Determinants and causes of mortality in HIV-infected patients receiving antiretroviral therapy in Burkina Faso: a five-year retrospective cohort study.

In this study, we investigated the causes of death and the factors associated with mortality in a cohort of patients receiving highly active antiretroviral therapy (HAART) in Burkina Faso, an African country with limited resources. This retrospective cohort study included patients aged 15 years and older who started HAART for the first time between January 2003 and December 2008 in 14 health districts. We used survival analyses, including the Kaplan-Meier method, to examine potential predictors of death and two Cox proportional hazard models to estimate hazard ratios for death, first from baseline covariates and then from time-dependent covariates. A total of 6641 patients initiated HAART during this period; of these, 5608 were included in the analysis. By the end of the study period, 4310 of those patients were still receiving HAART, 690 had died, 207 had been transferred and 401 were lost to follow-up. The median duration of follow-up was 23.2 months [interquartile range (IQR): 12.4-36.9], and the overall incidence of mortality was 6 per 100 person-years. The clinical stage, CD4 count, body mass index (BMI), haemoglobin level, HAART regimen, gender, age, profession and year of initiation were the primary risk factors associated with death. In the multivariate analysis, BMI, clinical stage, treatment regimen and CD4 count remained significantly associated with death. The most frequent causes of death were wasting syndrome, tuberculosis and anaemia. This result highlights the already advanced stage of immunodeficiency among patients in Burkina Faso when they start HAART. Testing patients for HIV and starting antiretroviral therapy earlier are necessary to further reduce the mortality of patients living with HIV. This study provides a solid evidence base with which future evaluations of HAART in Burkina Faso can be compared.

[Self-disclosure of a HIV-positive serostatus: factors favoring disclosure and consequences for persons living with HIV/AIDS in Burkina Faso]. / Partage de l'information sur le statut sérologique VIH positif : facteurs associés et conséquences pour les personnes vivant avec le VIH/sida au Burkina Faso.

UNLABELLED: Disclosure of HIV-serostatus remains a way to avoid sexual transmission of HIV because it allows partners to take the necessary protective measures, e.g. use of condoms. Disclosure is nevertheless difficult due to the discrimination associated with HIV. The objective of this study was to analyze factors leading to self-disclosure of HIV-positive status within a sample of persons of both sexes attending different healthcare services in Burkina Faso. METHODOLOGY: Cross-sectional study conducted by interviewing 740 patients in 26 healthcare services. Univariate (Chi(2) test) and multivariate (logistic regression) analyses were performed. The significance level was 5%. Qualitative data on factors associated with self-disclosure of HIV-positive status were analyzed. RESULTS: The majority of the patients (81.4%) informed at least one person who was very often a close relative (descendant, ascendant and sibling) or the partner. At multivariate analysis, HIV-serostatus was associated with using antiretroviral treatment, (OR=0.40, 95% CI: 0.3-0.7, P<0.001), known HIV-serostatus for at least one year (OR=0.6; 95% CI: 0.4-0.9), living in couple (2.3; 95% CI: 1.4-3.8). CONCLUSION: In a context limiting HIV testing due to the fear of social stigma, these results appear to be in favor of the Voluntary Counseling Testing model with a focus on the couple and/or families.

User fees and access to ARV treatment for persons living with HIV/AIDS: implementation and challenges in Burkina Faso, a limited-resource country.

Access to antiretroviral (ARV) treatment remains a crucial problem for patients living with HIV/AIDS (PLWHA) in limited-resources countries. Some African countries have adopted the principle of providing ARV free of charge, but Burkina Faso opted for a direct out-of-pocket payment at the point of care delivery, with subsidized payments and mechanisms for the poorest populations to receive these services free of charge. Our objectives were to determine the proportion of PLWHA who pay for ARV and to identify the factors associated with ARV access in Burkina Faso. A cross-sectional study was performed in 13 public health facilities, 10 Nongovernmental Organizations and association health facilities, and three faith-based health facilities. In each facility, 20 outpatients receiving ARV were interviewed during a routine clinic visit. A multivariate analysis by logistic regression was performed. Among the expected 520 patients receiving ARV, 499 (96.0%) were surveyed. The majority of patients (79%) did not pay for their ARV treatment, thereby limiting cost recovery from patient payments. In a multivariate analysis, level of education and income were associated with free access to ARV. Patients with no education more frequently received free ARV than those who had received some level of education (OR 2.7, 95% CI [1.3-5.6]). Patients without any income or with less than US$10 per month were more likely to receive free ARV (OR 2.6 [95% CI 1.3-5.2]) than those who earned more than US$10 per month. However, 16% of patients without any income and 21% of those without employment paid for ARV, and the costs of drugs for opportunistic infections, food, and transport remained a burden for 85%, 91%, and 74%, respectively, of those who did not pay for ARV. Free access to a minimum care package for every PLWHA would enhance access to ARV.

Quality of antenatal care and obstetrical coverage in rural Burkina Faso.

Improving maternal health is one of the Millennium Development Goals of the United Nations. Despite the efforts to promote maternal and neonatal care to achieve this goal, the use of delivery care remains below expectations in Burkina Faso. This situation raises the question of the quality of care offered in maternity wards. The aim of this study was to identify primary healthcare facility and antenatal care characteristics predictive of an assisted delivery in rural Burkina Faso. A cross-sectional study was carried out in Gnagna province (North-East Burkina Faso) in November 2003. The operational capacities of health facilities were assessed, and a non-participating observation of the antenatal care (ANC) procedure was undertaken to evaluate their quality. Scores were established to summarize the information gathered. The rate of professional childbirth (obstetrical coverage) was derived from the number of childbirths registered in the health facility compared to the size of the population. The established scores were related to the obstetrical coverage using non-parametric tests (Kendall). In total, 17 health facilities were visited, and 81 antenatal consultations were observed. Insufficiencies were observed at all steps of ANC (mean total score for the quality of ANC=10.3 +/- 3.0, ranging from 6 to 16, out of a maximum of 20). Health facilities are poorly equipped, and the availability of qualified staff remained low (mean total score for the provision of care was 22.9 +/- 4.2, ranging from 14 to 33). However, these scores were not significantly related to the rate of professional childbirth (tau Kendall=0.27: p=0.14 and 0.01, p=0.93 respectively). The ability of the primary health centres to provide good antenatal care remains low in rural Burkina Faso. The key factors involved in the limited use of professional childbirth relating to maternal health services may be the quality of ANC.

Reference values of IGF-I in children from birth to 5 years of age, in Burkina Faso, using blood samples on filter paper.

OBJECTIVES: The aims of this study were to validate the use of filter paper to measure insulin-like growth factor-I (IGF-I) and to establish normal levels of IGF-I in children appearing healthy, from birth to 5 years of age in an African population. METHODS: We determined IGF-I from blood collected on filter paper. We validated this method by comparing the IGF-I values from dried blood spots on filter paper (kept at 4 degrees C and ambient temperature) and from serum among 13 children under 5. IGF-I were measured by the classical IGF-I RIA, after separation of the IGF-I from its binding proteins, using Sep-Pak chromatography. To establish normal levels of IGF-I, we conducted a cross-sectional study and collected blood samples with filter paper among 360 children in Ouagadougou (Burkina Faso). RESULTS: IGF-I determined from dried blood spots on filter paper were in good agreement with IGF-I levels obtained from blood serum, whether the filter papers were kept at 4 degrees C or at ambient temperature. The results of IGF-I-levels in apparently healthy children showed that geometric mean IGF-I ranged from 27 microg/l in boys younger than five months to 31 microg/l in 5-year-old boys. In girls, mean IGF-I ranged from 29 microg/l for girls younger than five months to 45 microg/l at the age of 5. From birth to 24 months, IGF-I decreased by 0.32+/-0.08 microg/l/month in boys and by 0.27+/-0.06 microg/l/month in girls and these decreases were not significantly different (p=0.95). After the age of 24 months, there was an increase in IGF-I of 4.9+/-1.3 microg/l/year in boys and of 8.4+/-0.8 microg/l/year in girls. This increase was indeed significantly different (p<0.001). CONCLUSIONS: Reference values of IGF-I for African boys and girls were determined. They will be used for endocrine evaluations and nutritional monitoring.

[Management of severe acute malnutrition in an urban nutritional rehabilitation center in Burkina Faso]. / Prise en charge de la malnutrition aiguë sévère dans un centre de réhabilitation et d'éducation nutritionnelle urbain au Burkina Faso.

BACKGROUND: Management of acute severe malnutrition greatly contributes to the reduction of childhood mortality rate. In developing countries, where malnutrition is common, number of acute severe malnutrition cases exceeds inpatient treatment capacity. Recent success of community-based therapeutic care put back on agenda the management of acute severe malnutrition. We analysed key issues of inpatient management of severe malnutrition to suggest appropriate global approach. METHODS: Data of 1322 malnourished children, admitted in an urban nutritional rehabilitation center, in Burkina Faso, from 1999 to 2003 were analyzed. The nutritional status was assessed using anthropometrics indexes. Association between mortality and variables was measured by relative risks. Kaplan-Meier survival curves and Cox model were used. RESULTS: From the 1322 hospitalized children, 8.5% dropped out. Daily weight gain was 10.18 (+/-7.05) g/kg/d. Among hospitalized malnourished children, 16% died. Patients were at high risk of early death, as 80% of deaths occurred during the first week. The risk of dying was highest among the severely malnourished: weight-for-height<-4 standard deviation (SD), RR=2.55 P<0,001; low MUAC-for-age, RR=2.05 P<0.001. Kaplan-Meier survival curves and Cox model showed that the variables most strongly associated with mortality were weight-for-height and MUAC-for-age. Among children discharged from the nutritional rehabilitation centre, 10.9% had weight-for-height<-3 SD. CONCLUSION: The nutrition rehabilitation centre is confronted with extremely ill children with high risk of death. There is need to support those units for appropriate management of acute severe malnutrition. It is also important to implement community-based therapeutic care for management of children still malnourished at discharge from nutritional rehabilitation centre. These programs will contribute to reduce mortality rate and number of severely malnourished children attending inpatient nutrition rehabilitation centers, by prevention and early management.

Are patients who present spontaneously with PTB symptoms to the health services in Burkina Faso well managed?

SETTING: Six health districts selected from a total of 53 in Burkina Faso. OBJECTIVE: To evaluate the performance of the health services in identifying infectious pulmonary tuberculosis (PTB) cases in Burkina Faso. DESIGN: Retrospective review of initial consultation registers in the first level health centres and the laboratory and treatment registers kept at the Centres for TB Diagnosis and Treatment (CDTs) in 2001. RESULTS: The rate of detection of sputum-positive cases of PTB was 11.7 cases per 100000 population. Cough was the reason for consulting for 10.6% of 248,730 adults; 1.1% had chronic cough. Among patients with chronic cough, 66% had been referred for smear microscopy, 69.7% of whom were registered at the CDT to which they were referred. A positive diagnosis was made in 22.5% of the suspects referred and traced to the CDT. Among those with a positive diagnosis, 87.1% were put on treatment in the same CDT. CONCLUSIONS: The PTB case detection rate in Burkina Faso is low, due to the loss of cases at each of the stages leading to the diagnosis of TB. Case detection depends on the operational effectiveness of the staff working in the health services, as well as the referral of suspect patients to the CDT.

[Factors for non-observance of the extended program timetable for vaccination in health districts: the case of Boussé in Burkina Faso]. / Déterminants du non-respect du calendrier vaccinal du programme élargi de vaccination au niveau district sanitaire: cas du district sanitaire de Boussé, Burkina Faso.

UNLABELLED: Prevention through vaccination is a strong means to fight pediatric lethal diseases. In Burkina Faso, one of the main problems for vaccination is the non-respect of the vaccination timetable bringing about a significant reduction of validity of administered doses. OBJECTIVES: The authors had for aim to assess reasons for the non-compliance to the timetable. A transversal study was carried out in the Boussé health district to: 1) analyze the qualitative and organizational factors of the vaccination services linked to this non compliance; 2) analyze community factors accounting for this situation. POPULATION AND METHOD: The study target group included mothers of children aged 0 to 11 months vaccinated by the vaccination team of the Boussé health district from August 1st, 2003 to June 30th, 2004, and the vaccination team. Variables covered in this study included sociodemographic factors, the organization of vaccination campaigns, the mothers' perception of health service organization, the vaccination team's experience, vaccinal safety, knowledge of vaccination timetable. RESULTS: The following were identified as key factors for the non-observance of the vaccination timetable: poor organization of the vaccination services, inadequate competence of the vaccination team, poor educational level of mothers, poor communication level with mothers, postvaccination side effects. CONCLUSION: The study recommends the following: training of vaccination providers, a better organization of vaccination services, and the implementation of a communication plan.

[Capability of health services of the city of Ouagadougou to diagnose sexually transmitted diseases]. / Capacité de diagnostic des maladies sexuellement transmissibles par les structures de santé de la ville de Ouagadougou.

BACKGROUND: Quantitative and qualitative shortage of both human and material resources in the diagnosis of sexually transmitted diseases (STD's) remains one of the difficulties in dealing with these diseases in developing countries. The aim of this study was to determine the capability of health and medical laboratories personnel to diagnose STD's prevailing in Ouagadougou. METHOD: The study has been conducted in all the health centres and the medical laboratories of the town. The personnel ensuring out-patient clinics and the director of each medical laboratory have been interviewed. The interview as well as the assessment of the consulting room and the medical laboratories technical equipment were carried out. RESULTS: The range of STD's that the staff was able to point out was limited only to classical diseases. One member of the staff out of five mentioned two probable diagnoses of STD's in a case of a genito-urinary symptom. Errors in the diagnosis of vaginal discharge were significantly more frequent in the paramedical staff than in the medical one (p < 0.01), likewise the number of erroneous diagnoses of urethral discharge was more significant among the health agents in the private sector than those in the public sector (p = 0.04). The number of medical laboratories and the range of medical tests conducted in the town were lacking. Moreover, the results of these tests were not taken into account while prescribing the treatment for STD's. CONCLUSIONS: The above observations indicate a limited capability of the urban health services in establishing diagnoses of STD's on a rational basis. The transformation of current laboratory activities to a centralized specialized laboratory capable of a) identifying microorganisms circulating in the town and determine their magnitude and sensitivity to the main antimicrobials available, b) maintain regular surveillance of microorganism susceptibilities, and c) ensure quality control of laboratory tests conducted at a lower geographical level would contribute to the information and training of health care personnel and better acceptability of diagnosis and treatment strategies by this personnel.

[Preliminary information to patients and presentation by Burkinabe physicians of the results of HIV detection test in Burkina Faso]. / Information préalable des patients et annonce par les médecins burkinabé des résultats des tests sérologiques de dépistage de l'infection à VIH au Burkina Faso.

BACKGROUND: The action of individuals and their family is determining in the result of AIDS control and the knowledge of people's serological situation facilitates their involvement in AIDS control. This study was carried out in order METHODS: A transversal investigation through a self-administered anonymous questionnaire was carried out among the 250 Burkinabe physicians working in a public, private or religious health care sector. The questionnaire was sent by mail, attached to a response coupon. A response of 74% was obtained. RESULTS: Seventy seven physicians, that is 48.7% of the sample, informed patients who were likely to be HIV infected about their intention to ask for an HIV test. Seventy five physicians, that is 47.5% of the sample informed patients on the results of their serological tests on HIV infection. The characteristics of physicians who informed customers on the results of their serological test were similar to those of physicians who informed their patients on the demand for test concerning them. There were often specialists, physicians with long experience in medical practice and physicians more involving in curative consultations than in preventive ones (respectively 54.7% versus 23.3%, p=0.002). CONCLUSIONS: These results show the necessity of providing young physicians with counselling training, especially general practitioners who should be working in prevention services. Moreover, they constitute a basis for an objective discussion between physicians working in hospital, officials in charge of the national program for AIDS control and medical training schools.

[Assessment of management of patients with sexually transmitted infections in Burkina Faso]. / Evaluation de la prise en charge des cas d'infections sexuellement transmissibles au Burkina Faso.

BACKGROUND: In order to offer wide and efficient health care to patients, Burkina Faso has instituted the syndromic approach to sexually transmitted infections (STIs) since 1996. The current assessment has been carried out in view of measuring the degree of application of this approach in the management of the STIs in the health centres of the country. The assessment should specifically allow to: i) analyse the quality of the clinical health care of the patients coming in the health services with STI symptoms;ii) to determine the proportions of those patients to whom the care-provider give basic counselling on the use of condoms and the information of their sexual partners. METHODS: The study has been carried out from the 1(st) to the 28(th) July 2001 in all the 53 health districts and the two national hospitals of Burkina Faso. A one-day cross-section survey per health centres was used. The data were collected from a direct observation of the provider-patient relationship; and the handling of the anamnesis, the physical examination, the diagnosis and the prescriptions were analysed. RESULTS: During the survey, 358 patients had been consulted in the health centres. Only 4% of the patients who came in the health centres with STI or for STI consultation had been assessed and treated in accordance with national algorithm or WHO recommendations (Prevention indicator n degrees 6=4%); and 13% of those who came to consult with or for STI in the health centres had received basic counselling on condoms and the notification to their sexual partners (Prevention indicator n degrees 7=13%). CONCLUSION: These prevention indicators remain of a very weak level, showing therefore a poor quality of the management of STIs. Meanwhile, they show the areas of deficiencies on which a supervision and a recycling of the providers might bear.

[Nutritional status on admission and hospital mortality of under-five year old children with infectious diseases in Ouagadougou, Burkina Faso]. / Etat nutritionnel à l'admission et mortalité hospitalière des enfants de moins de 5ans atteints de maladies infectieuses à Ouagadougou, Burkina Faso.

BACKGROUND: It is known that malnutrition in childhood interacting with infectious diseases contributes to increase mortality. In Burkina Faso, infectious pathologies and malnutrition are public health problems. We examined the impact of malnutrition status, using the Weight-for-age (WA) index, on mortality of children hospitalized for infectious diseases. METHODS: This retrospective study uses a systematic sample derived from the year 1999 hospital register. In total data of 1573 children from 0 to 59 months were analyzed. The association between mortality and dependent variables was measured by relative risks (RR) in univariate analysis. A logistic regression was realized and attributable risk percent (etiologic fraction among exposed) of death was calculated. RESULTS: The total intra-hospital lethality amounted to 15.3%. Age, diagnosis, type of care recourse and malnutrition (low WA index) on admission were associated to mortality. The logistic regression model confirmed the high risks of deaths for young children (0-11m), children in malnutrition (low WA index) and those with severe malaria. The attributable risk percent of death indicates that, 87% of deaths are statically attributable to severe malnutrition (WA Z-score<=-3) and 64.3% of deaths are statically attributable to moderate malnutrition (WA Z-score]-3, -2]). CONCLUSION: Nutritional status evaluation would allow to select children at risk and reduce mortality by including nutritional intervention in standard treatment of children hospitalized for infectious diseases.

[Schistosomiasis endemic in Burkina Faso]. / L'endémie bilharzienne au Burkina Faso.

Burkina Faso, through the works of many teams of the OCCGE based in Bobo-Dioulasso, has signi-ficant data on several tropical endemics of which schistosomiasis. With the complementary works, it appears to be possible to establish a distribution of the schistosomiasis which reveals its importance. It will be the first stage of the planned national control program. The parasitologic data-gathering which covers the period of 1951 to 2000, used all the standard techniques. It is about Kato-Kartz and MIF for the intestinal schistosomiasis, centrifugation, filtration, serology reagent strips, macroscopy of urines and echography of the urinary system for the urinary schistosomiasis. All the eleven medical areas of the country have many sites submitted to parasitologic investigation. As regard the distribution of the two parasites involved with man (Schistosoma haematobium and S. mansoni), the data of prevalence (1% to 100%) and their distribution confirm their endemicity and the focal transmission. S. mansoni is located in eight medical areas particularly in the South and the West. S. haematobium is present in all the eleven medical areas of the country. In hydraulic planning as Sourou where the prevalences went from 23% to 70% for S. haematobium and from 0% to 69% for S. mansoni between 1987 and 1998. The situation requires a continuous monitoring. The spatial distribution of the six species of intermediate hosts shows that Bulinus truncatus and B. senegalensis Soudano-Sahelian species are present in all the ecological zones. B. globosus and Biomphalaria pfeifferi meet preferentially in the southern half of the country which reinforces the observation according to which the 14th northern parallel is often considered as the limit of septentrional extension of these two species. The other species Bulinus forskalii and B umbilicatus could have preference areas. All the species show a certain affinity with a type of biotope. The rarity and temporary aquatic systems lead to a concentration of the domestic and especially entertaining children activities around these biotopes very often contaminated. The phenomenon is amplified by the increase of contacts man-water, whose frequency and intensity are themselves dependent on activities related to hydro-agricultural planning. The analysis of the data shows, that in terms of colonization of the biotopes by molluscs and the relations between parasites and intermediate and final hosts, hydraulic planning turns out to be an amplifying factor of the species proliferation and parasitic flux host-parasite.

[Comparative study of 3 Schistosoma haematobium foci in Burkina Faso]. / Etude comparative de trois foyers bilharziens à Schistosoma haematobium au Burkina Faso.

The comparative study of the three most common schistosomiasis foci in Burkinabé villages shows a great disparity both in parasitological and malacological results. Parasitological investigations by reagent strips and urine filtration conducted on school children indicated respective prevalence rates of 85% at Thion, 37.5% at Donsin and 10.5% at Djerma. Malacological prospections found two species (Bulinus senegalensis and Bulinus truncatus) of intermediate hosts of schistosomiasis in the water biotopes in Thion and Donsin, and only one species (B globosus) at Djerma. We speculate that this situation could be related to initial levels of endemicity, to the distance between living quarters and sites of transmission, to sociological practices as well as to the mollusc vector species. Given the large distribution of these foci throughout the country, the Burkinabé medical authorities should recognise their importance with regard to the disease on a public health level and support the current orientation of the national schistosomiasis control programme which is coordinated around district health services.

[Parasitological profile of urinary schistosomiasis of the Sourou hydroagricultural complex of Burkina Faso]. / Profil parasitologique de la schistosomose urinaire du complexe hydroagricole du Sourou au Burkina Faso.

In the Sourou area of Burkina Faso, parasitological and malacological surveys of urinary schistosomiasis have been carried out in the constructed sites of Guédougou, Niasan and Débé dating respectively from 1967, 1986 and 1996. The investigations covered also the traditional villages of Lanfiera, Di, Poro, Tiao and Mara situated in the middle of the hydroagricultural planning for the first, very close to the lake for the second and about twenty kilometres distant for the three last. These towns represent the main sites in the Sourou area. The results of the parasitological surveys showed that urinary schistosomiasis was present in all sites. The levels of prevalence varied considerably: 70.3% in Guiédougou, 40.8% in Niassan, 8.5% in Débè in the irrigated zone, 55.6% in Lanfiéra, 56.8% in Di, 13.2% in Poro, 83.3% in Tiao and 64.7% in Mara. Concerning the malacological investigation, two species (Bulinus senegalensis and B. truncatus) were shown to be intermediate hosts of Schistosoma haematobium. The first was endemic to the area while the second was compatible with S. haematobium from the Sourou and other zones. Compared to the results of earlier investigations, the endemic had worsened with differences according to sites. This disparity of prevalence levels which has already been observed in other hydroagricultural area results from many factors, among which the impact of irrigation activities, the aquatic biotope system (irrigation canals, natural lake, pools and temporary rivers) and the type of contact of human communities with water rank high. Schistosomiasis expansion is amplified by the intermediate host dynamics and the introduction of new schistosomes carried by the new workers arriving from all over the country. In these conditions, in order to reduce rapidly prevalence levels, preventive measures should be centred on chemotherapy for the population. The treatment should be administered during a period of weak intermediate host density and be directed towards in-coming workers. Such an approach should be able to check the spread of schistosomiasis naturally occurring with the irrigation of new sites.

[Smoking in students in secondary schools in Burkina Faso]. / Tabagisme des élèves des établissements secondaires du Burkina Faso.

A multi-centre enquiry in 12 of 30 provinces of Burkina Faso was carried out to study smoking in pupils at secondary schools. The prevalence of smoking was 13.6 per cent. Amongst the smokers, occasional smoking was the most common, involving 62 per cent. Boys smoked more than girls. The average age of starting smoking was early, at 13.4 years. The majority of smokers consumed less than five cigarettes a day and the favourite place for consumption was the home of their parents or guardian and at school. The determinants of school smokers were above all environmental: the influence of friends and advertising. The students showed a good knowledge of the harmful effects of smoking. This knowledge was linked to their educational level and to their status as a smoker or non-smoker. The proportion of pupils who had obtained good results in the term which preceded the enquiry was more significant amongst the non-smokers than amongst the smokers. An awareness of the significance of smoking amongst pupils by their parents, guardians and teachers involves health education and rigorous legislative measures on advertising and these would contribute to some reduction in the extent of the phenomenon in educational establishments.

[Difficulties in quality of health evaluations in the context of an African hospital: experience of the Gynecology-Obstetrics Department of the National Hospital Center of Ouagadougou,Burkina Faso]. / Difficultés de l'évaluation de la qualité des soins dans un contexte d'hopital africain: l'expérience du Service de Gynécologie Obstétrique du Centre Hospitalier National de Ouagadougou, Burkina Faso.

The quality of medical care was studied in the gyneco-obstetrical department of the National Hospital Center of Ouagadougou, Burkina Faso. Evaluation covered not only facilities, procedures and results, but also patient satisfaction using standardized criteria. The results showed an apparent contradiction between poor facilities and high maternal and prenatal mortality rate on the one hand and proper use of procedures and good patient satisfaction on the other. Installation of a computerized medical record system should allow continuous monitoring of the quality of care in the context of a sub-Saharan hospital by providing ready access to simple standardized indicators especially of maternal and prenatal mortality.

[The financial costs of health care: a follow-up survey of women having a high-risk delivery]. / Le coût financier des soins de santé: enquête auprès de femmes ayant eu un accouchement à risque.

Our aim was to analyze the financial costs of health care for women in labor transferred to primary referral maternity units in childbirth at risk. Another aim was to consider the willingness of women and their husbands to financially save and support the increasing costs of health care. For 15 consecutive days, medical students interviewed all women transferred for a risky delivery in 12 of the 17 primary referral maternity units in Burkina Faso. The median cost for transferring the women and their necessary health care was approximately 30,500 CFA. The median cost for the kit of surgical supplies was 15,000 CFA; the costs of medicine and transportation fare for the woman and her husband were 14,000 CFA and 9,800 CFA, respectively. The median cost for the health care of the newborn was 2,400 CFA. When the decision for the transfer was made, the necessary money to pay for the expenses was available for only 40 out of 79 women. Women and their husbands were willing to save for health care either through existing community institutions such as groups of villagers and popular savings developments (69 women and men); or through annuity schemes to be created (33 women and men); or through banks (4 women and men). Four women and 6 men refused to contribute because of previous experiences of poor management of collective funds. The average savings were low and insufficient to cover the expected expenses for the transfer and care of the women. The savings were reserved for payment of the transportation fare for the women and their husbands to the referral units (21 women and 20 men), prescriptions (9 women and 5 men), the medical consultation (1 woman), and to provide for both (37 women and 39 men). The costs of health care are expensive. The poverty of the couple facing an urgent problem of life or death made them discover new options for investing in their available community associations such as groups of villagers and popular savings developments and other options such as annuity schemes. A policy directed towards the involvement of these populations could facilitate the transfer and treatment of women during their pregnancy.

[The use of contraceptive methods by the Mossi in a rural health district of Kaya, Burkina Faso]. / L'utilisation des méthodes contraceptives par les Mossi d'un district sanitaire rural de Kaya, Burkina Faso.

We investigated contraceptive practices in the rural health district of Kaya in Burkina Faso with the aim of a) comparing the sociodemographic and cultural characteristics of individuals who were well and poorly informed concerning contraceptive methods; b) analyzing the pattern of use of these contraceptive methods by the populations. We carried out a two-level cluster survey by the Hendersen method. For each household investigated, the chief, his wife (or one wife selected at random in polygamous families) and an adolescent (or one adolescent selected at random if there was more than one adolescent) were interviewed. Significantly more men than women were well informed concerning contraceptive methods. Similarly, a higher proportion of male adolescents than of female adolescents were well informed concerning contraceptive methods. The individuals who were well informed concerning contraceptive methods differed from those who were not well informed in terms of age, religion, level of education and radio listening habits. The prevalence of use of contraceptive methods in this study was found to be 4 to 36%, depending on the group studied. The majority of individuals expressed an intention to use contraceptive methods in the future: 59 to 78%, depending on the group studied. The contraceptive methods chosen for current and future use were, in order: the pill, condoms and contraceptive implants and the intrauterine device. Current patterns of contraceptive use favor, in decreasing order of preference, abstinence, the pill, condoms and contraceptive implants. There was also a strong tendency for individuals to experiment with diverse contraceptive methods. Thus, in the future, there is likely to be a trend towards the abandoning of abstinence in favor of the pill, condoms and contraceptive implants. Of these newer methods, condoms are likely to be the least popular and their relegation to a lower level of importance is likely to have disastrous consequences in terms of the prevention of HIV transmission by the sexual route. The results of this study indicate that information campaigns concerning contraceptive methods should be refocused on women and adolescent girls, condom promotion and maintaining the use of the methods chosen in the population.

[Chloroquine resistance of Plasmodium falciparum. Study of a surveillance method based on placental apposition and determination of blood chloroquine in pregnant women]. / Chloroquino-résistance de Plasmodium falciparum. Etude d'une méthode de surveillance reposant sur l'apposition placentaire couplée au dosage de la chloroquinémie chez la femme enceinte.

We investigated placental malaria infection and blood chloroquine concentration in pregnant women to assess a new method of monitoring the chloroquine resistance (CQ-R) of Plasmodium falciparum. We studied two groups of women: 96 women taking the usual prophylactic treatment of 300 mg chloroquine per week and 108 controls given no treatment. We carried out placental apposition, a thick smear and determination of blood chloroquine concentration after delivery. Malarial infection of the placenta was more frequent and the density of parasites higher in controls than in women given prophylaxis. Blood chloroquine concentrations were adequate in all women given prophylaxis (above 200 ng/ml, with a mean of 500 ng/ml). Twenty-six per cent of placentas in the treated group and 51% of placentas in the control group were infected. The placental infection rates for the two groups were compared. The frequency of chloroquine-resistant strains was about 50% (2 or 3 times higher than the CQ-R frequencies obtained in studies using in vivo tests). The simplicity of placental apposition makes this technique potentially valuable. However, determination of blood chloroquine concentration is also required and can only be carried out in a reference center.