[Epidemiological features of intestinal parasitic infection in Burkina Faso from 1997 to 2007]. / Aspects épidémiologiques des parasitoses intestinales rapportées au Burkina Faso de 1997 à 2007.

A retrospective review of parasitic intestinal infections reported to the Ministry of Health of Burkina Faso from 1997 to 2007 was conducted. Study focused on the results of 904,733 stool examinations performed for parasite detection in public hospital parasitology laboratories. The overall positivity rate for intestinal parasite infection was 54.7%. Protozoa and helminths were identified in 32.0% and 8.0% of stool examinations respectively. The main parasites checked for were amoebas (29.8%), hookworms (5.7%), tapeworms (1.7%) and Schistosoma mansoni (1.6%). Parasites were detected throughout the country and the proportion of positive samples differed significantly from one region to another. These findings highlight the high frequency of laboratory diagnosis of intestinal parasitic infection and demonstrate the need to improve environmental sanitation and provide health education to the population.

[In vitro susceptibility of 232 isolates of Plasmodium falciparum to antimalarials in Burkina Faso (West Africa)]. / Etude de la sensibilité in vitro de 232 isolats de Plasmodium falciparum aux antipaludéens au Burkina Faso (Afrique de l'Ouest).

Plasmodium falciparum in vitro susceptibility to chloroquine, quinine, mefloquine and halofantrine was investigated in patients living in Bobo-Dioulasso (Burkina Faso, West Africa). Our study was carried out from July to November 1997 at the Malaria Chemoresistance Reference Centre, Centre MurazIOCCGE. Inclusion criteria were: presence of a single infection by R falciparum with a parasite count > or =4000 infected red cells/mm3. The susceptibility to drugs was measured after an incubation period of 48 hours at 37 degrees C, under 5% CO2. (3H) Hypoxanthine was added to the medium to monitor parasite growth. 134 isolates of P. falciparum were tested against chloroquine; 24.6% (33/134) were resistant. We have also documented 11.2% (15/133) of resistant isolates to halofantrine. All the tested isolates were susceptible to quinine (n=135) and mefloquine (n=136). A significant positive correlation was found between the following IC50 values: chloroquine-quinine, quinine-mefloquine and mefloquine-halofantrine. Our study shows no significant increase of the prevalence of chloroquine-resistant strains of P. falciparum in our study area; as well as the persistence of resistance to halofantrine with regard to previous publications in the subject.

[Malaria morbidity in adults living in urban Burkina Faso]. / Morbidité palustre, notamment chez l'adulte, en milieu urbain au Burkina Faso.

Urbanization in countries located in areas of endemic malaria can decrease the level of immunization and make malaria a more serious public health problem in adults. The purpose of this prospective study was to describe the clinical and parasitological features of malaria in adults in the city of Bobo Dioulasso in Burkina Faso. Study was carried out between July and November 1992 at the medical testing laboratory of the Muraz Center in 494 patients including 378 adults and 116 children under the age of 15 years. The parasitic index was 23% in adults as compared to 62% in children. There was not a significant difference in the parasitic index according to whether the place of residence was located in the city center or outlying suburbs. Parasite density ranged from 6 to 145,000 parasites per mm3 in adults as compared to 6 to 426,000 parasites per mm3 in children. Median parasitemia was 696 parasites per mm3 in adults as compared to 8800 per mm3 in children. The threshold of parasitemia for appearance of clinical symptoms was thus lower in adults than in children. Because of the poor positive predictive value of the main clinical features and the high incidence of self-treatment, microscopic examination is indispensable to confirm diagnosis of malaria. The results of this study indicate that urbanization in the city of Bobo Dioulasso has not significantly changed the level of immunization to malaria in adults.

[Economics of health care in Mali]. / Economie de la santé au Mali.

From the results obtained regarding the financing of health care in Mali, we emphasize two important points. First, there is a lack of criteria for the distribution of finding in the health care sector, resulting in a waste of resources. Secondly, there is an absence of adequate pharmaceutical policies. The field studies led in 1987 provided the following observations. The rate of occupation of the beds is very low. Also, the numerous new investments are not yet put into service because of the lack of necessary equipment of qualified personnel. In addition, this does not consider the excessive investments occurring in certain localities where neither the rate of frequentation nor the economic conditions will ever allow the use of the capacity created. Among the possible solutions for the crisis of health care funding in Mali, the following should be priority: first, to fight against the complete lack of organization of the activities at the health care centers; secondly, to fight against the waste and misappropriation of money resulting from the behavior of the medical and paramedical personnel: and thirdly, to clarify the management of the resources coming from the charges for each service. The pharmaceutical policies adopted and implemented in recent years Largely contributed to, first, the creation of competition between essential generic medications and nongeneric medications that can be replaced, and then, the destruction of the public network of drug distribution. These conditions considerably limited the distribution of essential medications; yet, this is the only manner of reducing the pharmaceutical expenses and accordingly, allowing more funding for other medical services. As the distribution network is disorganized, the only alternative for the population to obtain the medications at the lowest price was to create centers of purchasing and distribution and to multiply the number of retailers of essential medications. Extensive work has been conducted in the health care sector in Mali, accompanied by concrete proposals allowing for improved functioning of the system. However, despite these improvements, these conclusions are rarely considered by the health policy makers. This is because behind the financial aspects of health services, there is an important political stake. Also, the governments of many countries, including Mali, had to resort to adjustment programs that reduce their maneuverability of economic policies in general, and of health care policies in particular. The sponsors "give" large sums of financial aid to the health care sector, but are not interested in the results. The promotion of the health care sector requires a courageous political will. In contrast, microeconomic studies allowed the creation of the first community health centers in Mali. These examples, now followed in many village throughout Mali, constitute the hope of the health care sector.

[The simplified isotopic microtest: a method for studying the drug resistance in vitro of Plasmodium falciparum to antimalarial drugs]. / Le microtest isotopique simplifié: une méthode pour l'étude de la chimio-résistance in vitro de Plasmodium falciparum aux antipaludiques.

We evaluated the efficiency of the simplified version of the isotopic microtest (simplified test) and compared it to that of the complete version (standard test), for determining the susceptibility of local strains of Plasmodium falciparum to chloroquine, quinine, mefloquine and halofantrine. The study was carried out from July to November 1996, at the MURAZ Center, Bobo-Dioulasso, Burkina Faso. The inclusion criteria were: single infection with P. falciparum, with a parasite count of at least 4,000 infected red blood cells per mm3. Susceptibility to each drug was determined after incubation for 48 hours at 37

[How to perform and interpret the results of a chemoresistance test of Plasmodium falciparum in malaria patients in a tropical region]. / Comment réaliser et interpréter les résultants d'une épreuve de chimiorésistance de Plasmodium falciparum chez les sujets malades en zone tropicale.

Since the emergence of chemoresistant malaria in Africa at the end of the 1970's, many scientific papers have been published. However, terms used in chemoresistant studies and interpretation of tests are not always appropriate. Based on the usual operative definitions, this paper updates methods of chemoresistance study, interpretation of tests and the course of action to take in case of resistance. Our emphasis is on symptomatic people. We distinguish the clinical response and the parasitological response, two notions which are often confused. A diagram is presented for interpreting the different types of responses of in vivo testing in symptomatic people. For adequate case management of malaria, rigorous analysis of chemoresistant malaria and accurate interpretation of the test results are required.

Intérêt du dosage de l'hémoglobine pré-don au Centre National de Transfusion Sanguine de Bamako

Le but de cette étude était d'évaluer la qualité de la sélection médicale des donneurs de sang par le dosage de l'hémoglobine pré-don.Nous avons mené de novembre 2012 à février 2013 une enquête transversale auprès de 2097 donneurs de sang du Centre National de Transfusion Sanguine de Bamako. L'hémoglobinomètre HemoCue® a été utilisé pour le dosage de l'hémoglobine pré-don et les infections par le VIH, le VHC, le VHB, le tréponème et le plasmodium ont été dépistées.Nos résultats ont montré que 10,3% des donneurs de sang avaient un taux d'hémoglobine inférieur à la normale et le don de sang de ces personnes a été ajourné.Au total, 543 donneurs ont été exclus dont 217 par le dosage pré-don de l'hémoglobine soit 39.97% des exclusions aux dons. L'anémie était plus présente chez les donneurs volontaires (12,5%) que les donneurs familiaux (9,2%), d'où la nécessité et l'importance d'effectuer le dosage de l'hémoglobine pré-don pour la sécurité des donneurs, en particulier pour les donneurs volontaires.Notre étude a montré clairement que la sélection des donneurs peut être mieux améliorée en faisant le dosage de l'hémoglobine pré-don qui permet d'assurer une bonne qualité des produits sanguins capables de corriger une anémie et garantir la sécurité transfusionnelle

[An outline of a method for estimating the calculated economic cost of malaria cases: its application to a rural area in Burkina Faso (Western Africa)]. / Esquisse d'une méthode d'estimation du coût économique chiffré des accès palustres: application à une zone rurale au Burkina Faso (Afrique de l'Ouest).

A precise method to estimate the cost of malaria in a rural area was developed and applied in 3 villages in Burkina Faso. The estimate takes into account direct costs such as consultation fees, microscopic examinations, medication and transport as well as indirect costs caused by lost work-days. The formula uses 6 variables: age of subject, degree of invalidity, duration of illness, profession, income and percentage of income lost. In the region of Bobo-Dioulasso, 3065 health centre clients were registered in the course of the study: 17% had been clinically diagnosed as having malaria but this was confirmed microscopically in only 11.6% of cases; 73.1% were children aged < 5 years, 13.9% children aged 6-15 years, 12.2% adults aged 16-50 years and 0.8% adults aged > 50 years. Most patients worked in agriculture and trade. The average duration of illness was 4 days, with each case incurring a cost of $11.7 comprised of $8 direct costs and $3.7 indirect costs.

In vitro sensitivity of Plasmodium falciparum to halofantrine compared with chloroquine, quinine and mefloquine in the region of Bobo-Dioulasso, Burkina Faso (West Africa).

The in vitro sensitivity of P. falciparum drug-resistant isolates was evaluated in the region of Bobo-Dioulasso during the 1995 and 1996 rainy seasons. Two routinely used antimalarials (chloroquine and quinine) and two new antimalarials (mefloquine and halofantrine) were assessed using 24-hour in vitro cultures with tritiated hypoxanthine and a parasite density > or = 4,000/microl of blood. The proportion of chloroquine-resistant isolates was 20% in 1995 and 19% in 1996, whilst in 1996, the proportion of isolates resistant to halofantrine was greater than in 1995 (9.6% versus 1%). No significant differences were seen in the mean IC50 values in relation to the susceptibility of chloroquine-resistant or chloroquine-sensitive isolates to mefloquine and halofantrine. In the case of quinine, the mean IC50 values were significantly higher in chloroquine-resistant isolates than in chloroquine-sensitive ones. A significant positive correlation was found between the following IC50 values: chloroquine versus quinine, quinine versus mefloquine and mefloquine versus halofantrine.

Chloroquine and sulphadoxine-pyrimethamine efficacy for uncomplicated malaria treatment and haematological recovery in children in Bobo-Dioulasso, Burkina Faso during a 3-year period 1998-2000.

We determined the parasitological resistance and the clinical failure to chloroquine (CQ) and sulphadoxine-pyrimethamine (SP) by the WHO 14-day in vivo test over three consecutive years in 948 children aged 6-59 months with uncomplicated malaria attending four health centres in the province of Houet, Burkina Faso. Children were alternatively allocated to either CQ or SP. Packed cell volume (PCV) was measured at days 0 and 14. Parasitological resistance (RI, RII and RIII) to CQ was 18% (83 of 455) and to SP <1% (two of 308). Clinical failure with CQ was 12% (53 of 455) with no evidence of increase over time. Only one case of clinical failure was detected among the children treated with SP. The prevalence of anaemia (PCV <25%) was about 40% at day 0 and had decreased substantially by day 14 in both groups. However, in children treated with SP the prevalence of anaemia at day 14 was significantly lower than in those treated with CQ:RR = 3.15 (95% CI: 1.33-7.42, P = 0.008). CQ and SP are still efficacious for the treatment of uncomplicated malaria in children, at least in this area of Burkina Faso. However, the prevalences of CQ resistance reported from other areas of the country are worrying because of its potential spread. Regular surveillance of resistance to commonly used antimalarial drugs should continue.

Enquête sanitaire de base sur les bilharzioses dans la zone d'amenagement hydro-agricole de Bagre Burkina Faso

Les auteurs ont mene une etude sur la prevalence des bilharzioses (schistosomiases) dans la region de Bagre; province du Boulgou (Burkina Faso) avant la mise en eau du barrage hydro-agricole. En aout 1991; ils ont effectue la recherche des oeufs de schistosoma haematobium chez 158 sujets et des oeufs de schistosoma mansoni chez 146 d'entre eux. Le taux de prevalence de la schistosomiase urinaire a ete de 36;7 pour cent. Ils n'ont pas trouve de schistosomiase intestinale. La protection malacologique effectuee en janvier 1992 a montre la presence de bulinus du groupe truncatus/tropicus; hotes intermediaires de la bilharziose urinaire et de planorbis du groupe pfeifferi; hotes intermediaires de la bilharziose intestinale. La presence du parasite et des hotes intermediaires des 2 formes de schistosomiase doivent faire craindre une extension de cette endemie avec les populations immigrantes; et imposer une surveillance epidemiologique continue

Situation de la chimioresistance du paludisme dans les Etats membres de l'OCCGE de 1991 a 1994

La chimioresistance du paludisme depuis son apparition dans les pays de l'OCCGE vers la fin des annees 1980 fait l'objet d'une surveillance organisee en reseau sous la coordination du CRCP (Centre de Reference de la Chimioresistance du Paludisme). La situation de la chimioresistance du paludisme dans ces pays de 1991 a 1994 a ete dressee a la suite des ateliers de 1993 et 1995