ST2859 serogroup A meningococcal meningitis outbreak in Nouna Health District, Burkina Faso: a prospective study

We analysed cerebrospinal fluid samples from suspected meningitis cases in Nouna Health District, Burkina Faso, during the meningitis seasons of 2004-2006. Serogroup A ST2859 meningococci belonging to the ST5 clonal complex of subgroup III meningococci were the predominant causative agent. ST2859 bacteria were associated with focal outbreaks in the north of the district. While >10% of the population of an outbreak village carried ST2859, the population in the south of the district was predominantly colonised by serogroup Y ST4375 meningococci, which were associated with only sporadic cases of meningitis. Colonisation with the less virulent Y meningococci may interfere with the spread of the ST2859 to the south of the district, but there are concerns that this serogroup A clone may cause a third wave of subgroup III meningococcal disease in the African Meningitis Belt.     

Chronicle of an outbreak foretold: meningococcal meningitis W135 in Burkina Faso

Burkina Faso lies within the African meningitis belt. Until recently, serogroup A of Neisseria meningitidis was the most common cause of epidemic meningitis in Burkina Faso. However, during the epidemic that started in January 2002, W135 was the predominant serogroup of meningococcus. Vaccine against the W135 serogroup is expensive and in short supply. Strategies to react to a future African epidemic of W135 meningococcal meningitis with a sufficient and affordable supply of vaccine must be put into place now.     

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.     

Prevalence and genotype characterization of human papillomaviruses among HIV-seropositive in Ouagadougou, Burkina Faso

Background

Approximately, 15–20 of 40 HPVs that infect the female genital tract confer a high-risk of invasive cancer, thus HPVs account for 95% of cervix cancers. The objectives of this study were to: (i) estimate the prevalence of HPV infection in women infected with HIV in Ouagadougou, (ii) identify potential carcinogenic HPV strains and (iii) determine whether existing HPV vaccines match the isolated strains.

Methods

From May 2009 to April 2010, 250 HIV-infected women were included in this study. Each woman was screened for the presence of HPV and for HPV genotype using PCR/hybridization technique.

Results

Of the 250 HIV-infected women, 59.6% were infected with at least one type of HPV. High-risk HPVs were identified with the following prevalence: HPV-18 (25.0%); HPV-50′S (25.5%); HPV-30′S (20.8%); HPV-16 (4.7%); HPV-45 (3.7%). Low-risk HPVs were represented by HPV-6 (5.7%) and HPV-11 (0.9%).

Conclusion

The issue of the study showed that the existing vaccines: Gardasil and Cervarix may be used in the country although they match only HPV-16, HPV-18, HPV-6 and HPV-11. Further investigations should be continued for the establishment of vaccine that matches all genotypes circulating in the country.     

Rheumatoid arthritis in Burkina Faso: clinical and serological profiles

The objective of this work was to study the clinical and serological profiles of rheumatoid arthritis in Burkina Faso (West Africa). It is a cross-sectional study conducted from March 2006 to February 2009 in the Internal Medicine Department of the University Hospital Yalgado Ouedraogo. All patients seen in the rheumatologic consultation unit during this period, with rheumatoid arthritis fulfilling the ACR criteria, were routinely selected. The determination of anticyclic citrullinated peptide antibodies (ACPA) was carried out with a computerized method (Elia CCP, Phadia AB, Uppsala, Sweden). Values higher than 10 IU/l were considered positive. Forty-eight cases of rheumatoid arthritis (RA) were recruited throughout the study period among 2,194 (2.2 %) patients. Forty-two files were subjected to the study. There were 34 women and 8 men. The average age was 41.70 ± 13 years with extremes of 22 and 71 years. The average duration of the disease was 86.17 ± 82.01 months with extremes of 8 and 360 months. Rheumatoid factors (RF) were positive in 21 out of 30 patients (70.0%). The determination of ACPA carried out in all the patients was positive in 34 (81%) patients; their average value was 217 IU/l with extremes of 38 and 1,170. RF and ACPA were associated to bones erosions (p = 0.0001). Twenty-two patients were placed on methotrexate, eight on hydroxychloroquine, and three on salazopyrine. Nine were given only NSAIDs or prednisolone. No patients had had a biotherapy agent. The frequency of RA was low in our study compared to other African studies published so far. The particularity of RA cases reported in African series, including ours, is the rarity of extra-articular manifestations of the disease. The severity of the disease at presentation in the rheumatology clinic may be due to their late consultation among other causes.     

Mobility and HIV-Related Sexual Behavior in Burkina Faso

This study compared HIV-related sexual behavior among mobile and non-mobile populations in Burkina Faso and identified venues where HIV/AIDS interventions targeting mobile individuals should be implemented. Men (N = 940) and women (N = 430) responded to a sexual behavior survey while socializing at venues where people meet sexual partners in eight Burkina Faso villages. Mobile women were more likely than non-mobile women to report new sexual partnerships (adjusted prevalence odds ratio (POR): 2.07, 95% confidence interval (CI): 1.19-3.59) and transactional sex (adjusted POR: 2.30, 95% CI: 1.55-3.42) in the past month. Mobility was most common and associations between mobility and sexual partnership levels were particularly strong among women interviewed in urban commercial towns situated near international borders. Mobile women were most likely to be interviewed at venues such as bars and clubs, making these appropriate locations for HIV/AIDS interventions. Mobility was not associated with HIV-related sexual behaviors among men.     

Fatal Malaria in a German Couple Returning from Burkina Faso

We report on a German couple found dead at home 7 days after returning from Burkina Faso. Postmortem evaluation revealed Plasmodium falciparum infection with a parasitemia of approximately 80% in both cases. No pathological findings of the organs were present at autopsy except moderate splenomegaly in both cases and myocarditis in one case. Typical findings of fatal malaria like petechial hemorrhages of the brain or other organs, or sequestration of parasitized erythrocytes in venules and capillaries were absent. Lack of sequestration with excessive hyperparasitemia leading to systemic hypoxemia and host cytokine release may have contributed to the rapid fatal course in these nonimmune patients.     

Epidemiology of HIV infection in urban Burkina Faso

We conducted a cross-sectional study of sexually transmitted disease and HIV infections among a random sample of the 2364 adult population in 2000 in Bobo-Dioulasso, the second largest town in Burkina Faso. The prevalence of HIV infection was 5.2%. Risk factor analysis was conducted among sexually active men 20 to 34 years old and women 15 to 24 years old. Factors independently associated with HIV infection among men were having been married (adjusted odds ratio (aOR)=8.19 [1.70-39]), reporting more than two non-marital partners in the last 12 months (aOR=6.07 [1.14-32.4]), reporting a past urban residence other than Bobo-Dioulasso (aOR =6.37 [1.96-20.7] and having a positive serology for HSV-2 infection (aOR=12.0 [3.49-40.9]). Among women the factors were being Christian (aOR=3.73 [1.20-11.6]), having had a first sexual partner more than 24 years old (aOR =4.30 [1.35-13.6]) and having a positive serology for HSV-2 infection (aOR =4.40 [1.32-14.6]). HIV infection in Bobo-Dioulasso therefore depends on both exposure factors (sexual behaviours) and transmissibility cofactors (HSV-2).     

Undertaking a complex evaluation of safe motherhood in rural Burkina Faso

Evaluations of composite health interventions, such as those attempting to make motherhood safer, are by definition complex, but nevertheless regarded as essential to informing progress in global health. This paper introduces a series of reports which set out the basis of Family Care International's Skilled Care Initiative in rural Burkina Faso, go on to describe strategies and methods for evaluating it, and present evaluation findings in terms of pregnancy outcomes, utilisation and effects of the intervention and economics. Although there were encouraging findings, no 'magic bullets' emerged from these studies, illustrating the reality that sustained and increasing resources are needed to achieve safe motherhood for all. There is no cheap or short-cut solution.     

Epidemiology and molecular characterization of influenza viruses in Burkina Faso,sub‐Saharan Africa

Background

The importance of influenza viruses in respiratory infections in sub‐Saharan Africa has been historically overlooked, including in Burkina Faso.

Objectives

This study therefore aimed at evaluating the prevalence and seasonal occurrence of influenza viruses in children under 5 years old, at risk of influenza‐related complications, presenting with influenza‐like illness (ILI) or severe acute respiratory infection (SARI). The study also aimed at identifying the periods with increased influenza transmission for vaccination recommendations in Burkina Faso.

Methods

From January 2014 to December 2015, ILI and SARI (2015 only) patients were recruited in six healthcare centers in Burkina Faso. Influenza A and B molecular detection and subtyping were performed. Clade clustering of a subset of A(H1N1)pdm09 and A(H3N2) strains was deduced by performing phylogenetic analyses on hemagglutinin gene sequences. Weekly surveillance data from FluNet (2011‐2013; 2016) and this study (2014‐2015) were used to identify periods of increased influenza activity.

Results

Influenza A and B viruses were detected in 15.1% (112 of 743) of ILI and 6.6% (12 of 181) of SARI patients. Overall, influenza A viruses were largely predominant (81 of 124, 65.3%), with 69.1% of A(H3N2) and 30.9% of A(H1N1)pdm09 strains. Four waves of increased transmission were identified in 2014‐2015, each dominated by different influenza subtypes and clades. Between 2011 and 2016, periods of increased influenza activity varied in their frequency, duration, and timing.

Conclusion

Influenza A and B viruses were detected in a substantial number of ILI and SARI cases in Burkina Faso. Vaccination in September‐October would likely protect the highest number of patients.     

Rapid risk household screening by neonatal arm circumference: results from a cohort study in rural Burkina Faso

Neonatal arm circumference (NAC) and other attributes of the newborn and its household were analysed as potential predictors of child death in a cohort of 1367 newborn children representing the majority of births in a rural area of Burkina Faso from 1992 to 1994. During 3872 person years observed 264 children died, resulting in an average mortality rate of 6.8% per year. 90 mm was chosen as the best cut-off to differentiate low NAC associated with high mortality from normal NAC. The hazard ratio of children with low NAC (15.7%) compared to others was 1.7 ( P < 0.001) in Cox regression. Kaplan-Meier curves of cumulative survival showed that this higher risk lasted throughout the first two years of life. Multivariate Cox regression comparing NAC with other variables known or suspected to influence child survival yielded a model including mother's death, twin birth, affiliation to a particular health centre, home delivery and birth during the rainy or harvest season as other significant risk factors beside NAC. Protective factors were mother's participation in antenatal care despite considerable distance to the health centre, medium household size (5–7 members) and household cash crop production. We propose a simple risk score for rapid household screening in rural Burkina Faso and comparable settings elsewhere for identifying households at risk of experiencing child death. As much of the other variables' contribution to the explanation of survival pattern is absorbed by NAC in more parsimonious models, even simpler screening strategies based on NAC make sense. In the study area risk households will be offered periodical home visits by the local nurse promoting immunization, treatment of illness and strengthening the mothers' competence to recognize and manage frequent health problems of their children as part of a 'Shared Care' concept.     

Evaluating skilled care at delivery in Burkina Faso: principles and practice

There are strong expectations of what could be achieved by skilled care at delivery for maternal and newborn survival and health. Meeting these expectations involves the translation of the concepts and principles of skilled attendance into the reality of routine programmes. This process of translation brings to light some of the tensions which lie behind the consensus on the ideal package and particularly the alternative configurations of provider and place necessary in the immediate term. Lessons learnt from the implementation of specific projects and initiatives have a crucial role to play in informing scaling-up and the achievement of universal coverage.
The Skilled Care Initiative implemented in Burkina Faso by Family Care International, evaluated and reported here, provides many lessons for moving from concepts to practice. Firstly, there is the crucial issue of local contextual adaptation, as no one-size-fits-all for skilled attendance. Secondly, interventions to achieve skilled care require and imply different levels of intensity of implementation, depending on the functionality of the wider health system in the intervention area. Thirdly, there is the crucial issue of the balance and sequencing of supply- and demand-side interventions. Finally, the concept of skilled attendance at delivery does not exist in a vacuum in space or time, and concurrent health initiatives and cross-sectoral developments, such as transport and road improvements, can strongly influence outcomes. This not only presents challenges for the implementation of specific interventions within health institutions and communities, but also for the evaluation of their effects.     

Assessing the costs and cost-effectiveness of a Skilled Care Initiative in rural Burkina Faso

Objectives  The objectives of this study were to assess the cost-effectiveness of a skilled attendance strategy (the Skilled Care Initiative, SCI) in enhancing maternal health care in a remote, rural district of Burkina Faso and to analyse more broadly the costs and cost patterns of maternal health provision in the intervention and comparison districts.
Methods  The approach used was to cost the standard provision of maternal care, to analyse the main cost structures, and to derive cost estimates per facility. The additional costs attributable to SCI were identified. Several measures of cost-effectiveness or performance were calculated, including cost per delivery and utilisation.
Results  If the increase in deliveries in Ouargaye between 2004 and 2005 is attributed solely to the stimulus of demand for skilled care by the SCI community mobilisation and behavioural communication change activities, the incremental cost per delivery was $164 international dollars. This compares with an average cost per delivery in Health Centres across the two districts of $214 international dollars. However, if a broader measure of SCI costs is used, the incremental cost per delivery increases markedly, to $1306 international dollars. At the level of individual Health Centres, utilisation is a better measure of performance than cost per delivery and Health Centres in Ouargaye are utilised more than in Diapaga.
Conclusions  Demand side actions, such as community mobilisation and behavioural communication change activities, can be as important in improving skilled care at delivery as investment in health facilities, assuming there is some spare capacity, as has been the case in Burkina Faso. These conclusions have important potential implications for planning and resource allocation to achieve safer delivery for all women in Burkina Faso.