Acceptability of children's testing for HIV infection during routine care activities in the Pediatrics Department of Sourô Sanou Teaching Hospital in Bobo-Dioulasso (Burkina Faso).

BACKGROUND: In order to contribute to the fight against the pediatric HIV infection, we have assessed, through a study in which we have systematically proposed to carry out children's testing, the rate of acceptability and the feasibility of children's HIV testing during the routine activities of the department. We have also analyzed the reasons for the acceptability or the refusal of the child's HIV testing by the accompanying person. METHODS: The study took place from May to September 2015 including all the parents/legal guardians of any child aged 0 to 14 years coming for a consultation or who was hospitalized in the Pediatric Department of Souro Sanou Teaching Hospital. Counseling sessions conducted by community health workers focused on informing and proposing the principle of child testing. After obtaining the verbal and informed consent of the accompanying person, the first test was performed with Determine® by a hospital health worker. A second SD Bioline®/ImmunoCombII® test was performed if the first test was positive. With children aged less than 18 months, after a positive antibody test, we resorted to PCR for confirmation. RESULTS: A total of 848 accompanying persons, 568 of whom were female, underwent a pre-test interview during which the HIV test was offered to them. The mean age of accompanying persons was 30 (25.5 to 38) years; 747 accompanying persons (88.1%) accepted the testing of their child. We have found an influence of the accompanying person's religion (P=0.02) and the type of accompanying person on the acceptability of children's testing. Mothers were more willing to accept the test compared to other accompanying persons (P=0.002). The main reason for refusing the child's testing was the absence of one of the child's parents, mainly the father whose opinion was needed. The test was positive for HIV1 in 10 children. CONCLUSION: In health centers, getting the informed consent from parents to test their children is a big challenge. However, our study shows that this is possible, through the high rate of acceptability obtained.

Value of chest X-ray in TB diagnosis in HIV-infected children living in resource-limited countries: the ANRS 12229-PAANTHER 01 study.

OBJECTIVE: To evaluate inter-reader agreement and diagnostic accuracy of chest radiography (CXR) in the diagnosis of tuberculosis (TB) in children with human immunodeficiency virus (HIV) infection. DESIGN: HIV-infected children with clinically suspected TB were enrolled in a prospective study conducted in Burkina Faso, Cambodia, Cameroon and Viet Nam from April 2010 to December 2014. Three readers-a local radiologist, a paediatric pulmonologist and a paediatric radiologist-independently reviewed the CXRs. Inter-reader agreement was then assessed using the κ coefficient. Diagnostic accuracy of CXR was assessed in culture-confirmed cases and controls. RESULTS: A total of 403 children (median age 7.3 years, interquartile range 3.5-9.7; 49.6% males) were enrolled. Inter-reader agreement was as follows: between local radiologist and paediatric pulmonologist, κ = 0.36 (95%CI 0.27-0.45); local radiologist and paediatric radiologist, κ = 0.16 (95%CI 0.08-0.24); and paediatric pulmonologist and paediatric radiologist, κ = 0.30 (95%CI 0.21-0.40). Among 51 cases and 151 controls, after a consensus, CXR had a sensitivity of 71.4% (95%CI 58.8-84.1) and a specificity of 50.0% (95%CI 41.9-58.1). Alveolar opacities and enlarged lymph nodes on CXR had limited specificity for TB (64.7% and 70.2%, respectively). Miliary and/or nodular opacities patterns on CXR were more specific to TB (specificity 94.3%). CONCLUSION: CXR showed poor-to-fair inter-reader agreement and limited diagnostic accuracy for TB in HIV-infected children, likely due to comorbidities. Radiological criteria for this specific population require further investigation.

[Serological markers of viral hepatitis B and C in children with sickle cell disease monitored in the Pediatrics Department at the University Hospital of Bobo-Dioulasso (Burkina Faso)]. / Étude des marqueurs sérologiques des hépatites virales B et C chez les drépanocytaires suivis en pédiatrie au CHU de Bobo-Dioulasso (Burkina Faso).

Viral hepatitis B and C are universal public health problems. Burkina Faso is a high endemic area for hepatitis B. Patients with sickle cell disease are at risk. The aim of this study was to investigate and quantify the serological markers of viral hepatitis B and C among pediatric patients with sickle cell disease. This was a descriptive cross-sectional study, which took place from July to November 2014 at the Department of Pediatrics, University Hospital of Bobo- Dioulasso. The study included 44 SS and 26 SC sickle cell patients. General data (age, gender) and medical information (vaccinations, medical history including transfusion) were collected. Blood samples were taken for research and titration of serological markers of hepatitis viruses B and C with a commercial Elisa test on the ARCHITECT i1000® automat of Abbott Laboratories. The mean age of the patients was 7.98 years. Seventeen patients (13 SS and SC 4) had already been transfused at least once. The transfusion rate was significantly higher among the SS patients than among SC (29.5% and 15.3% respectively) patients. No patient with HBs Ag was been found. In two patients, the anti-HBc Ab was found alone. In 33% of cases, no markers of hepatitis B were found. Less than 20% of children fully vaccinated (N = 45) had a protective level of anti-HBs Ab (greater than 10 IU/l). The prevalence of anti-VHC Ab was 2.8%. No case of HBV-HCV co-infection was found. The prevention of infection is an important part of the management of sickle cell patients. Immunization against hepatitis B should be systematic. The results of this study assume that blood safety was good.

[Impediments to HIV testing in HIV-infected children and teenagers in Africa: look for them where they are!]. / Les obstacles au dépistage des enfants et adolescents infectés par le VIH en Afrique : chercher ces enfants, là où ils se trouvent !

A huge number of HIV-infected children and teenagers have no access to care or receive it very late. Of the 3.2 million infected children, 2.8 million should be receiving highly active antiretroviral treatment (HAART) but only around 700,000 actually are. The first reason for this failure is the lack of HIV testing among HIV-exposed infants and thus early diagnosis or, even more frequently, the lack of testing among older children and teenagers. The objectives of this article are twofold: to review the current situation and to advocate routine offers of HIV testing to HIV-exposed children and teenagers (exposed either through mother-to-child transmission or repeated transfusions) and those suspected to be HIV-infected (because of malnutrition, tuberculosis, or other associated diseases). Finally, adults living with HIV should be made aware of the need for routine HIV screening of their children, even when asymptomatic.

[Missed opportunities for immunization in pediatric unit of the Bobo-Dioulasso hospital (Burkina Faso)]. / Les occasions manquees de vaccination en milieu hospitalier pediatrique de Bobo-Dioulasso (Burkina Faso).

AIM: This study was to determine the prevalence of missed opportunities for immunization in the pediatrics unit of the Souro Sanou University Hospital. METHODS: This was a cross-sectional descriptive study conducted from May to June 2010 involving children aged 0-11 months, accompanying persons and health personnel. Self-questionnaires were administered to health personnel in order to gage their knowledge of vaccination practices. RESULTS: 177 children including 101 girls and 49 health workers were recruited. The vaccination rate for children targeted by the Expanded Programme on Immunization (EPI) was 38% in the city of Bobo-Dioulasso and the rate of missed vaccination occasions was 50%. The low level of parental education, ignorance of EPI targeted diseases and a poor organization of the vaccination unit were noted. CONCLUSION: The overall strategy for vaccine administration should be rethought in a country with limited resources such as Burkina Faso to optimize immunization, EPI target diseases contributing to the mortality and morbidity in these regions.

BUT: L'objectif était de déterminer la fréquence des occasions manquées de vaccination dans le département de pédiatrie du Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso. MÉTHODE: il s'agissait d'une étude transversale descriptive de mai à juin 2010 enrobant les enfants âgés de 0­11 mois, les personnes accompagnatrices, les agents de santé. Des auto-questionnaires ont été administrés au personnel de santé afin de récolter leur connaissance sur la pratique de la vaccination. RÉSULTATS: Avaient été inclus dans l'étude, 177 enfants dont 101 filles ainsi que leurs accompagnants et 49 agents de santé. Le taux de couverture vaccinale des enfants cibles du programme élargi de vaccination (PEV) dans la ville de Bobo-Dioulasso était de 38% et le taux des occasions manquées de vaccination était de 50%. L'enquête avait noté un faible niveau d'instruction des parents, la méconnaissance des maladies cibles du PEV ainsi qu'une mauvaise organisation de l'unité de vaccination. CONCLUSION: La stratégie globale d'administration des vaccins devra être repensée dans les pays à ressources limitées comme le Burkina Faso afin d'optimiser la vaccination, les maladies cibles du PEV contribuant à alourdir la mortalité et la morbidité dans ces contrées.

[Evaluation of stool microscopy and culture to assist the diagnosis of pulmonary tuberculosis in a tuberculosis endemic country]. / Évaluation de la microscopie et de la culture des selles dans le diagnostic de la tuberculose pulmonaire dans un pays d'endémie tuberculeuse.

OBJECTIVE: the aim of this study is to evaluate the performance of stool microscopy and culture in the diagnosis of pulmonary tuberculosis (PTB). MATERIAL AND METHOD: In resource-limited settings, PTB is mainly diagnosed in sputum by microscopy methods. In patients unable to provide sputum, invasive procedures are necessary to obtain alternative respiratory tract specimens. Because Mycobacterium tuberculosis complex (MTC) organisms are known to survive in gastric fluid, we hypothesized that swallowed MTC organisms would be detectable in stool samples. We compared the presence of MTC organisms in sputum and stool specimens collected at the same time from the same patients. RESULTS: We included samples routinely submitted to our laboratory of microbiological diagnosis from patients with suspected PTB. In addition, a stool specimen was collected within 24 h of the sputum collection or gastric aspirate. In the 57 patients included, sputum microcopy and culture confirmed respectively 9 (21%) and 15 (26%) cases. Stool samples made it possible to confirm 9 cases by microscopy and 5 cases by culture. The sensitivity of microscopy was 60% and that of culture 33%. Sputum analysis was negative for one HIV-infected patient, but the stool sample was positive and permitted the diagnosis of PTB. CONCLUSION: This study proves that despite the low sensitivity of stool cultures it can be an alternative or additional interesting sample for the diagnosis of PTB in patients who have difficulty expectorating.

[Epidemiological and clinical profile of cerebral palsy at the Bobo-dioulasso university hospital (Burkina Faso)]. / Profil epidemiologique et clinique des infirmites motrices cerebrales au centre hospitalier universitaire de Bobo-dioulasso (Burkina Faso).

INTRODUCTION: Cerebral palsy is the leading cause of motor disability in children. OBJECTIVE: To describe the epidemiological and clinical profiles of cerebral palsy in children seen at the of Bobo-Dioulasso University Hospital. POPULATION AND METHODS: This is a descriptive cross-sectional study prospectively conducted at the Department of Physical Medicine at the University Hospital of Bobo-Dioulasso over a period of one year from 1 July 2012 to 30 June 2013. Our study population consisted of all children aged between 0 and 15 years received during the study period displaying cerebral palsy symptoms. RESULTS: We studied 174 patients including 106 boys and 68 girls. The average age was 32.79 months. Etiological factors were dominated by prematurity (34.5%) and cerebral anoxia (25.86%). The main clinical presentations were diplegia (50%), quadriplegia (19.54%), hemiplegia (14.37%), monoplegia (10.34%) and triplegia (5.75%). The most common associated symptoms were epilepsy (15%), eye disorders (12.6%), and hearing problems (10%). CONCLUSION: Due to its frequency and disabling potential, cerebral palsy is a major public health problem in Burkina Faso. Its support in the African environment is heavily complicated by self-medication and traditional therapy.

INTRODUCTION: L'infirmité motrice cérébrale est la première cause du handicap moteur chez l'enfant. OBJECTIF: Décrire les profils épidémiologique et clinique de l'infirmité motrice cérébrale chez les enfants vus en consultation au Centre Hospitalier Universitaire de Bobo-Dioulasso. MATÉRIEL ET MÉTHODE: Il s'est agi d'une étude transversale descriptive à collecte prospective conduite dans le service de médecine physique du Centre Hospitalier Universitaire de Bobo-Dioulasso sur une période d'un an, allant du 1er Juillet 2012 au 30 Juin 2013. Notre population d'étude se composait de tous les enfants âgés de 0 à 15 ans, reçus en consultation durant la période de l'étude et présentant un tableau d'infirmité motrice cérébrale. RÉSULTATS: L'analyse a concerné 174 patients dont 106 garçons et 68 filles. L'âge moyen à l'inclusion était de 32,79 mois. Les facteurs étiologiques étaient dominés par la prématurité (34,5%) et l'anoxie cérébrale (25,86%).Les principaux tableaux cliniques étaient la diplégie (50%),la tétraplégie (19,54%),l'hémiplégie (14,37%), la monoplégie (10,34%) et la triplégie (5,75%). Les signes associés les plus fréquents étaient les crises comitiales (15%), les troubles oculaires (12,6%), les difficultés auditives (10%). CONCLUSION: De par sa fréquence et son potentiel incapacitant, l'infirmité motrice cérébrale constitue un problèmemajeur de santé publique au Burkina Faso.Sa prise en charge en milieu africainest lourdement grevée par l'automédication et la tradithérapie.

HIV infection and severe malnutrition: a clinical and epidemiological study in Burkina Faso.

OBJECTIVE: To define a clinical profile indicative of HIV infection in a population of severely malnourished children in Burkina Faso. A total of 433 children (average age, 19 months) were recruited at the Sanou Souro National Hospital, Bobo Dioulasso, Burkina Faso. RESULTS: Sixty-three per cent presented with marasmus, 13% with kwashiorkor and 24% with both forms of malnutrition. The prevalence of HIV infection in children aged over 12 months was 13.8%, with a marked predominance of HIV-1 (95.8%). Mother-to-child transmission was proven in 77% of the cases; in 10% of the observed paediatric AIDS cases, transmission may have occurred through multi-injections with contaminated equipment. Marasmus was the form of malnutrition most frequently associated with HIV (P < 0.001); its severity was exacerbated by HIV infection. Adenopathy (P < 0.0001), oral candidiasis (P < 0.0006), skin disorders (P < 0.01) and hepatomegaly (P = 0.01) appeared to be significantly related to HIV infection. Discriminant analysis revealed that the presence of adenopathies was the strongest indicator symptom of HIV infection. Multivariate analysis revealed that a clinical profile of marasmus, adenopathies and oral candidiasis (specificity, 82%) was indicative of HIV infection in this population. The short-term clinical prognosis was poor and usually led to the death of the child when seropositive (P < 0.001). CONCLUSIONS: Among children exhibiting severe malnutrition, HIV-positive children are distinguished by a high horizontal transmission rate, a high specific clinical profile and a very poor prognosis.

PIP: Clinically, malnutrition appears as the last stage in pediatric AIDS. It is, however, difficult to determine the causes of malnutrition without diagnostic facilities and in the absence of differentiating clinical criteria. The authors therefore set out to determine the prevalence of HIV in children, to assess the various modes of infection in children, and to define a clinical profile indicative of HIV infection in malnourished children. They found that among children exhibiting severe malnutrition, HIV-seropositive children are distinguished by a high horizontal transmission rate, a high specific clinical profile, and a very poor prognosis. The study population consisted of 433 severely malnourished children of average age 19 months, in the range 4-48 months, admitted to the Sanou Souro National Hospital in Burkina Faso. 63% presented with marasmus, 13%% with kwashiorkor, and 24% with both forms of malnutrition. 13.8% of children older than 12 months were infected with HIV; HIV-1 in 95.8% of these cases. Mother-to-child transmission was proved in 77% of cases; in 10% of the observed pediatric AIDS cases, transmission may have occurred through multi-injections with contaminated equipment. Marasmus was the form of malnutrition most frequently associated with HIV, with its severity exacerbated by HIV infection. Adenopathy, oral candidiasis, skin disorders, and hepatomegaly appeared to be significantly related to HIV infection. Discriminant analysis, however, revealed that the presence of adenopathies was the strongest indicator symptom of HIV infection. Multivariate analysis defined a clinical profile of marasmus, adenopathies, and oral candidiasis as indicative of HIV infection in the population. The short-term clinical prognosis for the infants was poor and usually led to the death of the child when seropositive.

[Impaired fertility in women infected with HIV-1. Implications for sentinel serosurveillance]. / Réduction de la fertilité chez les femmes infectées par le VIH-1. Implications pour la sérosurveillance sentinelle.

BACKGROUND: Given the relationship between HIV infection and fertility, antenatal clinic-based HIV prevalence may not provide a good estimate of the community HIV prevalence. The objective of this work was to evaluate the impact of HIV infection on fertility among women attending antenatal clinics in Bobo-Dioulasso (Burkina Faso), and to discuss possible implications on HIV sentinel surveillance. METHODS: In the context of a phase II/III clinical trial of a short course of Zidovudine during pregnancy (DITRAME - ANRS 049 trial) we consecutively proposed voluntary counselling and HIV testing (VCT) to 1349 women aged at least 18 years, carrying a pregnancy of 7 months or less and living in Bobo-Dioulasso. During pre-test counselling session, a standardised questionnaire was administered to collect detailed information regarding socio-demographic characteristics and obstetrical history. Blood samples were then taken and tested for HIV after written informed consent. RESULTS: Mean age (+/- standard deviation) at first sexual intercourse was similar among HIV-infected (HIV+) (16.7+/- 2; n=83) and HIV-negative (HIV-) women (16.9+/- 2; n=1336). However, HIV+ women aged 25 years and above had, on the average fewer pregnancies (3.8+/- 1.5; n=37) than HIV- women (5.0+/- 2.3; n=567), p<0.01. Similarly, these HIV+ women had, on average, less live births (2.8+/- 1.3; n=35) than HIV- ones (3.7+/- 2.1; n=555), p=0.02. Other sexual and obstetrical characteristics such as maternal age, proportion of primigravidae, stillbirths or spontaneous abortions were comparable between HIV+ and HIV- women. CONCLUSIONS: Our data suggest that the level of fertility of HIV+ women aged 25 years and above is significantly lower than for HIV- women. Therefore, HIV+ women in this age group are likely to be under-represented among antenatal clinic attendees. These findings suggest adjusting antenatal clinic-based HIV sentinel surveillance data for age and fertility in order to derive a good estimate of the community HIV prevalence.

[Suspected palpebral anthrax in children. (Apropos of 3 cases)]. / Suspicion de charbon palpébral chez l'enfant. (A propos de trois cas).

Anthrax is an infectious disease caused by Bacillus anthracis. It is primarily a disease of domestic animals. Human beings can be infected by contact with infected animals, soiled objects, thorns or insect stings. In its cutaneous form, it may produce lesions of the eyelids. The authors report three suspected cases of palpebral anthrax in children. The clinical diagnosis was evident. Scraping from the necrotic tissue showed thick Gram positive rods in two children. This aspect evokes Bacillus. All the patients responded to the Penicillin G. No complications were noted. Prevention of anthrax in Africa poses the difficult problem of health education for the local population and immunization programs for animals which can be infected by Bacillus anthracis.

[Risk factors for neonatal tetanus in western Burkina Faso. Case-control study]. / Facteurs de risque du tétanos néonatal dans l'ouest du Burkina Faso. Etude cas témoin.

A case control study was done in Bobo-Dioulasso (Burkina Faso) during a one year period (1989), to identify practices during the pregnancy and childbirth, environmental and sociocultural factors associated with the occurrence of neonatal tetanus.

[Sleeping sickness in children at Bobo-Dioulasso Hospital Center: apropos of 3 cases]. / La maladie du sommeil chez l'enfant au Centre hospitalier de Bobo-Dioulasso: à propos de 3 observations.

The authors report three observations of trypanosomiasis in children aged 3 to 13 years from Ivory Coast and Burkina Faso. Two cases were imported from Côte d'Ivoire and one originated from an old endemic area of Bobo-Dioulasso region in Burkina Faso. Clinical features were comparable to classical descriptions in adults but neurological findings were dominant. Two children were at the lymphatic stage. Treatment with melarsoprol in two cases and eflornithine in one case led to complete recovery. Active epidemiologic surveillance of this zoonosis should be maintained and the devastating pandemic of the beginning of the century should be remembered.

[Acute respiratory infections in pediatric hospital at Bobo-Dioulasso (Burkina Faso)]. / Les infections respiratoires aiguës en milieu hospitalier pédiatrique de Bobo-Dioulasso (Burkina Faso).

BACKGROUND: Acute lower respiratory tract infections are the primary cause of morbidity in developing countries. POPULATION AND METHODS: Six hundred and sixty seven children (379 boys, 288 girls, aged 0-30 months) admitted for lower respiratory tract infections from January 1990 to March 1991 were included in the study. Immediate medical history was collected from the mother. The weight, height, temperature and clinical manifestations, plus the results of chest X-rays, parasitologic and bacteriological examination of stools, and blood smear for malaria were recorded for each patient. Sero-immunologic study for HIV infection of 473 of the patients aged 12-36 months and their mothers also took part in a sero-immunological study for HIV infection. RESULTS: Lower respiratory tract infections were the second major cause of admission (16.8%) after malaria (28.7%). Infections peaked between 6 and 11 months of age (29.5%). The main diseases were pneumonia and bronchial pneumonia (54%) followed by bronchiolitis (21.7%). Almost half the patients were admitted during the hot, dry season. Two hundred and eighty seven patients (43.4%) were referred only after they had been suffering from the disease for 3 to 9 days, partly explaining the high level of mortality. One hundred and twenty one patients (20.9%) died; the main cause of death was staphylococcal pneumonia (57.9%), followed by pneumonia and bronchial pneumonia (29.3%). Some criteria for severity could be identified, based on pulmonary signs and symptoms and associated manifestations (dehydration, malnutrition, convulsions, anemia). Twenty two patients were positive for HIV-1 infection. CONCLUSIONS: This study confirms that acute lower respiratory tract infections remain a public health problem. Early diagnosis and treatment are necessary to reduce mortality.

[Clinical profile of cryptosporidiosis in a pediatric hospital environment in Burkina Faso]. / Profil clinique de la cryptosporidiose en milieu hospitalier pédiatrique au Burkina Faso.

Data concerning Cryptosporidium parvum infection in Black Africa are highly fragmentary. A 12-month study was carried out on 1392 stool specimens from children under 36 months of age with (n = 756) or without diarrhea (n = 629) in the Pediatric Department of Bobo Dioulasso Hospital in Burkina Faso. In 558 children HIV blood tests were also performed. The phenicated fuchsin technique was used to identify Cryptosporidia oocysts. Results were positive in 72 of the 1392 stool specimens tested (5.2%) and in 59 of the 756 stool samples from children with diarrhea (7.8%). Oocysts were not detected in any child under the age of 6 months and the highest incidence of infection was between 6 and 23 months. Detection of oocysts during this year long study was significantly higher from April to June, which corresponds to the beginning of the rainy season in Burkina Faso. Occurrence of diarrhea was not significantly correlated with parasite density. Presence of oocysts was correlated with malnutrition (p < 0.01) and rotavirus infection (p < 0.05). Of the 558 children who underwent HIV testing, only one was positive. In contrast the incidence of HIV infections in the overall population tested was 7%. This study indicates that cryptosporidiasis is a major factor in development of diarrhea and dehydration in the pediatric hospital setting of Burkina Faso. Two other notable findings are that occurrence of cryptosporidiosis is closely linked to hygiene in the population but is not significantly correlated with HIV infection in the pediatric setting in Africa.

[Maternal HIV infection and the anthropometric characteristics of children at birth in Burkina Faso. DITRAME Study Group]. / Infection maternelle par le VIH et paramètres anthropométriques de l'enfant à la naissance au Burkina Faso.

The aim of this study was to investigate the relationship between maternal HIV status and the anthropometric characteristics of children at birth. A cross-sectional study was conducted in Bobo-Dioulasso from January 1995 to May 1996. We included all mother-child pairs seen postpartum for whom the HIV status of the mother had been determined at an antenatal visit and anthropometric measurements had been taken for the child at birth. Birth weights below 2,500 g were classed as "low", body lengths of less than 47 cm at birth were described as "small birth size" and head circumferences of less than 33 cm were classed as "small". We included 956 mothers and 956 children in the survey. Low birth-weights were recorded more frequently among children born to HIV-infected mothers than among those born to uninfected mothers (23. 37% versus 15.6%; p = 0.006). Mean birth-weight, birth size and head circumference did not differ significantly between the children of HIV-infected and uninfected mothers. In multivariate analysis, HIV infection and primiparity were independently associated with low birth-weight. Maternal HIV infection was the only factor associated with small birth size. There was no relationship between head circumference and maternal HIV status. Thus, maternal HIV infection appears to be associated with low birth-weight and small birth size.

[Analysis of the genetic factors controlling malarial infection in man]. / Analyse des facteurs génétiques contrôlant l'infection palustre chez l'homme.

Genetic factors have clearly been shown to play a role in controlling malarial infection in animal models. There is now also increasing evidence for the genetic control of malaria in man. We carried out a segregation analysis based on blood parasite load phenotype for a population of the town of Bobo-Dioulasso (Burkina-Faso). This analysis demonstrated a strong genetic effect. Our results were not consistent with the segregation of a major gene and thus suggest that parasite load is under the control of minor genes. The genetic effect was stronger in children than in adults. We carried out a regression analysis in children and found that there was an association between the phenotype for blood parasite load and the q31-33 region of chromosome 5. We identified a gene in this region, Pfil1 (Plasmodium falciparum infection levels 1), which accounted for almost 50% of the variance in blood parasite load and which played a fundamental role in the control of infection. The 5q31-33 region contains several genes encoding cytokines that regulate T lymphocytes. The identification of genes controlling malarial infection opens up new possibilities for preventive and treatment strategies. It should be possible in the near future to identify individuals at risk of malaria, who would derive the greatest benefit from preventive and therapeutic measures. Finally, a deeper understanding of these genes controlling protective immune responses could be of value for the development of vaccines.

[HIV infection and hepatitis B co-infection: survey of prevalence in pregnant women in Bobo Dioulasso, Burkina Faso]. / Co-infection hépatite B et VIH: enquête de préevalence chez les femmes enceintes à Bobo Dioulasso, Burkina Faso.

We carried out this study to assess the prevalence of co-infection with hepatitis B and HIV-1 in african pregnant women. Nine hundred and seventeen pregnant women attending two antenatal clinics in Bobo Dioulasso, Burkina Faso, were included. The characteristics of the women were the following: a mean age of 26 years and 83.5% married; a mean gravidity and para of 4 and 3 respectively and a mean gestational age of 27 weeks of amenorrhea. Then sera were drawn to be tested for both hepatitis B and HIV-1. Sera tested positive for HIV-1 at ELISA were confirmed by Western Blot. Ninety eight women (10.7%) were Ag HBs carriers of whose 18.2% were positive for Ag HBe, 66.7% anti-HBe positive and 95.6% anti-HBc positive. The HIV-1 prevalence rate was 5.9%. Eight women were positive for both Ag HBs and HIV-1, giving a co-infection rate of 0.88%. The co-infection rate by hepatitis B and HIV-1 is very low in pregnant women in Bobo Dioulasso despite a high prevalence of these two infections.

[HBs antigen carrier state in pregnant women in Bobo Dioulasso (Burkina Faso)]. / Portage de l'antigène HBs chez les femmes enceintes a Bobo-Dioulasso (Burkina Faso).

The aim of this study was to evaluate the prevalence rate and the risk factors for the carriage of hepatitis B markers in pregnant women in Bobo Dioulasso, Burkina Faso. Out of 917 pregnant women recruited during antenatal care, 98 (10.7%) were HBs antigen positive. Among these ones, 18.2% carded HBe antigen, 66.7% antiHBe antibodies and 95.6% antiHBc antibodies. Two risk factors were identified: maternal age of 23 and 28 (RR = 2.33, chi2 =12.21, p = 0.005) and widowage (Fisher test RR = 6.43, p = 0.0016). This high prevalence of HBs antigen calls for systematic screening for hepatitis B during antenatal care along with an immunization policy toward women of reproductive age and newborns.

[Epidemiological profile of physical disability in rehabilitation centers of Burkina Faso]. / Profil epidemiologique du handicap physique en centre de reeducation au Burkina Faso.

OBJECTIVE: The objective of our study was to determine the epidemiological profile of physical disability in Burkina Faso. METHODS: This was an epidemiological survey conducted among 17 functional rehabilitation centers in Burkina Faso. Our study population consisted of 113 patients with physical disabilities met during the investigation. RESULTS: The analysis was performed on 113 patients with physical disabilities including 67 males and 46 females. The average age was 30 years. Diseases responsible for physical disability in Burkina Faso are dominated by hemiplegia (25%), limb trauma (19%), poliomyelitis (11%), cerebral palsy (11%), traumatized central neurological trauma (central) (9%), congenital malformations (6%) and paralysis of the sciatic nerve (5%). CONCLUSION: The epidemiology of disability in Burkina Faso is marked by the emergence of diseases like hemiplegia and the regression of diseases such as poliomyelitis and iatrogenic sciatic nerve palsies.

BUT: L'objectif de notre étude était de déterminer le profil épidémiologique du handicap physique au Burkina Faso. MATÉRIEL ET MÉTHODE: Il s'est agi d'une enquête épidémiologique conduite auprès de 17 centres de réadaptation fonctionnelle du Burkina Faso. Notre population d'étude était composée de patients présentant un handicap physique et rencontrés au cours de l'enquête. RÉSULTATS: L'analyse a porté sur 113 patients en situation de handicap physique dont 67 hommes et 46 femmes. L'âge moyen était de 30 ans. Les pathologies responsables du handicap physique au Burkina Faso sont dominées par les hémiplégies (25%), les traumatismes des membres (19%), les séquelles paralytiques de poliomyélite (11%), les infirmités motrices cérébrales (11%), les traumatisés neurologiques centraux (9%), les malformations congénitales (6%) et les paralysies du nerf sciatique (5%). CONCLUSION: L'épidémiologie du handicap est marquée au Burkina Faso par l'émergence de pathologies comme les hémiplégies et la régression de maladies telles la poliomyélite et les paralysies iatrogènes du nerf sciatique.

24-Month adherence, tolerance and efficacy of once-a-day antiretroviral therapy with didanosine, lamivudine, and efavirenz in African HIV-1 infected children: ANRS 12103/12167.

BACKGROUND: There is no data on long-term benefit of once-a-day antiretroviral therapy (ART) with combination of DDI, 3TC and EFV to allow its use in future therapeutic strategies. OBJECTIVES: To assess 24-month immuno-virological, adherence, tolerance, and effectiveness of a once-a-day ART with DDI, 3TC and EFV. METHODS: A phase 2 open trial including 51 children aged from 30 months to 15 years, monitored a once-a-day regimen for 24 months from 2006 to 2008 in the Departement de Pediatrie du CHUSS, at Bobo-Dioulasso in Burkina Faso. We tested immunological and virological response, adherence, tolerance and resistance of the treatment. RESULTS: Children with CD4 >25% at 24 months were 67.4% (33/49) CI 95% [54%, 80%]. The proportion of children with viral plasma RNA <300 cp / ml at 24 months of treatment was 81.6 % (40/49) CI [68.0% 91.2%]. Good adherence was obtained with more than 88% adherence > 95% over the 24 months. Drugs were well tolerated. CONCLUSIONS: Given the limited number of antiretroviral drugs available in Africa and the inadequacy of laboratory monitoring in support program, once-a-day treatment and especially the DDI-based combination strategies could be an attractive operational option.