[Retrospective study of urogenital fistula in Burkina Faso from 2001 to 2003]. / Bilan rétrospectif des fistules urogénitales obstétricales de 2001 a 2003 au Burkina Faso.

The purpose of this study was to analyze aspects of obstetric urogenital fistulae to provide a foundation for implementation of a national control program in Burkina Faso. A cross-sectional study with quantitative and qualitative components was carried out in 47 hospitals in January 2004. The quantitative component consisted of analyzing available data for 2001, 2002 and 2003. The qualitative component consisted of interviewing women with fistulae to evaluate the impact of the disease on the quality of life and persons in charge of the health reference centers to identify the difficulties and needs of the facility. In the 3-year study period, 1,500,000 deliveries were attended and 347 fistulae were identified in the health reference centers. The incidence rate of obstetric fistulae was 23.1 per 100 000 deliveries (CI 95% 20.8-25.7). Women with fistulae were young and usually without paid employment. Many had a history of dystocia during the labor. Most fistulae were recent, small or average in size and located at the level of the vesico-vaginal septum. The failure rate of surgical treatment was about 17.5%. Four of the 12 women interviewed reported social alienation and ostrasization. Only 4 of the 47 hospitals studied had a personnel qualified to manage women with urogenital fistula on a daily basis. One NGO assisted women in obtaining care. Proposals for improvement of the situation were considered at a national validation workshop. These findings support the need to implement a national program that should be evaluated to see lessons learned from this study.

Surface-induced changes in the structure and activity of enzymes physically immobilized at solid/liquid interfaces.

A proteolytic enzyme, alpha-chymotrypsin, and a lipolytic enzyme, cutinase, were adsorbed from aqueous solutions on solid surfaces with different hydrophobicities and morphologies. With both enzymes the affinity of adsorption is larger for the more hydrophobic surface. Water-soluble, flexible oligomers grafted on the sorbent surface cause a decrease in enzyme adsorption. CD spectroscopy and differential scanning calorimetry (DSC) indicate severe structural perturbations in the enzymes resulting from adsorption. The CD spectra reflect an average of the structure of the whole protein population. The DSC data allow additional conclusions to be drawn on the heterogeneity in the conformational states of the adsorbed enzymes. The degree of structural perturbation, that is the fraction of the adsorbed molecules of which the structure is perturbed, is lower at a surface that (1) is less hydrophobic, (2) contains water-soluble flexible oligomers and (3) is more covered by the protein. The specific activities of the enzymes are decreased on adsorption, more or less following the extent of structural perturbation. Unlike in solution, in the adsorbed state the heat-induced inactivation process is not identical with the heat-induced unfolding process. Furthermore, when the enzymes are adsorbed their specific activities are much less sensitive to temperature variation.

Structure, Stability, and Activity of Adsorbed Enzymes

A proteolytic enzyme, alpha-chymotrypsin, and a lipolytic enzyme, cutinase, were adsorbed from aqueous solution onto a hydrophobic Teflon surface and a hydrophilic silica surface. We investigated the influence of adsorption on the structure, the structure thermal stability and the activity of these enzymes. Probing the protein structure by circular dichroism spectroscopy indicates that Teflon promotes the formation of helical structure in alpha-chymotrypsin, but the reverse effect is found with cutinase. The perturbed protein structures on Teflon are remarkably stable, showing no heat-induced structural transitions up to 100°C, as monitored by differential scanning calorimetry. Contact with the hydrophilic silica surface leads to a loss in the helix content of both proteins. Differential scanning calorimetry points to a heterogeneous population of adsorbed protein molecules with respect to their conformational states. The fraction of the native-like conformation in the adsorbed layer increases with increasing coverage of the silica surface by the proteins. The specific enzymatic activity in the adsorbed state qualitatively correlates with the fraction of proteins in the native-like conformation.

Bilan retrospectif des fistules urogenitales obstetricales de 2001 a 2003 au Burkina Faso

Pour analyser les fistules urogenitales au Burkina Faso en vue de la mise en place d'un programme national; une etude transversale a visee quantitative et qualitative en janvier 2004 a ete realisee dans les formations sanitaires de reference. L'etude quantitative a analyse les donnees disponibles sur les annees 2001; 2002 et 2003. L'etude qualitative a permis d'interviewer des femmes vivant avec la fistule et les responsables des services de sante. Au cours des 3 ans sur environ 1 500 000 accouchements attendus dans le pays; 347 cas de fistules ont ete identifies soit un taux d'incidence de 23;1 pour 100 000 accouchements (IC a 9520;8 - 25;7). Les femmes avec fistules etaient jeunes et surtout sans emploi remunere avec des antecedents de dystocie a l'accouchement. Les fistules etaient le plus souvent recentes; de tailles petites ou moyennes et localisees au niveau de la cloison vesico-vaginale. Les resultats de la chirurgie etaientmarques par un taux d'echec de l'ordre de 17;5. Quatre femmes sur 12 interviewees ont declare avoir ete abandonnees par le conjoint. Sur 47 hopitaux visites; seulement 4 avaient un personnel qualifie pour la realisa- tion de la prise en charge quotidienne des fistules. Une organisation non gouvernementale aidait les patientes pour l'obtention de soins. Un atelier national de validation a permis de faire des propositions pour l'amelioration de la situation. Les resultats montrent la necessite de la mise en place d'un programme national qui devrait etre evalue pour voir les acquis obtenus apres cette etude