Incidence of typhoid fever in Burkina Faso, Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar, and Nigeria (the Severe Typhoid in Africa programme): a population-based study.

BACKGROUND: Typhoid Fever remains a major cause of morbidity and mortality in low-income settings. The Severe Typhoid in Africa programme was designed to address regional gaps in typhoid burden data and identify populations eligible for interventions using novel typhoid conjugate vaccines. METHODS: A hybrid design, hospital-based prospective surveillance with population-based health-care utilisation surveys, was implemented in six countries in sub-Saharan Africa. Patients presenting with fever (≥37·5°C axillary or ≥38·0°C tympanic) or reporting fever for three consecutive days within the previous 7 days were invited to participate. Typhoid fever was ascertained by culture of blood collected upon enrolment. Disease incidence at the population level was estimated using a Bayesian mixture model. FINDINGS: 27 866 (33·8%) of 82 491 participants who met inclusion criteria were recruited. Blood cultures were performed for 27 544 (98·8%) of enrolled participants. Clinically significant organisms were detected in 2136 (7·7%) of these cultures, and 346 (16·2%) Salmonella enterica serovar Typhi were isolated. The overall adjusted incidence per 100 000 person-years of observation was highest in Kavuaya and Nkandu 1, Democratic Republic of the Congo (315, 95% credible interval 254-390). Overall, 46 (16·4%) of 280 tested isolates showed ciprofloxacin non-susceptibility. INTERPRETATION: High disease incidence (ie, >100 per 100 000 person-years of observation) recorded in four countries, the prevalence of typhoid hospitalisations and complicated disease, and the threat of resistant typhoid strains strengthen the need for rapid dispatch and implementation of effective typhoid conjugate vaccines along with measures designed to improve clean water, sanitation, and hygiene practices. FUNDING: The Bill & Melinda Gates Foundation.

Sahel terrorist crisis and development priorities: case of financial allocations for the control of non-communicable diseases in Burkina Faso.

In Africa, nearly 46% of all mortality will be attributed to non-communicable diseases (NCDs) by 2030. While the cost of inaction far exceeds the cost of action against NCDs, global funding for the prevention and control of NCDs is minimal. The objective of this was to explore the Ministry of Health budget allocations for NCDs from 2010 to 2020 as well as the effect of the terrorism crisis on these allocations. The methodology was based on the budget tracking tool developed by the Scaling Up Nutrition Movement. Twenty-nine budget lines related to the prevention and/or control of NCDs have been identified. About 29.9 million USD were allocated to the fight against NCDs with an absorption rate of more than 98%.There is an upward trend of allocated budget characterized by an exponential increase from the development of the national integrated strategic plan for the fight against NCDs (2016-2020). In 2017, an increase of 184% compared to 2016 was observed. However, the efforts were challenged by the emergence of the terrorist threat which triggered in January 2016, leading to a drastic reduction in allocations for NCDs in favor likely of defense and security priorities as well as addressing the needs of internally displaced persons. A trend analysis suggests that the NCDs budget significantly decrease as the country global terrorist index increase. Further analysis is needed to better understand the implication on NCD incidence, and identify advocacy opportunities for mitigating the negative impact of the terrorist treat on NCDs and other development issues.

Self-reported health effects of pesticides among cotton farmers from the Central-West region in Burkina Faso.

Pesticides are chemicals used to control pests with sometime harmful effects on human health. This paper presents results of self-reported health effects experienced by cotton farmers in the Central-West region of Burkina Faso. It was a cross-sectional survey conducted from October to December 2021 among 585 consenting conventional and organic cotton farmers. Data collected included pesticides used, they use conditions, farming practices, experienced health effects. Binary logistic regression was used to find relationships between self-reported health effects and the type of cotton produced. Results showed that all conventional cotton farmers (100%) reported using synthetic pesticides compared to organic ones who using only natural insecticides. Both conventional and organic farmers reported health effects that occurred at least once since they started using pesticides, involving skin effects (85.27% conventional, 65.52% organic), nervous (88.95% conventional, 48,71% organic), respiratory (88.10% conventional, 67.67% organic) systems. 99.72% of conventional farmers vs 46.98% of organic ones reported skin irritation following pesticide use. 69.97% of conventional vs 35.34% of organic cotton farmers reported acute signs such as severe headaches. In univariate and multivariate logistic regressions, severe headaches, dizziness, skin, and ocular effects were significantly associated with conventional farmers compared to organic ones (p < 0.05). There was a significant relationship between vomiting (p = 0.014), diarrhea (p = 0.003) and experience in synthetic pesticide use among conventional farmers. Among organic farmers, there was no significant relationship between health effects reported and experience in organic insecticides use. there was a significant relationship between severe headaches (p = 0.01), rhinitis (p = 0.006), cough (p = 0.0001), skin and ocular irritations (p = 0.007) and the frequency of synthetic insecticides use per year by conventional farmers. Study showed that conventional and organic cotton producers experience the same types of health effects. However, these health effects were significantly associated with conventional farmers compared to organic ones.

An overview of governance of noncommunicable diseases (NCDs) in West African countries.

Noncommunicable diseases (NCDs) account for over 50% of total premature mortality in most low- and middle-income countries (LMICs). However, responses to the fight against NCDs are yet to be efficient in most of these countries. There is little published data on how this response is structured from a governance perspective in the context of global health systems. This study explored from existing research, the state of the governance in the fight against NCDs in the ECOWAS region. It consists of a review of articles published in peer-reviewed journals between 2010 and 2020 on ECOWAS countries. Of three hundred thirty-three (333) articles initially identified, eight (8) publications were included in these studies. There is a serious lack of information on the governance of NCDs in French-speaking countries such as Burkina Faso where no article has been identified. Of the 8 studies meeting the inclusion criteria, none has addressed the coherence of policies and programs. Seven (7) publications provided information on the component national NCDs policies, strategies and action plans, four (4) studies on the component of actors, interventions and the multisectoral coordination mechanism, five (5) on the issue of budget allocations and financing of NCD prevention and control interventions. Political commitment and government leadership has been discussed in three (3) publications. While some studies have provided information on the components of governance, it is important to remember that most of the studies were literature reviews and not empirical studies, which does not allow a better understanding of the situation of governance in each country. Designing an empirical study to answer some questions related to the governance of NCDs in the selected countries is necessary.

Characterization of Typhoid Intestinal Perforation in Africa: Results From the Severe Typhoid Fever Surveillance in Africa Program.

Background: Typhoid intestinal perforation (TIP) remains the most serious complication of typhoid fever. In many countries, the diagnosis of TIP relies on intraoperative identification, as blood culture and pathology capacity remain limited. As a result, many cases of TIP may not be reported as typhoid. This study demonstrates the burden of TIP in sites in Burkina Faso, Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria. Methods: Patients with clinical suspicion of nontraumatic intestinal perforation were enrolled and demographic details, clinical findings, surgical records, blood cultures, tissue biopsies, and peritoneal fluid were collected. Participants were then classified as having confirmed TIP, probable TIP, possible TIP, or clinical intestinal perforation based on surgical descriptions and cultures. Results: A total of 608 participants were investigated for nontraumatic intestinal perforation; 214 (35%) participants had surgically-confirmed TIP and 33 participants (5%) had culture-confirmed typhoid. The overall proportion of blood or surgical site Salmonella enterica subspecies enterica serovar Typhi positivity in surgically verified TIP cases was 10.3%. TIP was high in children aged 5-14 years in DRC, Ghana, and Nigeria. We provide evidence for correlation between monthly case counts of S. Typhi and the occurrence of intestinal perforation. Conclusions: Low S. Typhi culture positivity rates, as well as a lack of blood and tissue culture capability in many regions where typhoid remains endemic, significantly underestimate the true burden of typhoid fever. The occurrence of TIP may indicate underlying typhoid burden, particularly in countries with limited culture capability.

Antiulcer Effect of Aqueous Ethanolic Extracts of Pseudocedrela kotschyi (Schweinf) Harms (Meliaceae) and Ximenia americana L. (Olacaceae).

Purpose: This study aimed to provide pharmacological evidence of Pseudocedrela kotschyi and Ximenia americana in preventing or healing peptic ulcers claimed by traditional healers in Burkina Faso. Methods: The trunk bark of Pseudocedrela kotschyi and the roots bark of Ximenia americana (Olacaceae) were macerated in mixed ethanol/water (80:20), respectively, to obtain dried extracts. Two models of hydrochloric acid (HCl, 0.3 M/ethanol, 60%) and hypothermic stress-induced peptic ulcer were used. The cytoprotective effect of individual or combined plant extracts was assessed at 1; 10; 30mg/kg. bw. Then, the healing effect of the extracts at 10mg/kg.bw was evaluated within 21 days of treatment on the hydrochloric acid-induced ulcer model. The extracts' antioxidant activity and phenolic content were assessed to support the plant extracts' efficiency. Results: The extracts of P. kotschyi and X. americana at 10 mg/kg.bw reduced ulceration index in hydrochloric acid- and hypothermic stress-ulcer models by more than 83% and 65%, respectively. The extract from X. americana at 10mg/kg.bw allowed complete ulcer healing but not the association of the two plant extracts. The plant extracts had IC50of inhibition of DPPH radical lower than 5µg/mL and total ferric reducing antioxidant power of more than 77 mg EQAA/100mg. The total polyphenolic content was 64.82 ±0.99 and 53.75 ±1.39 mg EGA/g of dried extract of P. kotschyi and X. americana, respectively. Conclusion: X. americana extract is better than the combined two plant extracts in gastric cytoprotection and ulcer healing. Further investigations are needed to highlight mechanism-based effects.

Gut Microbiome among Children with Uncomplicated Severe Acute Malnutrition in a Randomized Controlled Trial of Azithromycin versus Amoxicillin.

Antibiotics are routinely used as part of the management of severe acute malnutrition and are known to reduce gut microbial diversity in non-malnourished children. We evaluated gut microbiomes in children participating in a randomized controlled trial (RCT) of azithromycin versus amoxicillin for severe acute malnutrition. Three hundred one children aged 6 to 59 months with uncomplicated severe acute malnutrition (mid-upper arm circumference < 11.5 cm and/or weight-for-height Z-score < -3 without clinical complications) were enrolled in a 1:1 RCT of single-dose azithromycin versus a 7-day course of amoxicillin (standard of care). Of these, 109 children were randomly selected for microbiome evaluation at baseline and 8 weeks. Rectal swabs were processed with metagenomic DNA sequencing. We compared alpha diversity (inverse Simpson's index) at 8 weeks and evaluated relative abundance of microbial taxa using DESeq2. Of 109 children enrolled in the microbiome study, 95 were followed at 8 weeks. We found no evidence of a difference in alpha diversity between the azithromycin and amoxicillin groups at 8 weeks controlling for baseline diversity (mean difference -0.6, 95% CI -1.8 to 0.6, P = 0.30). Gut microbiomes did not diversify during the study. Differentially abundant genera at the P < 0.01 level included Salmonella spp. and Shigella spp., both of which were overabundant in the azithromycin compared with amoxicillin groups. We found no evidence to support an overall difference in gut microbiome diversity between azithromycin and amoxicillin among children with uncomplicated severe acute malnutrition, but potentially pathogenic bacteria that can cause invasive diarrhea were more common in the azithromycin group. Trial Registration: ClinicalTrials.gov NCT03568643.

Gut Resistome after Antibiotics among Children with Uncomplicated Severe Acute Malnutrition: A Randomized Controlled Trial.

A broad-spectrum antibiotic, typically amoxicillin, is included in many country guidelines as part of the management of uncomplicated severe acute malnutrition (SAM) in children without overt clinical symptoms of infection. Alternative antibiotics may be beneficial for children with SAM without increasing selection for beta-lactam resistance. We conducted a 1:1 randomized controlled trial of single dose azithromycin versus a 7-day course of amoxicillin for SAM. Children 6-59 months of age with uncomplicated SAM (mid-upper arm circumference < 11.5 cm and/or weight-for-height Z-score < -3) were enrolled in Boromo District, Burkina Faso, from June through October 2020. Rectal swabs were collected at baseline and 8 weeks after treatment and processed using DNA-Seq. We compared the resistome at the class level in children randomized to azithromycin compared with amoxicillin. We found no evidence of a difference in the distribution of genetic antibiotic resistance determinants to any antibiotic class 8 weeks after treatment. There was no difference in genetic macrolide resistance determinants (65% azithromycin, 65% placebo, odds ratio, OR, 1.00, 95% confidence interval, CI, 0.43-2.34) or beta-lactam resistance determinants (82% azithromycin, 83% amoxicillin, OR 0.94, 95% CI, 0.33-2.68) at 8 weeks. Although presence of genetic antibiotic resistance determinants to macrolides and beta-lactams was common, we found no evidence of a difference in the gut resistome 8 weeks after treatment. If there are earlier effects of antibiotics on selection for genetic antibiotic resistance determinants, the resistome may normalize by 8 weeks.

Physical, Hydric, Thermal and Mechanical Properties of Earth Renders Amended with Dolomitic Lime.

The global objective of this work was to manufacture resistant and durable (water resistant) earth renders with good thermal insulation. For this purpose, a medium plastic clayey soil from Kôdéni (Burkina Faso), constituted by kaolinite (62 wt.%), quartz (31 wt.%), and goethite (2 wt.%), was mixed with dolomitic lime (up to 6 wt.%) to manufacture earth renders. The mineralogical, microstructural, and chemical characteristics of dolomitic lime, as well as the physical (linear shrinkage, apparent density, and accessible porosity), hydric (water absorption test by capillarity and spray test), thermal (thermal conductivity), and mechanical (abrasion resistance, flexural, and compressive strengths) properties of the earth renders were evaluated. From these studies, it appears that the addition of dolomitic lime induces the formation of calcium silicate (CSH) and magnesium silicate (MSH) hydrates. These CSH and MSH are mainly formed from the pozzolanic reaction between finely ground quartz and the weak silica of kaolinite in basic media. These formed hydrates improve the physical, hydric, thermal, and mechanical properties of earth renders. This improvement is due to the fact that the formed CSH and MSH stick to the isolated particles of the soil, making them more compact. In view of the good mechanical strength and water resistance, as well as the low thermal conductivity, the elaborated earth renders are suitable for habitats with dry climates, such as the Sahel.

In Vitro Antioxidant and Anticancer Properties of Various E. senegalensis Extracts.

Although Erythrina senegalensis is a plant widely used in traditional medicine in sub-Saharan Africa, its biological properties have been poorly investigated to date. We first characterized by conventional reactions the composition of several stem bark extracts and evaluated in acellular and cellular assays their pro- or antioxidant properties supported by their high phenolic and flavonoid content, particularly with the methanolic extract. The pro- or antioxidant effects observed did not correlate with their IC50 concentrations against five cancer cell lines determined by MTT assay. Indeed, the CH2Cl2 extract and its ethyl acetate (EtOAc) subfraction appeared more potent although they harbored lower pro- or antioxidant effects. Nevertheless, at equipotent concentration, both extracts induced ER- and mitochondria-derived vacuoles observed by fluorescent microscopy that further led to non-apoptotic cell death. LC coupled to high resolution MS investigations have been performed to identify chemical compounds of the extracts. These investigations highlighted the presence of compounds formerly isolated from E. senegalensis including senegalensein that could be retrieved only in the EtOAc subfraction but also thirteen other compounds, such as 16:3-Glc-stigmasterol and hexadecanoic acid, whose anticancer properties have been previously reported. Nineteen other compounds remain to be identified. In conclusion, E. senegalensis appeared rich in compounds with antioxidant and anticancer properties, supporting its use in traditional practice and its status as a species of interest for further investigations in anticancer drug research.

An atlas to support the progressive control of tsetse-transmitted animal trypanosomosis in Burkina Faso.

BACKGROUND: African animal trypanosomosis (AAT), transmitted by tsetse flies, is arguably the main disease constraint to integrated crop-livestock agriculture in sub-Saharan Africa, and African heads of state and governments adopted a resolution to rid the continent of this scourge. In order to sustainably reduce or eliminate the burden of AAT, a progressive and evidence-based approach is needed, which must hinge on harmonized, spatially explicit information on the occurrence of AAT and its vectors. METHODS: A digital repository was assembled, containing tsetse and AAT data collected in Burkina Faso between 1990 and 2019. Data were collected either in the framework of control activities or for research purposes. Data were systematically verified, harmonized, georeferenced and integrated into a database (PostgreSQL). Entomological data on tsetse were mapped at the level of individual monitoring traps. When this was not possible, mapping was done at the level of site or location. Epidemiological data on AAT were mapped at the level of location or village. RESULTS: Entomological data showed the presence of four tsetse species in Burkina Faso. Glossina tachinoides, present from the eastern to the western part of the country, was the most widespread and abundant species (56.35% of the catches). Glossina palpalis gambiensis was the second most abundant species (35.56%), and it was mainly found in the west. Glossina morsitans submorsitans was found at lower densities (6.51%), with a patchy distribution in the southern parts of the country. A single cluster of G. medicorum was detected (less than 0.25%), located in the south-west. Unidentified tsetse flies accounted for 1.33%. For the AAT component, data for 54,948 animal blood samples were assembled from 218 geographic locations. The samples were tested with a variety of diagnostic methods. AAT was found in all surveyed departments, including the tsetse-free areas in the north. Trypanosoma vivax and T. congolense infections were the dominant ones, with a prevalence of 5.19 ± 18.97% and 6.11 ± 21.56%, respectively. Trypanosoma brucei infections were detected at a much lower rate (0.00 ± 0.10%). CONCLUSIONS: The atlas provides a synoptic view of the available information on tsetse and AAT distribution in Burkina Faso. Data are very scanty for most of the tsetse-free areas in the northern part of the country. Despite this limitation, this study generated a robust tool for targeting future surveillance and control activities. The development of the atlas also strengthened the collaboration between the different institutions involved in tsetse and AAT research and control in Burkina Faso, which will be crucial for future updates and the sustainability of the initiative.

How does baseline anthropometry affect anthropometric outcomes in children receiving treatment for severe acute malnutrition? A secondary analysis of a randomized controlled trial.

Mid-upper arm circumference (MUAC) < 11.5 cm and weight-for-height Z-score (WHZ) < -3 are used for screening for severe acute malnutrition (SAM). Underweight and concurrent wasting and stunting may better target those at the highest risk of mortality. We compared anthropometric outcomes in children enrolled in a trial of antibiotics for SAM based on categories of baseline anthropometry, including indicators for programme admission (WHZ < -3, MUAC < 11.5) and alternative indicators (weight-for-age Z-score [WAZ] < -3, concurrent wasting and stunting [WHZ < -3 and height-for-age Z-score < -3]). Participants were followed weekly until nutritional recovery and at 8 weeks. We evaluated changes in weight gain (g/kg/day), MUAC, and WHZ in children admitted by admissions criteria (MUAC only, WHZ only, or MUAC and WHZ) and by underweight or concurrent wasting and stunting. Of 301 admitted children, 100 (33%) were admitted based on MUAC only, 41 (14%) WHZ only, and 160 (53%) both MUAC and WHZ, 210 (68%) were underweight and 67 (22%) were concurrently wasted/stunted. Low MUAC and low WHZ children had the lowest probability of nutritional recovery (17% vs. 50% for MUAC-only and 34% for WHZ-only). There was no difference in weight gain velocity or WHZ by admissions criteria (WHZ and/or MUAC). Underweight and concurrently wasted/stunted children had lower MUAC and WHZ at 8 weeks compared with those who were not underweight or concurrently wasted and stunted. Children with both low MUAC and low WHZ had the worst outcomes. Relying on MUAC alone may miss children who have poor outcomes. Other indicators, such as WAZ, may be useful for identifying vulnerable children.

Comparing Azithromycin to Amoxicillin in the Management of Uncomplicated Severe Acute Malnutrition in Burkina Faso: A Pilot Randomized Trial.

Azithromycin is a promising alternative to amoxicillin in the management of uncomplicated severe acute malnutrition (SAM) as it can be administered as a single dose and has efficacy against several pathogens causing infectious disease and mortality in children under 5. In this pilot trial, we aimed to establish the feasibility of a larger randomized controlled trial and provide preliminary evidence comparing the effect of azithromycin to amoxicillin on weight gain in children with uncomplicated SAM. We enrolled children 6-59 months old with uncomplicated SAM at six healthcare centers in Burkina Faso. Participants were randomized to a single dose of azithromycin or a 7-day course of amoxicillin and followed weekly until nutritional recovery and again at 8 weeks. Apart from antibiotics, participants received standard of care, which includes ready-to-use therapeutic food. Primary feasibility outcomes included enrollment potential, refusals, and loss to follow-up. The primary clinical outcome was weight gain (g/kg/day) over 8 weeks. Outcome assessors were masked. Between June and October 2020, 312 children were screened, 301 were enrolled with zero refusals, and 282 (93.6%) completed the 8-week visit. Average weight gain was 2.5 g/kg/day (standard deviation [SD] 2.0) in the azithromycin group and 2.6 (SD 1.7) in the amoxicillin group (mean difference -0.1, 95% CI -0.5 to 0.3, P = 0.63). Fewer adverse events were reported in the azithromycin group (risk ratio 0.50, 95% CI 0.31-0.82, P = 0.006). With strong enrollment and follow-up, a fully powered trial in this setting is feasible.

Personal protective equipment wearing in the context of COVID-19 in a hospital in Burkina Faso / Port des équipements de protection individuelle dans le contexte de la COVID-19 dans un centre hospitalier du Burkina Faso

INTRODUCTION: Personal protective equipment (PPE) is used by health care workers to protect themselves and patients from various exposures such as infectious agents. However, the wearing of this equipment is not always optimal, especially in an epidemic context of COVID-19 transmission. AIM OF THE STUDY: The aim of this study, in the specific context of COVID-19, is to contribute to the improvement of PPE wearing practices by health workers. METHODS: This is a descriptive cross-sectional study conducted in 2020 at the Charles De Gaulle Pediatric University Hospital in Burkina Faso. All health workers in the care units and the laboratory were included. Data were collected using an observation grid during the first situation indicating the wearing of PPE. The assessment of the indications for wearing PPE was based on the recommendations of the French Society of Hospital Hygiene and on the technical guide for the prevention and control of healthcare-associated infections in Burkina Faso. RESULTS: Out of 350 targeted agents, 296 were observed. Gowns, masks and gloves were worn in 95.60%, 96.58% and 97.63% of cases respectively. However, PPE such as goggles (1.56%), apron (11.54%), and tunic and pants (46.28%) were poorly used during medical care. CONCLUSION: The practices of health workers with regard to the wearing of certain PPE are still insufficient. A training and awareness program on PPE should be considered to improve patient and staff safety.

Introduction: Les équipements de protection individuelle (EPI) sont utilisés par le personnel de santé dans le cadre des soins pour se protéger et protéger les patients contre les expositions diverses telles que les agents infectieux. Toutefois, le port de ces équipements n'est pas toujours optimal, surtout dans un contexte épidémique de transmission de la COVID-19. But de l'étude: La présente étude vise, dans le contexte spécifique de la COVID-19, à contribuer à l'amélioration des pratiques de port des EPI des agents de santé. Méthodes: Il s'agit d'une étude transversale descriptive conduite en 2020 au centre hospitalier universitaire pédiatrique Charles-de-Gaulle du Burkina Faso. Tous les agents de santé des unités de soins et du laboratoire ont été inclus. Les données ont été recueillies au moyen d'une grille d'observation lors de la première situation indiquant le port d'un EPI. L'appréciation des indications de port des EPI s'est basée sur les recommandations de la Société française d'hygiène hospitalière et sur le Guide technique de prévention et contrôle des infections associées aux soins au Burkina Faso. Résultats: Sur 350 agents ciblés, 296 ont été observés. Le port de la blouse, du masque et des gants était observé respectivement dans 95,60 %, 96,58 % et 97,63 % des cas. Cependant, les EPI tels que les lunettes de protection (1,56 %), le tablier (11,54 %) et la tenue professionnelle composée d'une tunique et d'un pantalon (46,28 %) étaient faiblement utilisés lors des soins médicaux. Conclusion: Les pratiques des agents de santé vis-à-vis du port de certains EPI restent insuffisantes. Un programme de formation et de sensibilisation sur les EPI doit être envisagé afin de renforcer la sécurité des patients et du personnel.

Facteurs imputables aux services de santé limitant la pratique de l´allaitement exclusif dans la région du Centre au Burkina Faso: une étude transversale / Factors attributable to health services limiting the practice of exclusive breastfeeding in the Center Region of Burkina Faso: a cross-study

Introduction: l´organisation mondiale de la santé affirme que l´allaitement revêt une importance fondamentale pour la survie et le développement de l´enfant. Le but de la présente étude a été d´apprécier le niveau de connaissance et les attitudes du personnel soignant dans la promotion de l´allaitement exclusif afin d´identifier les facteurs limitants qui sont imputables aux services de santé. Méthodes: il s´est agi d´une étude transversale réalisée de juillet à novembre 2021 auprès de 74 agents de santé du district sanitaire de Boulmiougou. La collecte de données a été basée sur l´observation directe et l´administration d´un questionnaire. Le niveau de connaissance et les performances ont été évalués par le calcul des moyennes et le score de satisfaction a été fixée à au moins 80%. Résultats: il ressort de cette étude que les sages-femmes et les maïeuticiens représentaient 48,65% et que la majorité 78,37% des personnes interviewées avaient plus de cinq ans d´ancienneté. Pour l´opérationnalité des services, un score de satisfaction global de 21,25% a été retrouvé par rapport à l´existence de directives et de documentations sur l´allaitement. En matière de connaissance, le score de performance le plus élevé (62,06%) a été obtenu par une sage-femme et le plus bas (27,58%) obtenu par une accoucheuse auxiliaire. Conclusion: l´étude a permis de mettre en exergue la situation catastrophique dans la promotion de l´allaitement exclusif d´où il parait urgent de revoir la politique sanitaire en la matière pour redynamiser les activités afin de réduire la mortalité néonatale et infantile.

Introduction: the World Health Organization states that breastfeeding is of fundamental importance for child survival and development. The purpose of this study was to assess the level of knowledge and attitudes of health care personnel in the promotion of exclusive breastfeeding in order to identify the limiting factors that are attributable to health services. Methods: this was a cross-sectional study carried out from July to November 2021 among 74 health workers in the Boulmiougou health district. Data collection was based on direct observation and the administration of a questionnaire. The level of knowledge and performance were assessed by calculating averages and the satisfaction score was set at at least 80%. Results: it appears from this study that midwives and midwives represented 48.65% and that the majority 78.37% of those interviewed had more than five years of seniority. For the operationality of the services, an overall satisfaction score of 21.25% was found in relation to the existence of guidelines and documentation on breastfeeding. In terms of knowledge, the highest performance score (62.06%) was obtained by a midwife and the lowest (27.58%) obtained by an auxiliary midwife. Conclusion: the study made it possible to highlight the catastrophic situation in the promotion of exclusive breastfeeding from which it seems urgent to review the health policy in this area to revitalize activities in order to reduce neonatal and infant mortality.

Azithromycin versus Amoxicillin and Malarial Parasitemia among Children with Uncomplicated Severe Acute Malnutrition: A Randomized Controlled Trial.

Antibiotics are recommended by the WHO as part of the management of uncomplicated severe acute malnutrition in children. We evaluated whether azithromycin, an antibiotic with antimalarial properties, improved malarial parasitemia outcomes in children with severe acute malnutrition compared with amoxicillin, an antibiotic commonly used for severe acute malnutrition that does not have antimalarial properties. Total of 301 children were randomized (1:1) to a single oral dose of azithromycin or a 7-day course of amoxicillin and followed for 8 weeks. We found no significant evidence that children receiving azithromycin had improved parasitemia outcomes relative to amoxicillin. Although azithromycin may have advantages over amoxicillin in terms of dosing and administration for uncomplicated severe acute malnutrition, it may not yield additional benefit for malaria outcomes.

Safety and immunogenicity of Vi-typhoid conjugate vaccine co-administration with routine 9-month vaccination in Burkina Faso: A randomized controlled phase 2 trial.

OBJECTIVES: In 2017, the World Health Organisation (WHO) pre-qualified a single-dose typhoid conjugate vaccine (TCV) and identified TCV co-administration studies as a research priority. Accordingly, we tested co-administration of Typbar TCV® (Bharat Biotech International) with measles-rubella (MR) and yellow fever (YF) vaccines. METHODS: We conducted a randomized, double-blind, and controlled, phase 2 trial in Ouagadougou, Burkina Faso. Healthy children aged 9-11 months were randomized 1:1 to receive TCV (Group 1) or control vaccine (inactivated polio vaccine (IPV), Group 2). Vaccines were administered intramuscularly with routine MR and YF vaccines. Safety was assessed by (1) local and systemic reactions on days 0, 3, and 7; (2) unsolicited adverse events within 28 days; and (3) serious adverse events (SAEs) within six months after immunization. RESULTS: We enrolled, randomized, and vaccinated 100 eligible children (49 Group 1 and 51 Group 2). Safety outcomes occurred with similar frequency in both groups: local/solicited reactions (Group 1: 1/49, Group 2: 3/50), systemic/solicited reactions (Group 1: 4/49, Group 2: 9/50), unsolicited adverse events (Group 1: 26/49, Group 2: 33/51), and SAEs (Group 1: 2/49, Group 2: 3/51). TCV conferred robust immunogenicity without interference with MR or YF vaccines. CONCLUSION: TCV can be safely co-administered with MR and YF vaccines to children at the 9-month vaccination visit.

Food availability, accessibility and dietary practices during the COVID-19 pandemic: a multi-country survey.

OBJECTIVE: To investigate the perceived effects of the coronavirus disease (COVID-19) pandemic lockdown measures on food availability, accessibility, dietary practices and strategies used by participants to cope with these measures. DESIGN: We conducted a cross-sectional multi-country online survey between May and July 2020. We used a study-specific questionnaire mainly based on the adaptation of questions to assess food security and coping strategies from the World Food Programme's 'Emergency Food Security Assessment' and 'The Coping Strategy Index'. SETTING: The questionnaire was hosted online using Google Forms and shared using social media platforms. PARTICIPANTS: A total of 1075 adult participants from eighty-two countries completed the questionnaire. RESULTS: As a prelude to COVID-19 lockdowns, 62·7 % of the participants reported to have stockpiled food, mainly cereals (59·5 % of the respondents) and legumes (48·8 %). An increase in the prices of staples, such as cereals and legumes, was widely reported. Price increases have been identified as an obstacle to food acquisition by 32·7 % of participants. Participants reported having lesser variety (50·4 %), quality (30·2 %) and quantity (39·2 %) of foods, with disparities across regions. Vulnerable groups were reported to be facing some struggle to acquire adequate food, especially people with chronic diseases (20·2 %), the elderly (17·3 %) and children (14·5 %). To cope with the situation, participants mostly relied on less preferred foods (49 %), reduced portion sizes (30 %) and/or reduced the number of meals (25·7 %). CONCLUSIONS: The COVID-19 pandemic negatively impacted food accessibility and availability, altered dietary practices and worsened the food insecurity situation, particularly in the most fragile regions.

Systematic Review of Potential Anticancerous Activities of Erythrina senegalensis DC (Fabaceae).

The objective of this study was to carry out a systematic review of the substances isolated from the African medicinal plant Erythrina senegalensis, focusing on compounds harboring activities against cancer models detailed in depth herein at both in vitro and in vivo preclinical levels. The review was conducted through Pubmed and Google Scholar. Nineteen out of the forty-two secondary metabolites isolated to date from E. senegalensis displayed interesting in vitro and/or in vivo antitumor activities. They belonged to alkaloid (Erysodine), triterpenes (Erythrodiol, maniladiol, oleanolic acid), prenylated isoflavonoids (senegalensin, erysenegalensein E, erysenegalensein M, alpinumisoflavone, derrone, warangalone), flavonoids (erythrisenegalone, senegalensein, lupinifolin, carpachromene) and pterocarpans (erybraedine A, erybraedine C, phaseollin). Among the isoflavonoids called "erysenegalensein", only erysenealenseins E and M have been tested for their anticancerous properties and turned out to be cytotoxic. Although the stem bark is the most frequently used part of the plant, all pterocarpans were isolated from roots and all alkaloids from seeds. The mechanisms of action of its metabolites include apoptosis, pyroptosis, autophagy and mitophagy via the modulation of cytoplasmic proteins, miRNA and enzymes involved in critical pathways deregulated in cancer. Alpinumisoflavone and oleanolic acid were studied in a broad spectrum of cancer models both in vitro and in preclinical models in vivo with promising results. Other metabolites, including carpachromen, phaseollin, erybraedin A, erysenegalensein M and maniladiol need to be further investigated, as they display potent in vitro effects.

Safety and immunogenicity of co-administration of meningococcal type A and measles-rubella vaccines with typhoid conjugate vaccine in children aged 15-23 months in Burkina Faso.

OBJECTIVES: The World Health Organization pre-qualified single-dose typhoid conjugate vaccine (TCV) and requested data on co-administration with routine vaccines. The co-administration of Typbar TCV (Bharat Biotech International) with routine group A meningococcal conjugate vaccine (MCV-A) and measles-rubella (MR) vaccine was tested. METHODS: This was a double-blind, randomized controlled trial performed in Ouagadougou, Burkina Faso. Children were recruited at the 15-month vaccination visit and were assigned randomly (1:1:1) to three groups. Group 1 children received TCV plus control vaccine (inactivated polio vaccine) and MCV-A 28 days later; group 2 children received TCV and MCV-A; group 3 children received MCV-A and control vaccine. Routine MR vaccine was administered to all participants. Safety was assessed at 0, 3, and 7 days after immunization, and unsolicited adverse events and serious adverse events were assessed for 28 days and 6 months after immunization, respectively. RESULTS: A total of 150 children were recruited and vaccinated. Solicited symptoms were infrequent and similar for TCV and control recipients, as were adverse events (group 1, 61.2%; group 2, 64.0%; group 3, 68.6%) and serious adverse events (group 1, 2.0%; group 2, 8.0%; group 3, 5.9%). TCV generated robust immunity without interference with MCV-A vaccine. CONCLUSIONS: TCV can be safely co-administered at 15 months with MCV-A without interference. This novel study on the co-administration of TCV with MCV-A provides data to support large-scale uptake in sub-Saharan Africa.