Characterization of Plasmodium Falciparum Resistance Genes to Common Antimalarial Drugs in Semi-urban Areas of Burkina Faso.

INTRODUCTION: Malaria still remains the most frequent parasitic disease on the world with, in 2022, 249 million cases and 608,000 deaths worldwide. Malaria control is compromised by the spread of the parasite's resistance to available antimalarials. The objective of our study is to characterize the Plasmodium falciparum resistance genes to common antimalarial drugs in semi-urban areas of Burkina Faso. MATERIALS AND METHODS: This is a prospective cross-sectional study whose collection took place from June to October 2021 and from June to October 2022 in five health facilities in Burkina Faso. The molecular analysis based on PCR-RFLP took place from January to June 2023 at Centre National de Recherche et de Formation (CNRFP) to determine resistance genes such as Pfcrt, Pfmdr1, Pfdhps, and Pfdhfr. RESULTS: A total of 150 samples were analyzed giving a prevalence of 46.67, 1.33, 0.67, 20, 82, and 4.67%, for Pfcrt 76 T, Pfmdr1 86Y, Pfdhps 437G, Pfdhfr 51I, Pfdhfr 59R, and Pfdhfr 108N mutations, respectively. There are no mutations observed Pfdhps 540E and Pfdhfr 164L positions. However, mutation on Pfdhfr 59R position was the most common. In addition, triple mutation (Pfdhps 437G + Pfdhfr 59R + Pfdhfr 108N) was found with a low frequency which is 0.67%. CONCLUSION: Surveillance of Plasmodium falciparum resistance markers to antimalarial drugs, remains one of the priorities in the context of the control or malaria elimination.

International review of blood donation nucleic acid amplification testing.

BACKGROUND AND OBJECTIVES: Nucleic acid amplification testing (NAT), in blood services context, is used for the detection of viral and parasite nucleic acids to reduce transfusion-transmitted infections. This project reviewed NAT for screening blood donations globally. MATERIALS AND METHODS: A survey on NAT usage, developed by the International Society of Blood Transfusion Working Party on Transfusion-transmitted Infectious Diseases (ISBT WP-TTID), was distributed through ISBT WP-TTID members. Data were analysed using descriptive statistics. RESULTS: Forty-three responses were received from 32 countries. Increased adoption of blood donation viral screening by NAT was observed over the past decade. NAT-positive donations were detected for all viruses tested in 2019 (proportion of donations positive by NAT were 0.0099% for human immunodeficiency virus [HIV], 0.0063% for hepatitis C virus [HCV], 0.0247% for hepatitis B virus [HBV], 0.0323% for hepatitis E virus [HEV], 0.0014% for West Nile virus [WNV] and 0.00005% for Zika virus [ZIKV]). Globally, over 3100 NAT-positive donations were identified as NAT yield or solely by NAT in 2019 and over 22,000 since the introduction of NAT, with HBV accounting for over half. NAT-positivity rate was higher in first-time donors for all viruses tested except WNV. During 2019, a small number of participants performed NAT for parasites (Trypanosoma cruzi, Babesia spp., Plasmodium spp.). CONCLUSION: This survey captures current use of blood donation NAT globally. There has been increased NAT usage over the last decade. It is clear that NAT contributes to improving blood transfusion safety globally; however, there is a need to overcome economic barriers for regions/countries not performing NAT.

[Prognostic factors and survival in adult acute leukemia in Burkina Faso]. / Facteurs pronostiques et survie des leucémies aiguës de l'adulte au Burkina Faso.

Introduction: Acute leukemia is both a diagnostic and therapeutic emergency. Our study aimed to describe the prognostic factors and survival of adults with acute leukemia in Burkina Faso. Patients and methods: Cross-sectional descriptive study with retrospective data collection covering a period of 4.5 years (2018-2022) in two university hospitals in Burkina Faso. Were included all patients over 18 years hospitalized for acute leukemia in these sites with a usable medical record. Results: A total of 42 cases were collected, of which 45% suffered from acute lymphoblastic leukemia and 43% from acute myeloid leukemia. In 12% of cases, acute leukemia was not classified. The average age was 35 ± 15 years, with extremes of 19 and 72 years. 12% of the patients presented an age of poor prognosis. Comorbidities were present in 14% of patients. The deterioration in general condition was fairly constant with 95% of patients at WHO stages 3 and 4. All patients presented with bone marrow failure syndrome and tumor syndrome was found in 45%. Anemia and thrombocytopenia were present in almost all cases. Hyperleukocytosis at diagnosis was present in 28 patients (67%); among them 18 patients (64%) had leukocytes greater than 50 G/L. Death in hospital was found in 38% of patients and loss of sight in 31%. The median survival was 3 months. Survival was 30% at 6 months and 0% at 12 months. Conclusion: Acute leukemias are in our practice conditions of poor prognosis with a fairly short survival.

Establishment of reference values for prothrombin time, activated partial thromboplastin time and fibrinogen in adults in Burkina Faso.

The ordering of clinical haemostasis tests is increasing in Burkina Faso due to the newly emergence of cardiovascular and metabolic diseases. However, appropriate local reference values (RV) are lacking. Our study aimed to establish RV for prothrombin time (PT), activated partial thromboplastin time (aPTT) and fibrinogen assays. In 2020, we carried out a cross-sectional study at the transfusion centre of Ouagadougou and included 280 healthy blood donors (140 males and 140 females) as reference subjects (RS) according to CLSI guidelines (C28 A3). From each RS a 5 mL blood sample had been withdrawn in citrated tubes. We performed PT, aPTT and fibrinogen assays using the Sysmex™ CA660 coagulometer and Siemens™ reagents. RV were calculated using the "central 95 percentile" method. Reference values of PT, aPTT and Fibrinogen were respectively [73.84%-117.50%], [20,01-29.45] seconds and [2.04-3.83] g/L for females and [58.81%-112,31%] seconds, [20,9-29,98] seconds and [1.58-3.35] g/L for males. We report for the first time locally appropriate haemostasis RV for the Burkina Faso adult's population. They will be of clinical use to our health care professionals.

Plasmodium falciparum Genetic Diversity and Resistance Genotype Profile in Infected Placental Samples Collected After Delivery in Ouagadougou.

Purpose: Intermittent preventive treatment with sulfadoxine-pyrimethamine is widely used for the prevention of malaria in pregnant women in Africa. Known resistance cases of sulfadoxine-pyrimethamine during pregnancy need to be follow up to support IPTp implementation in Burkina Faso. However, data on the development and spread of resistance to this molecule are lacking. This study aimed to investigating the genetic diversity of P. falciparum and the mutation prevalence in the dhfr and dhps genes infected from postpartum infected placentas. Patients and Methods: This was a prospective and cross-sectional study conducted between April 2019 and March 2020 in four health districts of Ouagadougou capital city. From the placentas collected after delivery, P. falciparum detection and mps1 and msp2 polymorphism analysis were performed by nested PCR. The resistance profile was checked after analyzing the mutation point on dhfr and dhps genes. Results: PCR-positive samples were estimated at 96% for msp1 and 98% for msp2. The polymorphism analysis showed that the RO33 and 3D7 allelic families were the most widespread with 62.5% and 91.83%, respectively. Multiple infections by msp1 and msp2 were frequent with 12.50% and 92.92%, respectively. The prevalence of individual dhfr mutation point, 51I, 108A, and 59R, was 1.96, 15.68, and 7.84, respectively, and the dhps mutation point, 437G, was 3.92. There is no detected mutation at the point 164L and 540E. The triple (51I+108A+59R) in dhfr and quadruple (51I+108A+59R+ 437G) mutation were not found. Conclusion: The results showed that Plasmodium falciparum has a high genetic diversity of msp1 and msp2. This suggests that dhfr and dhps mutant genotypes are potential early warning factors in the increase in the sulfadoxine-pyrimethamine resistance.

Prevalence and specificity of red blood cell antibodies in patients transfused in tertiary hospitals in Burkina Faso.

BACKGROUND: Sub-Saharan African countries face the challenge of immunological transfusion safety that puts many patients at risk of post-transfusion hemolytic reactions. This is because pre-transfusion testing for irregular/unexpected antibodies that helps to prevent these risks are neither universally available nor accessible. The aim of our study was to determine the prevalence of red blood cell alloantibodies and their specificity in patients transfused in Burkina Faso. MATERIALS AND METHODS: This was a cross-sectional study including patients who had received at least one blood transfusion. Indirect antiglobulin testing using LISS-enhanced medium gel column agglutination technique was used for antibodies screening and identification. Enzymatic technique with papain-treated red cell reagent was performed in attempt to solve some difficulties if necessary as well as auto-control test and RH-KEL phenotyping when possible to help antibodies identification. RESULTS: A total of 832 patients were included, 51.6% of whom were female, and the median (IQR) age was 34 (20-49) years. Of these, 43.7% had chronic kidney disease and 20.4% were sickle cell patients. The median (IQR) number of immunisation episodes (blood transfusion and pregnancies) was 3 (2-6) with the median (IQR) number of blood units received per patient of 2 (1-5). The proportion of patients with RBCs antibodies was 6.4% (53/832), with mainly anti-Rh antibodies. A combination of 2 antibodies was found in 7 patients and a combination of 3 antibodies in one patient. Antibodies of unknown specificity (AUS) were encountered in 29%. Independent factors associated with antibody positivity were age (OR = 1.02; p = 0.026), sickle cell disease (OR = 3.23; p = 0.017) and receiving more than 10 blood units (OR = 7.33; p = 0.01). CONCLUSION: In this study, the proportion of patients with RBC antibodies was quite similar to that observed in Sub-Saharan African countries. However, the availability and accessibility of pre-transfusion compatibility tests as well as the quality of methods used should be improved to ensure the safety of blood transfusions.

Red blood cell alloimmunisation in multi-transfused patients from an haemodialysis service in Burkina Faso.

Background: In Burkina Faso, red blood cell (RBC) transfusion remains the crucial anaemia treatment following chronic renal failure (CRF) as erythropoietin and its analogues are unavailable. However, blood group matching beyond the ABO and Rhesus is not common in Burkina Faso. Thus, alloimmunisation is a potential issue for transfused patients. Objective: Our study aimed to identify anti-erythrocyte antibodies in multi-transfused CRF patients at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso. Methods: This cross-sectional study, conducted from October 2018 to November 2019, included CRF patients who had received at least two RBC units. We screened patients for the presence of RBC antibodies using three commercial Cells panels and identified antibody specificities for positive screenings using 11 Cells panels for an indirect antiglobulin test (IAT) in a low ionic strength microcolumn gel-card system. Results: Two hundred and thirty-five patients (45.1% female; average age: 41.5 years) were included. The median number of blood units received per patient was 10 (interquartile range: 5-20). The overall alloimmunisation rate was 5.9% (14/235). Antibodies identified included: anti-D (1 case), anti-C (1 case), anti-D+C (4 cases), anti-CW (1 case), anti-E (1 case), anti-S (1 case) and anti-Lea (1 case). In four positive patients, the specificity of the antibodies was indeterminate. No risk factors were associated with alloimmunisation. Conclusion: In Burkina Faso, screening for RBC alloantibodies should be mandated for patients at risk. The high rate of indeterminate antibodies suggests the need to develop a local RBC antibody panel adapted to the local population.

[Alloimmunisation in polytransfused patients with non-phenotyped red blood cells at the University Hospital Souro Sanou of Bobo Dioulasso (Burkina Faso)]. / Allo-immunisation chez les patients polytransfusés avec des concentrés de globules rouges non phénotypés au Centre Hospitalier Universitaire Souro Sanou de Bobo Dioulasso (Burkina Faso).

Introduction: in Burkina Faso, blood transfusion is carried out with only ABO and RHD compatibility between the donor and the recipient. Such a practice carries risks of alloimmunisation, which can lead to clinical complications especially in polytransfused patients. The objective is to determine the prevalence and factors associated with alloimmunisation in polytransfused patients with non-phenotyped red blood cells at Souro Sanou University Hospital. Methods: we conducted a cross-sectional study in polytransfused patients in the clinical departments of the University Hospital Souro Sanou over a 3-month period (March to May 2019). In each of the 141 patients included, 5 ml of whole blood was collected in an ethylenediaminetetraacetic acid (EDTA) tube for testing for irregular antibodies. Irregular antibody testing was performed using the indirect Coombs gel filtration technical. Results: in total, the frequency of alloimmunisation obtained was 5.67%. The majority of the antibodies identified belonged to the Rhesus systems and Kell. We found no statistically significant relationship between age, sex, disease history, number of bags transfused and the positivity of the Irregular Antibody test (p = 0.37, p = 0, 75, p = 0.96). Conclusion: we found that the risk of alloimmunisation is major. Additional measures should be taken to strengthen the immunological safety of transfusions in Burkina Faso. We propose that in Burkina Faso, anti-globulin compatibility testing should be performed systematically in patients with a high risk of immunisation.

Distribution and Incidence of Blood-Borne Infection among Blood Donors from Regional Transfusion Centers in Burkina Faso: A Comprehensive Study.

There is a high prevalence of blood-borne infections in West Africa. This study sought to determine the seroprevalence of blood-borne infections, including hepatitis B virus (HBV), hepatitis C virus (HCV), HIV, and syphilis, in blood donors in Burkina Faso. Blood donors were recruited from 2009 to 2013 in four major cities in Burkina Faso of urban area (Ouagadougou) and rural area (Bobo Dioulasso, Fada N'Gourma, and Ouahigouya). Serology tests including hepatitis B surface antigen, anti-HCV, anti-HIV, and rapid plasma reagin test were used for screening and were confirmed with ELISA. Disease prevalence was calculated among first-time donors. Incidence and residual risk were calculated from repeat donors. There were 166,681 donors; 43,084 had ≥ 2 donations. The overall seroprevalence of HBV, HCV, HIV, and syphilis were 13.4%, 6.9%, 2.1%, and 2.4%, respectively. The incidence rates (IRs) of HBV, HCV, HIV, and syphilis infection were 2,433, 3,056, 1,121, and 1,287 per 100,000 person-years. There was lower seroprevalence of HBV and HCV in urban area than in rural area (12.9% versus 14.0%, P < 0.001; and 5.9% versus 8.0%, P < 0.001), and no difference in HIV (2.1% versus 2.1%, P = 0.25). The IRs of new HBV, HCV, HIV, and syphilis were 2.43, 3.06, 1.12, and 1.29 per 100,000 person-years, respectively. The residual risk was one per 268 donations for HBV, one per 181 donations for HCV, and one per 1,480 donations for HIV, respectively. In conclusion, this comprehensive study from four blood donation sites in Burkina Faso showed high HBV and HCV seroprevalence and incidence with high residual risk from blood donation.

Seroprevalence and factors associated with IgG anti-DENV positivity in blood donors in Burkina Faso during the 2016 dengue outbreak and implications for blood supply.

OBJECTIVES: Our study aimed to update the seroprevalence and factors associated with anti-dengue virus (DENV) antibody positivity among blood donors and to discuss their implications for blood supply. BACKGROUND: Questions on the potential transmission of DENV by transfusion increased after the documentation of the risk of transmission of the West Nile virus. This risk was estimated after transfusion of DENV RNA-positive blood units of up to 37.5%. In Burkina Faso, very few studies on DENV in blood donors have been conducted. As a result, there were no reliable data on DENV to allow the implementation of appropriate measures to control the risk of transmission of the dengue virus by blood transfusion. METHODS: We conducted a 4-week cross-sectional study from December 4 to 30, 2016. Blood donors of both genders, aged 18-60 years, accepted for blood donation after medical selection were consecutively enrolled. RESULTS: Our study included a total of 1007 blood donors, in which donors living in urban areas represented 78.2%. The mean age was 26.1 ± 8.1 years. After adjustment in a multiple regression logistic model, the odds of having IgG anti-DENV increased as age increased. The odds of DENV was 53% lower in rural areas (OR = 0.47; P = .000) compared to urban settings and 42% lower in mobile sites (OR = 0.58; P = .03) compared to fixed ones. CONCLUSION: Our study provides new and useful insights for future research on the risk of TT-DENV throughout blood transfusion.

Blood transfusion requirements among children with severe malarial anemia: a cross-sectional study in a second level reference hospital in Burkina Faso.

INTRODUCTION: blood transfusion (BT) is an important part of pediatrics healthcare in sub-Saharan Africa because of anemia due to malaria, malnutrition and hereditary anomalies of red blood cells. However, BT services experienced chronic blood shortage, unsafe blood products and poor procedures of clinical use of blood. This results in inadequate management of severe anemia. METHODS: to assess the quality of BT requirements in severe malarial anemia at the regional hospital center of Koudougou in Burkina Faso, we carried out a cross-sectional study including 402 children with severe malaria (WHO 2000 criteria). RESULTS: over the study period, severe malaria represented 45.6% (402/882) of pediatric admissions. Anemia was observed in 97.5% (392/402) of cases and BT was required for 78.4% (315/402). The median age was 16 months (IQR 9-27) and the average hemoglobin was 51.4±22.2 g/L. The prescriptions were in accordance with WHO and national guidelines respectively in 63.8% and 92.7%. Blood units were issued in 99.4% (350/352) of blood orderings. Out of 350 blood units delivered, blood was administered in 98% (343/350). The median actual time to transfusion was 65 minutes (IQR: 45-100) and median transfusion duration was 73.8 minutes (IQR: 47.5-110). The signs of intolerance to anemia disappeared in 134/138 cases (97.1%) and the average haemoglobin increased of 37.9±17.6 g/L. Death occurred in 23 cases (5.7%). CONCLUSION: the management of severe malaria requires blood transfusion in almost half of cases. Blood was available to meet most requests. However, efforts are still required for proper use of the blood.

Residual risk of HIV, HCV, and HBV transmission by blood transfusion between 2015 and 2017 at the Regional Blood Transfusion Center of Ouagadougou, Burkina Faso.

INTRODUCTION: In sub-Saharan Africa, the high endemicity of blood-borne infections is a serious threat to transfusion safety. In order to improve transfusion safety, Burkina Faso has undertaken in recent years a reorganization of its blood-transfusion system through the creation of a National Blood Transfusion Center, which is the only blood operator in the whole country. This study aimed to estimate the residual risk of transmission of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) by blood transfusion at the Regional Blood Transfusion Center (RBTC) of Ouagadougou. METHODS: This was a retrospective study conducted at the RBTC of Ouagadougou between 2015 and 2017. Prevalence of infectious markers was calculated for first-time donors and incidence rates calculated for repeat donors who had made at least two donations of blood over the study period. Residual risks were estimated for the three viruses (HIV, HBV, and HCV) by multiplying the incidence rate per 100,000 person-years by the respective durations of serological windows. RESULTS: Between 2015 and 2017, of a total of 84,299 blood donors, 68,391 (81.13%) were first-time donors compared to 15,908 (18.87%) repeat donors. The seroprevalence of HBV (8.56%) was twice that of HCV (4.40%) and fourfold that of HIV (1.80%). Incidence rates were 1,215, 2,601, and 1,599 per 100,000 donations for HIV, HCV, and HBV, respectively. In contrast, the estimated residual risk for HCV (1 in 213 donations) was double that of HBV (1 in 408 donations) and four times that of HIV (1 in 1,366). CONCLUSION: The residual risk of transmission of these viruses by blood transfusion remains high in repeat donors. An effective donor-retention and education policy could help to reduce this residual risk.

Distribution of ABO and RHD blood group antigens in blood donors in Burkina Faso.

Geographical distribution of ABO and RHD antigens is important for blood transfusion services and population genetics studies. There are few data on this topic in Burkina Faso, a multi-ethnic country. Our study aims at reporting phenotypic and allelic frequencies of ABO and RHD blood groups among voluntary blood donors from various ethnical regions of Burkina Faso. We conducted a cross-sectional study including 81,486 blood donors. ABO allelic frequencies were determined using the Bernstein method. Differences in phenotypic distribution of blood groups were assessed using the chi-square test; a p value <0.05 being considered as statistically significant. We noticed that O+>B+>A+>AB+>O->B->A->AB- in our population. Phenotypic frequencies of blood groups A, B, O and AB were respectively 22.54%, 28.56%, 43.30% and 5.60%. RHD+was 92.24%. The allelic frequencies of A, B, O and D were respectively 0.1524; 0.1887; 0.6590 and 0.7214. We noticed statistical differences (p < 0.05) between these administrative regions which corresponded roughly to some natural ethnic areas. Indeed, the phenotype O was more frequent in the Central-west, Central and East regions corresponding to "Mossi," "Gourounsi," "Gourmantché" areas while the phenotype A and AB were more reported in "Boucle du mouhoun" and "Hauts-Bassins" regions where we have "Bwaba" and "Bobo." The phenotype O negative was less frequent in "Bwaba." Our study provides interesting information to blood services that will allow them to better refine their donor recruitment strategies.

Impact of Multiplex PCR in Reducing the Risk of Residual Transfusion-Transmitted Human Immunodeficiency and Hepatitis B and C Viruses in Burkina Faso.

BACKGROUND AND OBJECTIVE: The improved performance of serological tests has significantly reduced the risk of human immunodeficiency and hepatitis B and C viruses transmission by blood transfusion, but there is a persistence of residual risk. The objective of this study was to evaluate the impact of multiplex PCR in reducing the risk of residual transmission of these viruses in seronegative blood donors in Burkina Faso. METHODS: This cross-sectional study was conducted from March to September 2017. The serological tests were performed on sera using ARCHITECTSRi1000 (Abbot diagnosis, USA). Detection of viral nucleic acids was performed by multiplex PCR on mini-pools of seronegative plasma for HBV, HCV and HIV using SaCycler-96 Real Time PCR v.7.3 (Sacace Biotechnologies). Multiplex PCR-positive samples from these mini-pools were then individually tested by the same method. RESULTS: A total of 989 donors aged 17 to 65 were included in the present study. "Repeat donors" accounted for 44.79% (443/989). Seroprevalences for HIV, HBV, and HCV were 2.53% (25/989), 7.28% (72/989) and 2.73% (27/989), respectively. Of the 14 co-infections detected, HBV/HCV was the most common with 0.71% (7/989) of cases. Of 808 donations tested by multiplex PCR, 4.70% (38/808) were positive for HBV while no donation was positive for HIV or HCV. CONCLUSION: Our study showed a high residual risk of HBV transmission through blood transfusion. Due to the high prevalence of blood-borne infections in Burkina Faso, we recommend the addition of multiplex PCR to serologic tests for optimal blood donation screening.

Traceability of Blood Transfusions and Reporting of Adverse Reactions in Developing Countries: A Six-Year Postpilot Phase Experience in Burkina Faso.

Traceability is an essential tool for haemovigilance and transfusion safety. In Burkina Faso, the implementation of haemovigilance has been achieved as part of a pilot project from 2005 to 2009. Our study aims to evaluate the traceability of blood transfusions and reporting of adverse reactions over the 6-year postpilot phase. A cross-sectional study including all blood units ordered between 2010 and 2015 has been conducted in public and private health care facilities supplied with blood products by the transfusion center of Bobo-Dioulasso. The complete traceability was possible for 83.5% of blood units delivered. Adverse reactions were reported in 107 cases representing 2.1/1,000 blood units per annum. Transfusions of wrong blood to wrong patient were reported in 13 cases. Our study shows that the haemovigilance system in Burkina Faso must be improved. Healthcare workers have to be sensitized on how traceability and haemovigilance could impact the quality of care provided to patients.

Alopecia in consultations in the dermatology department at Burkina Faso: epidemiologic, clinical, and etiologic aspects.

BACKGROUND: Hair loss, or alopecia, in a man or woman can have major psychologic repercussions. AIM: The aim of this study was to describe the epidemiologic, clinical, and etiologic aspects of alopecia in our service. MATERIALS AND METHODS: A retrospective study was performed over two years. All patients of both sexes, who consulted a dermatologist for alopecia, were included. Sociodemographic, clinical, and etiologic data were collected. RESULTS: The prevalence of alopecia is 1.02%. It generally concerns young people who are pupils or students. Hair loss was generally asymptomatic; the onset was often progressive. Alopecia was diffuse in 13.20% of cases. It was noted that 13.20% involved partial alopecia. The scalp was scarred or inflamed in 54.71% of cases. Tinea (21 cases), Alopecia areata (14 cases), Keloid folliculitis (6 cases), androgenetic alopecia (4 cases), traction alopecia (4 cases) and cosmetic alopecia (2 cases) were the most common etiologies we found in our patients. CONCLUSION: This preliminary study shows few epidemiologic, clinic and etiological aspects of the alopecia in Black African.