The direct cost of dialysis supported by families for patients with chronic renal failure in Ouagadougou (Burkina Faso).

BACKGROUND: Chronic renal failure can lead to dialysis and/or a kidney transplant in the final stage. The number of patients under dialysis has increased considerably in the world and particularly in sub-Saharan Africa. Dialysis is a very expensive care. This is the reason why this study on the costs of dialysis management was initiated in Burkina Faso. The objective of the study is to determine the direct medical and non-medical costs of managing chronic renal failure among dialysis patients in Ouagadougou in 2020. METHODS: An analytical cross-sectional study was conducted. Data were collected in the hemodialysis department of three public university hospitals in Ouagadougou, Burkina Faso. All dialysis patients with chronic renal failure were included in the study. Linear regression was used to investigate the determinants of the direct medical and non-medical cost of hemodialysis. RESULTS: A total of 290 patients participated in this study, including children, adults, and the elderly with extremes of 12 and 82 years. Almost half of the patients (47.5%) had no income. The average monthly total direct cost across all patients was 75842 CFA or US$134.41.The average direct medical cost was 51315 CFA or US$90.94 and the average direct non-medical cost was 24 527 CFA or US$43.47. Most of the patients (45.2%) funded their hemodialysis by their own source. The multivariate analysis showed that the presence of an accompanying person during treatment, residing in a rural area, ambulatory care, use of personal cars, and treatment at the dialysis center of Yalgado Teaching Hospital were associated with higher direct costs. CONCLUSION: The average cost of dialysis services borne by the patient and his family is very high in Burkina Faso, since it is 2.1 times higher than the country's minimum interprofessional wage (34664 CFA or US$61.4). It appears that the precariousness of the means of subsistence increases strongly with the onset of chronic renal failure requiring dialysis. Thus, to alleviate the expenses borne by dialysis patients, it would be important to extend the government subsidy scheme to the cost of drugs and to promote health insurance to ensure equitable care for these patients.

Involving the health sector in the prevention and care of female genital mutilation: results from formative research in Guinea.

BACKGROUND: Despite efforts to reduce the burden of female genital mutilation (FGM) in Guinea, the practice remains prevalent, and health care providers are increasingly being implicated in its medicalization. This formative study was conducted to understand the factors that facilitate or impede the health sector in providing FGM prevention and care services to inform the development of health sector-based interventions. METHODS: Between April and May 2018, a mixed methods formative study was carried out using a rapid assessment methodology in three regions of Guinea-Faranah, Labe and Conakry. A structured questionnaire was completed by one hundred and fifty health care providers of different cadres and 37 semi-structured interviews were conducted with health care providers, women seeking services at public health clinics and key stakeholders, including health systems managers, heads of professional associations and schools of nursing, midwifery, and medicine as well as representatives of the Ministry of Health. Eleven focus group discussions were conducted with female and male community members. RESULTS: This study revealed health systems factors, attitudinal factors held by health care providers, and other factors, that may not only promote FGM medicalization but also impede a comprehensive health sector response. Our findings confirm that there is currently no standardized pre-service training on how to assess, document and manage complications of FGM nor are there interventions to promote the prevention of the practice within the health sector. This research also demonstrates the deeply held beliefs of health care providers and community members that perpetuate this practice, and which need to be addressed as part of a health sector approach to FGM prevention. CONCLUSION: As integral members of FGM practicing communities, health care providers understand community beliefs and norms, making them potential change agents. The health sector can support them by incorporating FGM content into their clinical training, ensuring accountability to legal and policy standards, and promoting FGM abandonment as part of a multi-sectoral approach. The findings from this formative research have informed the development of a health sector intervention that is being field tested as part of a multi-country implementation research study in Guinea, Kenya, and Somalia.

Despite the implementation of various interventions to prevent female genital mutilation (FGM), it is still widely practiced in Guinea, and health care providers are increasingly being implicated in the practice. We conducted research in three regions of Guinea, namely, Faranah, Labe and Conakry, to understand factors that might be addressed to strengthen the role of the health sector in prevention and care of women and girls who have undergone FGM. Our findings highlight the need to strengthen the capacity of health care providers to be able to identify cases of FGM and manage complications. The study also highlights the importance of engaging health care providers in efforts to prevent FGM, which will require that any trainings include an opportunity to discuss their own values and beliefs around FGM so that they are better equipped to communicate with their clients and patients in a sensitive and non-judgmental manner, whether during consultation visits or community health outreach activities. The results of this research have informed the development of a health system strengthening intervention package for the prevention and care of FGM, which is being tested in Kenya, Somalia, and Guinea.

Investigation of the water quality of daily used surface-sources for drinking and irrigation by the population of Segou in the center of Mali.

This study evaluates the quality and pollution status of source surface waters in Segou, Mali. The nature, sources, and extent of pollution of Comatex Stream, Cerfitex Pond, and Sonikoura River were studied for a period of twelve months (July 2016-June 2017). Analysis included 209 water samples collected from eleven different locations in the study area. Laboratory and field analysis were realized using the standard methods and concerned eleven parameters including four physicals, six chemicals and one bacteriological. Also, organoleptic parameters were observed. Most of the average values of parameters addressing the quality of water were significantly higher (P < 0.05) in both the stream and river compared to the pond. Fecal coliform counts (FCC) were not in significant correlation with the temperature; pH and turbidity; but had a significant and positive correlation (P < 0.05) with conductivity: total dissolved solids (TDS); total suspended solids (TSS); Cl-; PO4 -P; NO3 -N and 5-day biochemical oxygen demand (BOD5). Analysis of samples revealed a level of FCC that is above the permissible limit for both drinking water and of fresh vegetable irrigation water. In all, there is a pressing need to inform the public about the state of water bodies and the application of relevant laws regarding the proper treatment of sewage before it is discharged into surface water.

Drinking water quality and risk for human health in Pelengana commune, Segou, Mali.

Water is an indispensable commodity for the survival of all living beings and for their well-being. The objective of this work is to evaluate the level of pollution of different drinking water sources consumed and its link with health in Pelengana commune, Mali. Samples of water were taken from various sources, namely, hand pumps, boreholes, dug wells, and shallow wells for physical, chemical, heavy metals, and bacteriological analyses, using American Public Health Association (APHA) Standard Techniques. Results revealed that the nitrate-nitrogen (NO3 -N) values of the water samples from the different water sources had concentrations exceeding the United States Environmental Protection Agency's (US-EPA) regulation of 10 mg/L, as well as World Health Organization Guideline for Drinking Water Quality (WHO GDWQ) (11 mg/L). The same applies to heavy metals such as Cd, Pb, and Fe, in which, concentrations exceed their allowable limits in certain locations. Moreover, apart from water samples from some different boreholes, total coliform, and Escherichia coli have been detected in all selected water sources, which indicates fecal contamination. In all, there is a pressing need to stop the consumption of drinking water from contaminated sources and to effect appropriate treatment.

[National reference unit of neonatology: state of play]. / Unit6é de néonatologie de référence nationale du Mali: état des lieux.

BACKGROUND: The neonatal mortality rate in Mali is one of the highest in the world. Only one national reference neonatology unit is available in the country. AIM: To describe the time-course of morbidity, mortality, staff and accommodation facilities from 2008 to 2009 in Mali's unique national reference neonatology unit. METHODS: This descriptive and cross-sectional study was conducted in the neonatology unit of Gabriel Touré Teaching Hospital, Bamako. Data concerning staff number of admissions, sex ratio, diseases, patients outcome, capacity and length-of-stay were compiled for the period from 1st January 2008 to 31 December 2012. RESULTS: Medical staff increased from one to three in 2009 and the number of nurses and midwives decreased from 16 to 14 with an average number of beds of 44. The mean number of hospitalizations per year was 3,900 (range: 3667-4585) with 14% of in-born deliveries and a mean length-of-stay of 3.7 days. Prematurity birth asphyxia and infection represented 80.5% of reasons for admission and 79.5% of deaths. The mortality rate varied from 28.5% to 36.8% with an annual mean of 33.2%. The diseases associated with the highest mortality were tetanus (60.8%), prematurity (42.7%), birth asphyxia (29.4%) and infection (25.7%). CONCLUSION: Neonatal mortality remains very high in Mali. Health authorities should take measures to decentralize the care of sick newborns in order to reduce neonatal mortality in Mali.

Prevalence and factors associated with overweight in children under 5 years in West African countries.

Background: Overweight is a risk factor for non-communicable diseases and is affecting an increasing number of children worldwide. The objective of this study was to measure the prevalence and related factors to overweight among children under 5 years in five West African countries. Methods: This study was a secondary analysis of nationally representative cross-sectional data. These data were drawn from Demographic and Health Surveys (DHS) from five countries in the West African region (Benin, Guinea, Mali, Nigeria, and Togo) from 2015 to 2018.Continuous quantitative data were categorized and all analyses were weighted according to the probability that each participant was selected in the sample. Children under 5 years of age were the study population. Multilevel logistic regression was used with Stata 16.0 software. Results: The total sample size for the analysis was 38,657 children. The pooled prevalence of overweight among children under 5 years of age in the five countries was 3%. Guinea had the highest prevalence (6%) compared to the other countries, which had a prevalence of 2%. The likelihood of being overweight was higher among children aged 0-6 months (adjusted odds ratio [AOR] = 3.09; 95% confidence interval [CI] [2.41-3.95]), who had a high birth height (AOR = 1.64; 95% CI [1.29-2.09]), whose mothers were overweight (AOR = 1.35; 95% CI [1.09-1.68]), who lived in households with fewer than five members (AOR = 1.19; 95% CI [1.00-1.46]), or who lived in Guinea (AOR = 2.79; 95% CI [1.62-4.79]). Conclusion: This study showed that overweight concerns few children under 5 years of age in West Africa. However, it does exist, and its prevalence could likely increase if its modifiable factors (maternal overweight, household size, and height at birth) are not taken into account in nutritional interventions.

Silanization of Chitosan and Hydrogel Preparation for Skeletal Tissue Engineering.

Tissue engineering is a multidisciplinary field that relies on the development of customized biomaterial to support cell growth, differentiation and matrix production. Toward that goal, we designed the grafting of silane groups onto the chitosan backbone (Si-chito) for the preparation of in situ setting hydrogels in association with silanized hydroxypropyl methylcellulose (Si-HPMC). Once functionalized, the chitosan was characterized, and the presence of silane groups and its ability to gel were demonstrated by rheology that strongly suggests the presence of silane groups. Throughout physicochemical investigations, the Si-HPMC hydrogels containing Si-chito were found to be stiffer with an injection force unmodified. The presence of chitosan within the hydrogel has demonstrated a higher adhesion of the hydrogel onto the surface of tissues. The results of cell viability assays indicated that there was no cytotoxicity of Si-chito hydrogels in 2D and 3D culture of human SW1353 cells and human adipose stromal cells, respectively. Moreover, Si-chito allows the transplantation of human nasal chondrocytes in the subcutis of nude mice while maintaining their viability and extracellular matrix secretory activity. To conclude, Si-chito mixed with Si-HPMC is an injectable, self-setting and cytocompatible hydrogel able to support the in vitro and in vivo viability and activity of hASC.

Distribution of out of pocket health expenditures in a sub-Saharan Africa country: evidence from the national survey of household standard of living, Côte d'Ivoire.

OBJECTIVE: The purpose and objective of our research is to identify the determinants of the out of pocket (OOP) health expenditures in the population of Ivory Coast and the ratios across three different area; Abidjan, the rural and urban area. We used data from the 2015 standard households living survey conducted by the National Institute of Statistic. RESULTS: About 6315 (13.3%) of the participants had experienced OOP health expenditure. There was significant differences in the self-reported OOP between these three areas (p < 0.001). The overall mean of OOP expenditure among all participants was 16,034.33 XOF (29 USD). People in Abidjan spent an average of 1.6 and 1.5 times more than those in the rural and urban areas respectively (p < 0.001). Hospitalization is the highest expenditure item in terms of money spent, while drugs are the most common item of expenditure in terms of frequency, regardless of the place of residence. Female gender, high social economic status and large household size increase OOP health expenditure significantly in all areas of residence when insurance reduce it. To reduce the impact of the direct payments there is a need to take into account social demographic factors in addition to economic factor in health policy development.

A spatial database of lowland cropping systems in Benin, Mali and Sierra Leone.

This paper presents data collected in 2013, 2014 and 2015 on the cultural practices and agronomic performance of cropping systems in 500 lowland rice fields located in five regions of three West African countries, Benin, Mali and Sierra Leone. Data were collected in two stages. In the first stage, the main regions containing inland valleys were identified in each of the three countries and the most cultivated inland valley in each region was selected. Weather data were obtained from weather stations located close to the selected inland valleys. In regions with no weather stations, Tinytag data loggers were installed in the inland valleys to collect data on temperature, rainfall and relative humidity. In the second stage, the location and size of all the farmers' fields in each inland valley were determined using GPS devices. In 2013, soil samples were collected in each farmer's field and the soil physical-chemical properties were determined. Agronomic and socio-economic surveys were conducted to collect data on cultivated crops, crop sequences and management techniques using questionnaires and informal interviews. Crop yields were determined in each farmer's field in the growing season. The database contains a total of 131 variables divided into 9 themes: field characteristics, land preparation, field maintenance, irrigation, residue management, soil data, weather data, crop productions in the dry season and crop production in the rainy season.

Validation of two parent-reported autism spectrum disorders screening tools M-CHAT-R and SCQ in Bamako, Mali.

BACKGROUND: Early screening is crucial for early autism spectrum disorders (ASD) diagnosis and intervention. ASD screening tools have mostly been constructed based on the Western cultural context. We hypothesized that their use in Mali may require a prior validation. OBJECTIVE: To validate the modified checklist for autism in toddlers-Revised (M-CHAT-R) and the social communication questionnaire (SCQ) in the Malian sociocultural context for ASD screening. STUDY DESIGN: We administered M-CHAT-R and SCQ in 947 toddlers aged 16-30 months old at the district and community health centers in Bamako and 120 patients (60 autistic and 60 age and sex matched controls) aged ≥4 years old at the psychiatry department in Bamako. Toddlers at moderate to high risk of ASD underwent M-CHAT-R/F and clinical evaluation by an ASD multidisciplinary team. M-CHAT-R and SCQ were evaluated for cultural appropriateness by Malian anthropologists. The sensitivity, specificity, PPV, NPV were determined for both M-CHAT-R and SCQ. Health professionals have been trained during ASD seminary on how to use M-CHAT-R and SCQ for ASD screening in Bamako. RESULTS: We found for the M-CHAT-R a sensitivity of 50%, a specificity of 100%, a PPV of 100% and a NPV of 87%. The SCQ had a sensitivity of 71%, a specificity of 72%, a PPV of 73% and a NPV of 70%. We have found four out of 20 items on the M-CHAT-R that were culturally inappropriate in the Malian context. DISCUSSION: M-CHAT-R and SCQ can be used for early autism screening in Mali. In the future, we plan to train a descent number of Malian physicians in chief and pediatricians at the district hospitals across the country to integrate the early ASD screening into the national health system. CONCLUSION: M-CHAT-R has a perfect specificity and SCQ a fair diagnostic accuracy for ASD in Mali.

The prevalence and distribution of the amyloidogenic transthyretin (TTR) V122I allele in Africa.

BACKGROUND: Transthyretin (TTR) pV142I (rs76992529-A) is one of the 113 variants in the human TTR gene associated with systemic amyloidosis. It results from a G to A transition at a CG dinucleotide in the codon for amino acid 122 of the mature protein (TTR V122I). The allele frequency is 0.0173 in African Americans. METHODS: PCR-based assays to genotype 2767 DNA samples obtained from participants in genetic studies from various African populations supplemented with sequencing data from 529 samples within the 1000 Genomes Project. RESULTS: The rs76992529-A variant allele was most prevalent (allele frequency 0.0253) in the contiguous West African countries of Sierra Leone, Guinea, Ivory Coast, Burkina Faso, Ghana, and Nigeria. In other African countries, the mean allele frequency was 0.011. CONCLUSIONS: Our data are consistent with a small number of founder carriers of the amyloidogenic TTR V122I (p.Val142Ile) allele in southern West Africa, with no apparent advantage or disadvantage of an allele carrying newborn reaching adulthood. In U.S. African Americans, the allele represents a significant risk for congestive heart failure late in life. If clinical penetrance is similar in African countries with high allele frequencies, then cardiac amyloidosis could also represent a significant cause of heart disease in the elderly in those populations.

Does the survival motor neuron copy number variation play a role in the onset and severity of sporadic amyotrophic lateral sclerosis in Malians?

INTRODUCTION: Spinal muscular atrophy (SMA) and sporadic amyotrophic lateral sclerosis (SALS) are both motor neuron disorders. SMA results from the deletion of the survival motor neuron (SMN) 1 gene. High or low SMN1 copy number and the absence of SMN2 have been reported as risk factors for the development or severity of SALS. OBJECTIVE: To investigate the role of SMN gene copy number in the onset and severity of SALS in Malians. MATERIAL AND METHODS: We determined the SMN1 and SMN2 copy number in genomic DNA samples from 391 Malian adult volunteers, 120 Yoruba from Nigeria, 120 Luyha from Kenya and 74 U.S. Caucasians using a Taqman quantitative PCR assay. We evaluated the SALS risk based on the estimated SMA protein level using the Veldink formula (SMN1 copy number + 0.2 ∗ SMN2 copy number). We also characterized the disease natural history in 15 ALS patients at the teaching hospital of Point G, Bamako, Mali. RESULTS: We found that 131 of 391 (33.5%) had an estimated SMN protein expression of ≤ 2.2; 60 out of 391 (15.3%) had an estimated SMN protein expression < 2 and would be at risk of ALS and the disease onset was as early as 16 years old. All 15 patients were male and some were physically handicapped within 1-2 years in the disease course. CONCLUSION: Because of the short survival time of our patients, family histories and sample DNA for testing were not done. However, our results show that sporadic ALS is of earlier onset and shorter survival time as compared to patients elsewhere. We plan to establish a network of neurologists and researchers for early screening of ALS.

Effect of heterogeneities in the cellular microstructure on propagation of the cardiac action potential.

Cardiac arrhythmias are initiated in regions that undergo cellular remodeling as a result of disease. Using a sub-cellular model of myocardium, we studied the mechanism of block caused by tissue microstructure remodeling: cell geometry [quantified as length/width (L/W) cell ratio] and cell-to-cell coupling (G(j)). Heterogeneities in cell L/W ratio and G ( j ) lead to block when excitability is reduced and the corresponding space constant λ (in the direction of propagation) increases by >40 %. Tissue architectures with elongated cells (i.e. large cell L/W ratios) that are better coupled (i.e. large G(j)) are less prone to block at sites of regional heterogeneities in cell geometry and/or cell coupling than tissue architectures consisting of cells with smaller L/W ratios and/or poorer coupling. Whether an increase in tissue anisotropic ratio (ANR) is arrhythmogenic or not depends on the cellular mechanism of the increase: ANR leads to an increased risk of block when G(j) decreases, but to a decreased risk of block when cell L/W ratio increases. Our findings are useful to understand the mechanisms of block in cardiac pathologies that result in tissue architecture remodeling.

Effect of cell geometry on conduction velocity in a subcellular model of myocardium.

We have studied the effect of cell geometry on propagation velocity of the cardiac impulse using a subcellular computer model of myocardium. Variation of cell size has only small effects on longitudinal and transverse conduction velocities, when the ratio of cell length/width is constant, for cell sizes (length x width) between (60 microm x 20 microm) and (120 microm x 40 microm). The results were not dependent on gap-junction conductance (range 0.25-1 microS), gap-junction distribution, or the specific tissue architecture. Longitudinal conduction velocity increased with the cell length/width ratio and transverse velocity decreased. The cell length/width ratio was a good estimator of the anisotropic ratio. In conclusion, cell length/width ratio is more important than cell size in determining conduction velocity.