Incidence rate and predictors of COVID-19 in the two largest cities of Burkina Faso - prospective cohort study in 2021 (ANRS-COV13).

BACKGROUND: Early data on COVID-19 (based primarily on PCR testing) indicated a low burden in Sub-Saharan Africa. To better understand this, this study aimed to estimate the incidence rate and identify predictors of SARS-CoV-2 seroconversion in the two largest cities of Burkina Faso. This study is part of the EmulCOVID-19 project (ANRS-COV13). METHODS: Our study utilized the WHO Unity protocol for cohort sero-epidemiological studies of COVID-19 in general population. We conducted random sampling stratified by age group and sex. Individuals aged 10 years and older in the cities of Ouagadougou and Bobo-Dioulasso, Burkina Faso were included and surveyed at 4 time points, each 21 days apart, from March 3 to May 15, 2021. WANTAI SARS-CoV-2 Ab ELISA serological tests were used to detect total antibodies (IgM, IgG) in serum. Predictors were investigated using Cox proportional hazards regression. RESULTS: We analyzed the data from 1399 participants (1051 in Ouagadougou, 348 in Bobo-Dioulasso) who were SARS-CoV-2 seronegative at baseline and had at least one follow-up visit. The incidence rate of SARS-CoV-2 seroconversion was 14.3 cases [95%CI 13.3-15.4] per 100 person-weeks. The incidence rate was almost three times higher in Ouagadougou than in Bobo-Dioulasso (Incidence rate ratio: IRR = 2.7 [2.2-3.2], p < 0.001). The highest incidence rate was reported among women aged 19-59 years in Ouagadougou (22.8 cases [19.6-26.4] per 100 person-weeks) and the lowest among participants aged 60 years and over in Bobo-Dioulasso, 6.3 cases [4.6-8.6] per 100 person-weeks. Multivariable analysis showed that participants aged 19 years and older were almost twice as likely to seroconvert during the study period compared with those aged 10 to 18 years (Hazard ratio: HR = 1.7 [1.3-2.3], p < 0.001). Those aged 10-18 years exhibited more asymptomatic forms than those aged 19 years and older, among those who achieved seroconversion (72.9% vs. 40.4%, p < 0.001). CONCLUSION: The spread of COVID-19 is more rapid in adults and in large cities. Strategies to control this pandemic in Burkina Faso, must take this into account. Adults living in large cities should be the priority targets for vaccination efforts against COVID-19.

Facteurs structurels et communautaires augmentant la vulnérabilité des hommes ayant des relations sexuelles avec des hommes dans la riposte au virus de l'immunodéficience humaine au Burkina Faso.

INTRODUCTION: Worldwide and particularly in Africa, Men who have sex with men (MSM) can play a significant role in response to the Human Immunodeficiency Virus (HIV). In Burkina Faso the fight against HIV within this population seems to be limited by violence towards MSM. PURPOSE OF RESEARCH: The goal of this study was to identify the social obstacles to HIV response among MSM in Burkina Faso. METHODS: It has been a descriptive study with an exploratory aim in a mainly qualitative approach. It was conducted in the two biggest cities as well as two border ones of the country. Nonstructural interviews have been conducted with the help of prevention MSM actors. The data have been thematically analyzed. RESULTS: In the structural level, homosexuality is publically condemned by politicians some of whom seeking its criminalization. According to them it has "come from elsewhere" and is "contrary to morals". Even though there is no legally punishing regulation against it, political and administrative authorities and security forces do not protect MSM against homophobic violence. There is not enough care structures for MSM in the country. At the community level, many religious leaders condemn homosexuality, considered as a sin; they view homosexuality as an "abomination". MSM feel that they are victims of homophobic violence. CONCLUSIONS: The MSM are victims of violence from populations and state institutions too. To reach MSM by activities in response to HIV these obstacles must necessarily be removed.

Representations of HIV/AIDS and HIV status disclosure among serodifferent couples in Burkina Faso / Représentations du VIH/Sida et partage de l'information sur la sérologie dans les couples sérodifférents au Burkina Faso

BACKGROUND: In Burkina Faso, the prevalence of HIV in serodifferent couples is comparable to that of some key populations. Our aim was to show the influence of HIV representation on the disclosure of HIV information in serodifferent couples. METHODS: A cross-sectional qualitative study was carried out from January to September 2019 in the city of Bobo-Dioulasso in Burkina Faso. In-depth individual interviews and focus groups were conducted with each partner of the couple using interview guides. The data was subject to thematic content analysis. RESULTS: The results show that more than three-quarters of the respondents did not share their HIV status. Those who had a negative attitude towards PLWHIV were less keen to share the information, considering that that HIV would transform the infected person negatively in the eyes of others. Also, sharing information was seen as a risk to the couple’s peace and stability. Others found the suffering of HIV so personal that it was difficult to share with others. CONCLUSION: People living with HIV, who see AIDS as a bad disease, fear the social effects of HIV and are therefore less favorable to disclose their HIV status. On the other hand, those who equated HIV with an illness like any other were keen to share information about their status.

Introduction: Au Burkina Faso, la prévalence du VIH dans les couples sérodifférents est comparable à celle des travailleuses de sexe et des hommes ayant des rapports sexuels avec d'autres hommes considérés comme des populations clés dans la lutte contre le VIH. Notre objectif était de montrer l'influence des représentations du VIH sur le partage de l'information sur la sérologie dans les couples sérodifférents. Méthodes: Nous avons réalisé une étude qualitative transversale de janvier à septembre 2019 dans la ville de Bobo-Dioulasso au Burkina Faso. Des entretiens individuels approfondis et des focus groups ont été menés auprès de chaque partenaire du couple au moyen de guides d'entretien. Les données ont fait l'objet d'une analyse de contenu thématique. Résultats: Les résultats révèlent que plus de trois quarts des enquêtés n'avaient pas partagé leur statut sérologique. Ceux qui avaient une attitude négative envers le VIH partageaient moins l'information. Ces enquêtés pensaient que le VIH transformait négativement la personne infectée aux yeux des autres ; aussi, le partage de l'information était considéré comme un risque pour la paix et la stabilité du couple. D'autres considéraient que la souffrance liée au VIH est si personnelle qu'il était difficile de la partager avec les autres. Conclusion: Les personnes Vivant avec le VIH (PVVIH) qui considèrent le sida comme une mauvaise maladie redoutent les effets sociaux du VIH donc sont moins favorables au partage de l'information sur la sérologie. Par contre, celles qui assimilent le VIH à une maladie comme les autres, étaient enclines à partager l'information sur leur sérologie.

COVID-19 epidemiological, sociological and anthropological investigation: study protocol for a multidisciplinary mixed methods research in Burkina Faso.

BACKGROUND: The world has high hopes of vaccination against COVID-19 to protect the population, boost economies and return to normal life. Vaccination programmes are being rolled out in high income countries, but the pandemic continues to progress in many low-and middle-income countries (LMICs) despite implementation of strict hygiene measures. We aim to present a comprehensive research protocol that will generate epidemiological, sociological and anthropological data about the COVID-19 epidemic in Burkina Faso, a landlocked country in West Africa with scarce resources. METHODS: We will perform a multidisciplinary research using mixed methods in the two main cities in Burkina Faso (Ouagadougou and Bobo-Dioulasso). Data will be collected in the general population and in COVID-19 patients, caregivers and health care professionals in reference care centers: (i) to determine cumulative incidence of SARS-CoV-2 infection in the Burkinabe population using blood samples collected from randomly selected households according to the WHO-recommended protocol; (ii) develop a score to predict severe complications of COVID-19 in persons infected with SARS-CoV-2 using retrospective and prospective data; (iii) perform semi-structured interviews and direct observation on site, to describe and analyze the healthcare pathways and experiences of patients with COVID-19 attending reference care centers, and to identify the perceptions, acceptability and application of preventive strategies among the population. DISCUSSION: This study will generate comprehensive data that will contribute to improving COVID-19 response strategies in Burkina Faso. The lessons learned from the management of this epidemic may serve as examples to the country authorities to better design preventive strategies in the case of future epidemics or pandemics. The protocol was approved by the Ministry for Health (N° 2020-00952/MS/CAB/INSP/CM) and the Health Research Ethics Committee in Burkina Faso (N° 2020-8-140).

[Potentially inappropriate medication use in elderly care in Burkina Faso]. / Utilisation des médicaments potentiellement inappropriés dans les soins gériatriques au Burkina Faso.

These results suggest approaches to encourage the development of care provider skills, standardized practices and rational prescription to help improve medication use in the elderly..

Prevalence and patterns of multimorbidity among the elderly in Burkina Faso: cross-sectional study.

OBJECTIVES: To assess the prevalence and distribution patterns of multimorbidity among urban older adults in Burkina Faso. METHODS: Cross-sectional study among community-dwelling elderly people aged ≥60 in Bobo-Dioulasso. We performed interviews, clinical examination and medical record review. Multimorbidity was defined as co-occurrence of at least two chronic diseases in one person whether as a coincidence or not. RESULTS: The overall prevalence of multimorbidity among older adults was 65%. Age ≥70 was associated with multimorbidity in multivariate analysis: adjusted OR = 1.65, 95% CI (1.01-2.68, P = 0.04). The most common chronic diseases were hypertension (82%) 95% CI (78; 86), malnutrition (39%) 95% CI (34; 44), visual impairments (28%) 95% CI (24; 33) and diabetes mellitus (27%) 95% CI (22; 31). Those aged ≥70 had significantly more malnutrition (50% vs. 31%, P = 0.0003) and osteoarthritis (8% vs. 3%, P = 0.01) than those aged 60-69. CONCLUSIONS: The high prevalence of multimorbidity requires a reorganization of healthcare systems in sub-Saharan Africa, especially in Burkina Faso. Interventions and care guidelines usually focused on individual diseases should be improved to better reflect this reality.

The key actors maintaining elders in functional autonomy in Bobo-Dioulasso (Burkina Faso).

BACKGROUND: Globally, a significant increase in functional disability among the elderly is expected in the near future. It is therefore vital to begin considering how Sub-Saharan Africa countries can best start building or strengthening the care and support system for that target population. Study objectives are: 1) identify the key actors of the social system who maintain elders in functional autonomy at home in Bobo-Dioulasso (Burkina Faso) and 2) to describe the functional status of older people living at home. METHODS: We conducted a longitudinal descriptive study among the elderly aged 60 and above (351). Their functional status was evaluated using the Functional Autonomy Measurement System (SMAF). Data analysis was done using the statistical software package STATA (SE11). RESULTS: In Bobo-Dioulasso, 68% of seniors have good functional capacity or a slight incapacity and 32% have moderate to severe incapacities. Older people die before (3%) or during (14%) moderate to severe disabilities. This would mean that the quality of medical and/or social care is not good for maintaining functional autonomy of older people with moderate to severe disabilities. Two main groups of people contribute to maintain elders in functional autonomy: the elderly themselves and their family. Community, private or public structures for maintaining elders in functional autonomy are non-existent. The social system for maintaining elders in functional autonomy is incomplete and failing. In case of functional handicap at home, the elders die. But stakeholders are not conscious of this situation; they believe that this system is good for maintaining elders in functional autonomy. CONCLUSION: It is likely that the absence of formal care and support structure likely shortens the lifespan of severely disabled older people. Stakeholders have not yet looked at this possibility. The stakeholders should seriously think about: 1) how to establish the third level of actors who can fulfill the needs to maintain elders in functional autonomy that are not satisfied by others (family members or the older individuals themselves), and 2) how to reinforce the role of each actor and the collaboration between the different groups of people of this system.

[Governance of HIV/AIDS organizations in Bobo-Dioulasso (Burkina Faso)]. / La gouvernance au sein des organisations de lutte contre le VIH à Bobo-Dioulasso (Burkina Faso).

INTRODUCTION: Although HIV/AIDS organizations continue to play a major role in the fight against pandemic HIV infections, they are still faced with enormous governance challenges that impair their operations / interventions and their sustainability. The objective of this study was to develop an inventory of the quality of governance within HIV/AIDS organizations in Bobo-Dioulasso. METHODS: This qualitative research was conducted in 40 organizations from Bobo-Dioulasso. Qualitative data were collected over a 45-day period using an interview guide. Thematic analysis of the data was performed and the results were reported. RESULTS: Although all 40 organizations had established good governance mechanisms, only fifteen complied with the major rules of democratic functioning and the roles of the various bodies. The majority of these organizations (29/40) ignored many democratic rules. The number of members required for the Executive Board was not met in 29/40 organizations resulting in monopolization of decision-making by a handful of people. Technical and financial reports were not published, resulting in limited access to information on the organization's activities. Gender equality also constituted a weakness. DISCUSSION: Application of good governance principles was limited in these organizations. Organization members, leaders and technical and financial partners must reinforce good governance efforts in order to improve good governance in these organizations.

[Quality of chronic patient care according to the Chronic Care Model in Burkina Faso]. / Qualité de la prise en charge des malades chroniques au Burkina Faso selon le Chronic Care Model.

INTRODUCTION: There is a lack of organizational knowledge concerning optimal management by the health care system for patients with chronic health conditions in sub-Saharan Africa. The objective of this study was to describe the quality of chronic patient care at first-line heath facilities in Bobo-Dioulasso, Burkina Faso. METHODS: We conducted a cross-sectional study in six health facilities in Bobo-Dioulasso from October to November 2013. The chronic care model was used as a reference to describe the care of hypertensive patients. A score was calculated for each item in the model, and the strengths and weaknesses of health care organization were identified RESULTS: The overall level of support for the management of hypertensive patients was "basic" for all surveyed structures: median score and IQR 3.7 (3.4, 4.4). The level of support was basic for primary health facilities (median score 4.4), district hospitals (median score 4.1) and the University health center (median score 5.4). The relationship with the community and support to decision-making were identified as weak components of the model. CONCLUSIONS: To improve the quality of chronic patient care in first-line health facilities in Burkina Faso, efforts must be made to strengthen clinical governance and partnership with the community.

A Qualitative Study of the Experience of COVID-19 Patients in Burkina Faso.

In Burkina Faso, the health system is characterized by systemic insufficient and antiquated health-care infrastructures. Consequently, few health-care establishments have the required resources to diagnose and manage patients with COVID-19, and fewer still have intensive care facilities for severely ill patients with COVID. Furthermore, there is a widespread scarcity of qualified health-care staff. The aim of this study was to explore the experiences of patients with COVID-19 who recovered after being cared for in Bobo Dioulasso and Ouagadougou. Using individual semistructured interviews, we performed a cross-sectional qualitative, descriptive study from June 12 to 30, 2020 with the aid of 13 well-educated patients who had survived COVID-19. The results reveal that prior to hospital admission, the main reason that prompted patients to seek care was onset of symptoms of COVID-19, regardless of whether they had been in contact with suspected or confirmed cases. Transmission was mainly believed to have occurred in the community, in the hospital, and during travel. Patient management was punctuated by frequent self-medication with medicinal plants or pharmaceutical drugs. The participants reported a negative perception of hospitalization or home-based management, with several forms of stigmatization, but a positive perception influenced by the satisfactory quality of management in health-care centers. This report of patient experiences could be helpful in improving the management of COVID-19 in Burkina Faso, both in the health-care setting and in home-based care.

The state of the research for health environment in the ministries of health of the Economic Community of the West African States (ECOWAS).

BACKGROUND: An assessment of the state of the Research for Health (R4H) environment can provide relevant information about what aspects of national health research systems needs strengthening, so that research output can be relevant to meet national priorities for decision-making. There is limited information on the state of the R4H environment in the Economic Community of West African States (ECOWAS). This article describes the state of the R4H environment within the Ministries of Health of the ECOWAS member states and outlines of some possibilities to strengthen health research activities within the ECOWAS region. METHODS: Information on the national-level R4H environment (governance and management; existence of a national policy; strategic and research priorities documents; ethics committees; research funds; coordination structures; monitoring and evaluation systems; networking and capacity building opportunities) was collected from the Ministries of Health research units in 14 ECOWAS countries using self-administered questionnaires. A workshop was held where country report presentations and group discussions were used to review and validate responses. Data from the discussions was transcribed using Nvivo, and strengths, weaknesses, opportunities and threats (SWOT) analysis of the functioning of the units was done using Robert Preziosi's organisational diagnosis tool. RESULTS: The findings indicate that as of January 2011, 50% of ECOWAS countries had established directorates for health research with defined terms of reference. The existing funding mechanisms were inadequate to support the research structures within and outside the MoHs, and for building the capacity of researchers. Networking and monitoring activities were weak and only 7% of the directors of research units were trained in research management. The majority (85.7%) of countries had broader national health policies, and 57% of the countries had some form of policy or strategic document for research development. Half of the countries had developed national research priorities. CONCLUSIONS: These results call for urgent action to improve the research environment in the Ministries of Health in the West African sub-region.

[The elderly in sub-Saharan Africa: a vulnerable population often ignored in public policy]. / Les personnes âgées en Afrique subsaharienne : une population vulnérable, trop souvent négligée dans les politiques publiques.

Many people and financial institutions believe that the elderly are not a priority in sub-Saharan Africa, a region marked by serious economic, socio-political and health crises. The purpose of this paper is to describe and analyze the assumptions and arguments underlying this view and to demonstrate that the elderly are a vulnerable priority population ignored by all stakeholders and primarily by technical and financial partners. The premise is that development must be viewed as a whole. In addition to improving the living conditions of children, youth and women, efforts to promote development in Africa must also take into account the needs of the elderly. The paper argues that there are four main reasons for focusing on the elderly in sub-Saharan Africa: systemic reasons, ethical/humanitarian reasons, developmental reasons and/or the interests and future of youth and adults.

The burden of the coronavirus disease 2019 virus infection in Burkina Faso: Results from a World Health Organization UNITY population-based, age-stratified sero-epidemiological investigation.

BACKGROUND: This study aimed to estimate the anti-SARS-CoV-2 antibody seroprevalence in the general population of Bobo-Dioulasso and Ouagadougou (Burkina Faso). METHODS: We collected from March to April 2021 blood samples from randomly selected residents in both main cities based on the World Health Organization (WHO) sero-epidemiological investigations protocols and tested them with WANTAI SARS-CoV-2 total antibodies enzyme-linked immunosorbent assay (ELISA) kits intended for qualitative assessment. We also recorded participants' socio-demographic and clinical characteristics and information on exposure to SARS-CoV-2. Data were analysed with descriptive and comparative statistics. RESULTS: We tested 5240 blood samples collected between 03 March and 16 April 2021. The overall test-adjusted seroprevalence for SARS-CoV-2 antibodies was (67.8% [95% CI 65.9-70.2]) (N = 3553/3982). Seroprevalence was highest among participants aged 15-18 years old (74.2% [95% CI 70.5-77.5]) (N = 465/627), compared with those aged 10-14 years old (62.6% [95% CI 58.7-66.4]) (N = 395/631), or those over 18 (67.6% [95% CI 66.2-69.1]) (N = 2693/3982). Approximately 71.0% (601/860) of participants aged 10-18 years old who tested positive for SARS-CoV-2 antibodies experienced no clinical COVID-19 symptoms in the weeks before the survey, compared with 39.3% (1059/2693) among those aged over 18 years old. CONCLUSION: This study reports the results of the first known large serological survey in the general population of Burkina Faso. It shows high circulation of SARS-CoV-2 in the two cities and a high proportion of asymptomatic adolescents. Further studies are needed to identify the SARS-CoV-2 variants and to elucidate the factors protecting some infected individuals from developing clinical COVID-19.

[Functional disabilities in elderly people living at home in Bobo-Dioulasso, Burkina Faso]. / Les incapacités fonctionnelles des personnes âgées vivant à domicile à Bobo-Dioulasso, Burkina Faso.

In sub-Saharan Africa, very little research has been conducted on moderate to severe disabilities affecting mobility, communication and mental function in elderly people living at home. The studies that have been conducted have not always described the broader social context, a key factor for understanding and interpreting results. This study was conducted in Burkina Faso and was designed to fill the gaps in our understanding of disability in these areas. A cross-sectional descriptive study was conducted in Bobo-Dioulasso among the elderly population (aged 60 and above). Functional status was assessed using the Functional Autonomy Measurement System (SMAF). Data analysis was performed using Stata software. Interviews were conducted with a systematic random sample of 351 elderly adults. Moderate to severe functional disability or the need for supervision or assistance were related to mobility in 10 % of cases, to mental function in 28 % of cases and to communication in 37 % of cases. The need for assistance varied according to the different activities or items in each domain. The rates of disability in this study were higher than those found in previous studies, which have often assessed severe disabilities. All individuals affected by disability stated that they had a stable support network to manage their disability. Families were found to be the primary source of support. The results can be explained by the social context. A good visibility of moderate to severe disabilities should contribute to the development of effective policies to provide care and support to the elderly.

Nutritional, Microbiological, and Toxicological Quality Assessment of Foods Sold in Urban and Suburban Markets in Burkina Faso.

Food safety risks are becoming a public health problem with important socioeconomic consequences for human wellbeing, especially for pregnant women and infants. In this article, we describe findings from microbiological, toxicological, and nutritional quality assessments of foods from 5 localities in Burkina Faso, with the aim to provide baseline data on the quality of food and the risks to mothers and children. Samples for assessment included food sold in markets, stores, and restaurants (eg, cereals, oilseeds, vegetables, edible oils, powdered milk, dried fish, packaged water, ready-to-eat meals). The research team selected the samples using the random route method and analyzed them at the National Public Health Laboratory in Ouagadougou between January and December 2020. A total of 443 food samples were collected, of which 101 were analyzed for microbial contamination, 360 were analyzed for the presence of toxins, and 59 were analyzed for their nutritional value. The microbiological quality of 11.88% of the food samples was unsatisfactory, and 41.50% were contaminated with aflatoxins. At least 1 pesticide residue and cyfluthrin were detected in 58.10% of samples. The most detected contaminant (cyfluthrin) was found in 79.10% of the analyzed samples. A peroxide index higher than the normal value (10 mEq/kg) was found in 3.38% of the oil samples and 76.27% of the oil samples had a vitamin A content lower than the recommended limit of 11 mg/kg. This study is the first in Burkina Faso that provides baseline data on the quality of food and potential health risks to mothers and children in Burkina Faso. Considering the level of contaminants reported in this article, it is imperative to enhance routine monitoring of foods in the country.

Revisiting COVID-19 Communication in Western Africa: A Health Literacy-based Approach to Health Communication.

Adherence to protective measures is a major component of COVID-19 epidemic control. COVID-19 health literacy is a major driver of this adherence, and the evaluation of health literacy levels is the basis for designing an effective communication strategy. We conducted a quantitative socio-anthropological study of the knowledge of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and perception of the prevention messages in Burkina Faso, Cabo Verde, Guinea-Bissau, Ivory Coast, and Sierra Leone. There are widespread erroneous ideas regarding the transmission of and the protection against COVID-19. The majority of people are unaware that asymptomatic individuals can transmit the virus. Knowledge of the risk factors for severe disease is not sufficient, and the majority of individuals fear contracting COVID-19 by visiting a health center. Our study also shows the achievements of communication campaigns on several aspects: almost everybody has heard of the virus and heard or read the messages on the protective measures and a large majority of people think that these measures are effective against COVID-19. Based on these results, we propose a communication strategy that will emphasize that asymptomatic individuals can transmit the virus, emphasize the risk factors, reassure individuals regarding the safety of frequenting health centers, and design specific messages targeting young populations.

[Patient complaints: an opportunity to improve the quality of care of older people with multimorbidity in Burkina Faso]. / Plaintes des patients: une opportunité pour améliorer la qualité des soins des personnes âgées avec des multimorbidités au Burkina Faso.

INTRODUCTION: Little data exist on patient complaints to identify the strategy for the improvement of the quality of care of older people with multimorbidities. The aim of this study was to investigate the complaints of older people with multimorbidities at the health care facilities in Bobo-Dioulasso, Burkina Faso. METHODS: We conducted a cross-sectional study in the health care facilities in Bobo-Dioulasso from November 2013 to February 2014. Older people aged 60 years or more, with at least a chronic disease, examined in ambulatory or in hospital during the study period were included. Qualitative interviews were conducted using a semi-structured questionnaire. A content analysis was performed. RESULTS: We recorded the complaints related to long waiting time for health care, unsuitable hospital transfer service, lack of shared information on diseases and unsuitable hospitality conditions for older patients come to consultation and hospitalization. CONCLUSION: Improvement strategies should include the renovation and extension of the waiting rooms in the health care facilities, the separation of chronic care practice from acute care practice in ambulatory and in hospital, the support to the empowerment through a better communication with the patient, a community mutual assistance group and the involvement of family members.

[Functional disability in activities of daily living and instrumental or domestic activities of daily living in the elderly living at home in Bobo-Dioulasso (Burkina Faso)]. / L'incapacité fonctionnelle dans les domaines des activités de la vie quotidienne et domestique chez les personnes âgées vivant à domicile à Bobo-Dioulasso (Burkina Faso).

In sub-Saharan Africa, various studies have been conducted on severe disability in activities of daily living, instrumental or domestic activities. These studies have reported different rates without describing the social context for understanding their results. This study was conducted in Burkina Faso to fill the gaps in scientific information on disability in these areas. We conducted a cross-sectional descriptive study in Bobo-Dioulasso among the older population, aged 60 and above. Their functional status was evaluated using the Functional Autonomy Measurement System (SMAF). Data analysis was done with the help of Stata. A systematic random sample of 351 aging adults was interviewed. Moderate to severe functional disability or the need for supervision or assistance was present in 7% in activities of daily living and 86% in instrumental or domestic activities of daily living. This need for assistance varied according to the different activities or items in each domain. The proportions of disability found in this study are higher than those of previous studies that measured the often severe disabilities. All persons with disability claimed to have stable human resources which help them to manage their disabilities. The social context instrumental or domestic activities of daily living are divided by generation and/or by sex. That explains some results. With this division, it's inacceptable in some family that elders and/or old men do instrumental or domestic activities of daily living as prepare meals, do laundry, carry water to wash. The variation of this division from one family to another complicates the assessment of functional disability. To best manage elders disabilities, strategies must develop to: 1) retard the resignation of the family in care of its elderly in functional disability, 2) anticipate the preparation of formal social networks, public structures to support the elderly.

[Traditional enema for newborns and infants in Bobo Dioulasso: health practice or socialisation]. / Hygiène et socialisation du nourrisson: le lavement rectal en milieu urbain à Bobo Dioulasso.

Kanki demonstrated a high prevalence and frequency of enema practised with newborns in the South-West of Burkina Faso. Little is known about the risks on children's health possibly associated with this practice and about its impact on other treatments in paediatrics. In this study, the authors describe daily administered enema (DAE) and analyse local conceptual frameworks underlying this practice through in-depth-interviews and focus group discussions with 30 mothers, 5 traditional healers and 5 health agents. Various medications are used to compose the liquid introduced by the mothers in the child's anus. Many of these substances are prone to irritate intestinal mucus, others are simply toxic. Practically, enema aims at curing or preventing a variety of diseases caused by an accumulation of impurities (nògò) in the intestines due to the consumption of inappropriate food. With newborns, diseases are transmitted by mothers through breastfeeding after eating food which is too sweet or too fat. In addition to provoking diseases, the nògò also "block" the child's physical and psychic development during his/her first year of life. Therefore, as soon as the child has excreted for the first time, most mothers give enema daily both to protect their children from diseases and to speed their development. In fact, beside prophylaxy and therapy lies a "didactic" function of enema as a medication used to help the child to stand up, to get teeth..., to gain independence from his/her mother. DAE therefore plays an important role in the process of acquiring bio-social aptitudes, i.e., important educational virtues to achieve a successful first step in the socialisation process. Exploring more deeply local perceptions explaining the origin of the n g , the authors found an interesting relationship with religious taboos. Beside prohibited food, the n g are also due to transgression of various taboos surrounding birth and breastfeeding and even suggest a religious, rather than hygienic, explanation for the food prohibited. DAE ultimately consists in re-adjusting the child and his mother according to moral and cultural rules, avoiding the negative consequences of transgression. Consistently, DAE also facilitates the process of acquiring bio-social aptitudes for the child and therefore help him to enter his/her family as a fully accepted member. Moreover, religious prohibitions surrounding birth end as soon as the child is able to eat solid food and free him/herself. Therefore, DAE also helps the parents to get back to their normal life conditions. In conclusion, in addition to prophylactic and therapeutic explanations, the DAE participates in a general process of socialisation of newborns. To a certain extent, the child's health depends on the respect of the social and religious system and rules. The study reveals the important conceptual gap that may exist between two different logical frameworks--biomedical and popular--prone to explain health risk for newborns. The authors then reflect on the possible impact of health education programmes seeking to intervene at the hygienic level and ultimately facing an important set of cultural values aiming at keeping the social and cultural organisation coherent.

The ambivalence of stigma and the double-edged sword of HIV/AIDS intervention in Burkina Faso.

This article analyses the causes of HIV stigmatisation in Burkina Faso as perceived by people living with HIV/AIDS (PLHIV) and people working in AIDS-related Community Based Organisations (CBOs). Stigmatisation continues to be a pressing issue when dealing with HIV/AIDS in Sub-Saharan Africa. The article is based on direct observation of HIV-related practices within 20 CBOs in Burkina Faso, as well as semi-structured interviews or focus group discussions with 72 PLHIV and 90 professionals and volunteers working in CBOs. PLHIV were chosen by convenience sampling among the persons who accessed CBO services and were interviewed about their life quality and experience relating to HIV. Professionals and volunteers were interviewed about their strategies, their achievements, and the problems they encountered. The research was conducted in the course of three months fieldwork between September and November 2009. Our principal findings show, firstly, that moral or social stigmatisation does not in any simple way derive from fear, ignorance or inaccurate beliefs but that it is also established and continually reinforced by official campaigns addressing HIV/AIDS. Secondly, we show that stigmatisation is a socially complex and ambiguous process. Based on these empirical findings we conclude that HIV/AIDS need no longer be approached in AIDS intervention as a sexually acquired and fatal disease. When reliable access to antiretroviral drugs is in place, AIDS becomes a chronic condition with which one can live for many years, and this makes it easier to address HIV and moral or social stigmatisation by downplaying the current focus upon sexuality and morality.