD screening and management. In order to improve care of Hp, neurological and nutritional training should be accompanied by specific training in SD, emphasizing screening and simple management.