Living with HIV: women's experience in Burkina Faso, West Africa

Our study aimed at studying HIV-infected women's experience with sharing serostatus with their partner and their group support. A survey was carried out among 79 seropositive women involved in a therapeutic trial in Bobo-Dioulasso, following freely consented prenatal HIV testing. The study revealed that women are reluctant to inform their partners and fear being stigmatized by relatives and friends. The major concern reported was health consequences and most women wished to receive care. The non-governmental organizations supporting people living with HIV were not known by these women, but providing this information raised a high interest and many women considered joining them soon and getting themselves involved. These community-based organizations, lead by qualified and highly motivated volunteers, could facilitate a better social integration of HIV infected women in Burkina Faso.     

Genomic Epidemiology of SARS-CoV-2 in Western Burkina Faso,West Africa

Background: After its initial detection in Wuhan, China, in December 2019, SARS-CoV-2 has spread rapidly, causing successive epidemic waves worldwide. This study aims to provide a genomic epidemiology of SARS-CoV-2 in Burkina Faso. Methods: Three hundred and seventy-seven SARS-CoV-2 genomes obtained from PCR-positive nasopharyngeal samples (PCR cycle threshold score < 35) collected between 5 May 2020, and 31 January 2022 were analyzed. Genomic sequences were assigned to phylogenetic clades using NextClade and to Pango lineages using pangolin. Phylogenetic and phylogeographic analyses were performed to determine the geographical sources and time of virus introduction in Burkina Faso. Results: The analyzed SARS-CoV-2 genomes can be assigned to 10 phylogenetic clades and 27 Pango lineages already described worldwide. Our analyses revealed the important role of cross-border human mobility in the successive SARS-CoV-2 introductions in Burkina Faso from neighboring countries. Conclusions: This study provides additional insights into the genomic epidemiology of SARS-CoV-2 in West Africa. It highlights the importance of land travel in the spread of the virus and the need to rapidly implement preventive policies. Regional cross-border collaborations and the adherence of the general population to government policies are key to prevent new epidemic waves.     

Seasonal patterns of cardiovascular disease mortality of adults in Burkina Faso,West Africa

Objective To evaluate seasonal patterns of cardiovascular death in adults, which are possibly influenced by hot and dry climate, in a rural setting of Burkina Faso. Methods Cause of death was ascertained by verbal autopsy. Age‐specific death rates (cardiovascular death and all‐cause) by month of death were calculated. Seasonal trends and temperature effects were modelled with Poisson regression. Results In 11 174 adults (40+), 1238 deaths were recorded for the period 1999–2003. All‐cause mortality in adults (40–64 years) and the elderly (65+ years) was 1269 per 100 000 (95% CI 1156–1382) and 7074 (95% CI 6569–7579), respectively. Cardiovascular death was the fourth most frequent cause of death in adults (40+), with a mortality of 109.9 (95% CI 76.6–143.1) for ages 40–64 and 544.9 (95% CI 404.6–685.1) for ages 65+. For all‐causes, the mortality was highest in March and for cardiovascular death highest in April, the hot dry season (March–May). Mean monthly temperature was significantly related to mortality in old ages. Conclusions Cardiovascular mortality varies by season, with higher mortality rates in the hot dry season. The pattern seems to be consistent with other studies suggesting association between hot weather and cardiovascular disease. A ‘heat‐wave’ effect appears to be observable also in areas with hot average temperatures.     

Seroprevalence and incidence of transfusion-transmitted infectious diseases among blood donors from regional blood transfusion centres in Burkina Faso, West Africa

Background and objective The high prevalence of numerous transfusion‐transmitted infectious diseases such as HIV, HBV, HCV and syphilis in sub‐Saharan Africa affects blood safety for transfusion recipients. The aim of this study was to evaluate the prevalence and incidence of transfusion‐transmissible infectious diseases among blood donors in Burkina Faso. Methods A retrospective study of blood donors’ records from January to December 2009 was conducted. Prevalence and incidence of viral infections were calculated among repeat and first‐time blood donors. Results Of the total of 31 405 first‐time volunteer blood donors in 2009, 24.0% were infected with at least one pathogen and 1.8% had serological evidence of multiple infections. The seroprevalence of HIV, HBV, HCV and syphilis in first‐time volunteer donors was 1.8%, 13.4%, 6.3% and 2.1%, respectively. In 3981 repeat donors, the incidence rate was 3270.2, 5874.1 and 6784.6 per 100 000 donations for anti‐HIV‐1, HBsAg and anti‐HCV, respectively. These numbers varied significantly according to populations where blood is collected and blood centres in Burkina Faso. Conclusion The relatively high prevalence of viral markers in first‐time volunteers and remarkably high incidence of infections in repeat donors raise concerns regarding the safety of these donors and suggest that implementation of NAT might significantly improve the situation.     

Stabilization of HIV infection rates in urban Burkina Faso, 1995-1999

The objectives of this study were to monitor the trends of the HIV epidemic between 1995 and 1999 among pregnant women in Bobo-Dioulasso, the second largest town of Burkina Faso, and to discuss the possible effect of preventive interventions (condom availability) on sexual transmission of HIV in this context. Age-specific trends in HIV prevalence obtained from sentinel surveillance programme were analysed. Among antenatal clinic attendees, HIV prevalence was 7.5% (n=401) in 1995, 10% (n=200) in 1996, 7.6% (n=448) in 1997, 8.4% (n=642) in 1998 and 5.3% (n=716) in 1999 without demonstrated temporal trend (P=0.12). The average number of condoms available per person (aged 15-49 years) per year increased from 0.6 in 1992 to 5.7 in 1995 and 6.0 in 1999. Anonymous surveys are less subject to selection bias and suggest a stabilization of the HIV prevalence around 7.3% in Bobo-Dioulasso. Distribution of condoms could explain at least, partly, this stabilization of the HIV epidemic.     

Towards the complete eradication of mother-to-child HIV/HBV coinfection at Saint Camille Medical Centre in Burkina Faso,Africa

The coinfection of HIV and hepatitis B virus (HBV) and their vertical transmission constitute a public health problem in sub-Saharan countries of Africa. The objectives of this research are: i) identify the pregnant women that are coinfected by HIV and HBV at Saint Camille Medical Centre; ii) use three antiretroviral drugs (zidovudine, nevirapine and lamivudine) to interrupt the vertical transmission of HIV and HBV from infected mothers; and iii) use the PCR technique to diagnose children who are vertically infected by these viruses in order to offer them an early medical assistance. At Saint Camille Medical Centre, 115 pregnant women, aged from 19 to 41 years, were diagnosed as HIV-positive and, among them, 14 coinfected with HBV. They had at least 32 weeks of amenorrhoea and all of them received the HAART, which contained lamivudine. Two to six months after childbirth, the babies underwent PCR diagnosis for HIV and HBV. The results revealed that, among these mothers, 64.4% were housewives, 36.5% were illiterates, and only 1.7% had a university degree. The rate of vertical transmission of HIV and HBV was 0.0% (0/115) and 21.4% (3/14), respectively. The 3 mothers who transmitted the HBV to their children had all HBsAg, HbeAg, and HBV DNA positive. An antiretroviral therapy that in addition to zidovudine and nevirapine includes lamivudine could, as in the present study, block or reduce the vertical transmission in HIV positive pregnant women who are coinfected with HBV.     

Identification and geographic distribution of the ACE-1R mutation in the malaria vector Anopheles gambiae in south-western Burkina Faso, West Africa

Resistance of Anopheles gambiae to organophosphate and carbamate insecticides was first reported in C?te d'Ivoire, West Africa. Subsequent studies revealed that it resulted from a single point mutation in the oxyanion hole of the acetycholinesterase enzyme (ace-1(R) mutation). We investigated the distribution and prevalence of the ace-1(R) mutation in An. gambiae s.l. populations from seven locations in south-western Burkina Faso. The ace-1(R) mutation was found in both M and S molecular forms of An. gambiae s.s., but it was absent in An. arabiensis. Its frequency ranged from 0.25 to 0.5 in S form and 0.04 to 0.13 in M form, though they were sympatric. The lack of homozygous resistance indicated a strong genetic cost associated with the mutation. These data suggest that organophosphate and carbamate resistance conferred by target site insensitivity is spreading in populations of An. gambiae s.s. from West Africa.     

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.     

Mortality patterns, 1993-98, in a rural area of Burkina Faso, West Africa, based on the Nouna demographic surveillance system

The Nouna demographic surveillance system database was analysed for the period 1993-98. Basic demographic parameters, age-specific and age-standardized mortality rates were calculated and a seasonal variation in mortality was analysed. Poisson regression was used to model the calculated mortality rates and to investigate the seasonal mortality pattern. Both the population distribution by age and the mortality rates reflect a typical pattern of population structures and total mortality in rural Africa as a whole: high childhood mortality and a young population (about 60% are up to age 25; about 10% above age 64). We identified a significant seasonal pattern with highest mortality rates in February. Demographic surveillance systems in Africa provide a viable method for the collection of reliable data on vital events in rural Africa and should therefore be established and supported.     

Genetic polymorphisms and resistance mutations of HIV type 2 in antiretroviral-naive patients in Burkina Faso

Natural polymorphisms in the pol gene of HIV-2 may influence the susceptibility to antiretroviral drugs and the choice of treatment. We collected samples in centers for anonymous HIV testing in Ouagadougou, Burkina Faso, in patients supposedly naive for any antiretroviral treatment. Eighty-four samples were first tested as HIV-2 positive in Burkina Faso and then shipped to Brussels, Belgium, for confirmation of the serological status and plasma viral load. Fifty-two samples were confirmed as HIV-2 positive in Belgium. Twelve others were HIV-1 positive and 20 were dually reactive. Twenty-one of HIV-2 confirmed samples had an HIV-2 plasma viral load higher than 1000 copies/ml. These viruses were sequenced in the protease and reverse trancriptase genes and 17 sequences of the pol gene were obtained. Highly polymorphic positions were identified in protease and RT genes. Two samples harbored known resistance mutations: M184V RT mutation in one and Q151M with M184V in the other. Phylogenetic analysis showed that viruses in Burkina Faso did not cluster separately from published sequences from neighboring countries. The two resistant strains were unrelated. Our findings imply either that resistant viruses are circulating in Burkina Faso or that some individuals take unsupervised treatment. Both hypotheses present problems.     

Seasonal variation in wing size and shape between geographic populations of the malaria vector, Anopheles coluzzii in Burkina Faso (West Africa)

The mosquito, Anopheles coluzzii is a major vector of human malaria in Africa with widespread distribution throughout the continent. The species hence populates a wide range of environments in contrasted ecological settings often exposed to strong seasonal fluctuations. In the dry savannahs of West Africa, this mosquito population dynamics closely follows the pace of surface water availability: the species pullulates during the rainy season and is able to reproduce throughout the dry season in areas where permanent water bodies are available for breeding. The impact of such environmental fluctuation on mosquito development and the phenotypic quality of emerging adults has however not been addressed in details. Here, we examined and compared phenotypic changes in the duration of pre-imaginal development, body dry mass at emergence and wing size, shape and surface area in young adult females An. coluzzii originated from five distinct geographic locations when they are reared in two contrasting conditions mimicking those experienced by mosquitoes during the rainy season (RS) and at the onset of the dry season (ODS) in Burkina Faso (West Africa). Our results demonstrated strong phenotypic plasticity in all traits, with differences in the magnitude and direction of changes between RS and ODS depending upon the geographic origin, hence the genetic background of the mosquito populations. Highest heterogeneity within population was observed in Bama, where large irrigation schemes allow year-round mosquito breeding. Further studies are needed to explore the adaptive value of such phenotypic plasticity and its relevance for local adaptation in An. coluzzii.     

HIV infection among pregnant women in Bobo-Dioulasso, Burkina Faso: comparison of voluntary and blinded seroprevalence estimates

The objective of our study was to estimate the prevalence of HIV infection among pregnant women in Bobo-Dioulasso (Burkina Faso) according to 2 survey methods. Unlinked anonymous HIV screening was performed among women attending 2 antenatal clinics. Voluntary and confidential HIV counselling and testing were offered to women attending 2 other antenatal clinics in the same time period, September-October 1996. Voluntary HIV testing was performed in the context of a clinical trial on mother-to-child transmission of HIV (ANRS 049 clinical trial) with an acceptance rate of HIV testing of 93%. The first survey recruited 200 women and the second, 424. The mean age (24.6 years vs 24.8 years) and the mean number of pregnancies (3.1 vs 3.3) of women were comparable, in the 2 studies (P=0.69 and P=0.26, respectively). Prevalence of HIV infection in the blinded survey was estimated at 10.0% (95% confidence interval (CI): 6.4-15.2), while it was 9.4% (95% CI: 6.9-12.7) in the voluntary HIV screening programme. These 2 estimates were not statistically different (P=0.82). In the voluntary screening study, the prevalence of HIV infection was significantly different between age groups 15-24 years and 25-49 years (13.9% vs 4.5%, P < 0.001). In the age group 25-49 years, the prevalence of HIV infection estimated in the blinded study and in the voluntary screening study were significantly different (10.5% vs 4.5%, P=0.04) suggesting a potential participation bias among pregnant women of older age in the voluntary, confidential HIV screening group. In conclusion, for the purpose of HIV surveillance, the most reliable method for HIV prevalence remains the unlinked, anonymous testing.     

From evaluating a Skilled Care Initiative in rural Burkina Faso to policy implications for safe motherhood in Africa

Evaluation findings from a particular setting need to be generalized into policy implications if they are to find widespread use. Skilled attendance at delivery is widely regarded as one of the most important intervention strategies for safe motherhood in low-resource settings, particularly in Africa, but implementations of such strategies are often not rigorously evaluated or interpreted into future policy. Initiative for Maternal Mortality Programme Assessment (Immpact) has applied a package of research-based monitoring and evaluation tools to assess the Family Care International Skilled Care Initiative in Ouargaye District, Burkina Faso. This evaluation research aimed to generate reliable, evidence-based policies for accelerating safe motherhood programmes in Burkina Faso and elsewhere in Africa. Five policy priorities were identified as representing real chances of improving the safety of motherhood: (1) enhancing national coverage of delivery by professionally skilled attendants; (2) to provide a network of 24-h basic emergency obstetric care within 5 km; (3) to have an effective referral system, equipped and resourced to undertake a reasonable number of Caesarean sections; (4) to promote community mobilization activities as a lever to increasing delivery care utilization; and (5) to implement strategies to remove financial barriers to delivery care. To meet Millennium Development Goal five by 2015, both supply and demand side constraints on the provision of quality maternity care have to be addressed, which in turn need greater political commitment and funding.