Pleuropulmonary staphylococcal infection in infants, in a hospital environment in Ouagadougou (Burkina Faso)

We observed 36 cases of pleuropulmonary staphylococcal infection (PPS) in infants aged 0 to 30 months, during a prospective study carried out between April 1st 1995 and March 31 1996 at the Pediatrics Department of Ouagadougou University Hospital. PPS accounted for 0.5% of all hospital admissions and 11.6% of all acute basal respiratory infections in children aged less than 30 months. Slightly more boys than girls were affected, with a sex ratio of 1.2. We identified the classic triad of symptoms: cough-fever-polypnea, associated with abdominal ballooning and a change in general condition. On X rays, the typical images showing parenchymatous bubbles were the second most frequent observation (27.8%) after parenchymatous opacities (69.5%). The most frequently used antibiotics were oxacillin (Bristopen), gentamycin (Gentallin) and cefuroxime-axetil (Zinnat). The prognosis of PPS is poor, with a high mortality rate (27.8%) and a risk of pleural recurrence. Being very young, late hospitalization, malnutrition and leukopenia were identified as factors indicating a poor prognosis. Recygling of health care personnel for the management of acute respiratory infections, a decrease in malnutrition and an improvement in vaccination cover are essential if the mortality and morbidity of acute respiratory infections, and PPS in particular, are to be reduced.     

The components of self-rated health among adults in Ouagadougou,Burkina Faso

Background

Although the relationship between self-rated health (SRH) and physical and mental health is well documented in developed countries, very few studies have analyzed this association in the developing world, particularly in Africa. In this study, we examine the associations of SRH with measures of physical and mental health (chronic diseases, functional limitations, and depression) among adults in Ouagadougou, Burkina Faso, and how these associations vary by sex, age, and education level.

Methods

This study was based on 2195 individuals aged 15 years or older who participated in a cross-sectional interviewer-administered health survey conducted in 2010 in areas of the Ouagadougou Health and Demographic Surveillance System. Logistic regression models were used to analyze the associations of poor SRH with chronic diseases, functional limitations, and depression, first in the whole sample and then stratified by sex, age, and education level.

Results

Poor SRH was strongly correlated with chronic diseases and functional limitations, but not with depression, suggesting that in this context, physical health probably makes up most of people’s perceptions of their health status. The effect of functional limitations on poor SRH increased with age, probably because the ability to circumvent or compensate for a disability diminishes with age. The effect of functional limitations was also stronger among the least educated, probably because physical integrity is more important for people who depend on it for their livelihood. In contrast, the effect of chronic diseases appeared to decrease with age. No variation by sex was observed in the associations of SRH with chronic diseases, functional limitations, or depression.

Conclusions

Our findings suggest that different subpopulations delineated by age and education level weight the components of health differently in their self-rated health in Ouagadougou, Burkina Faso. In-depth studies are needed to understand why and how these groups do so.

     

Nutritional status and feeding practices of under-five children in Simanjiro District, Tanzania

This study was undertaken to assess the nutritional status and feeding practices of < 5 year children among the pastoral communities of Simanjiro district, northern Tanzania. Face-to-face interviews with the sampled mothers were conducted using a semi-structured questionnaire. Anthropometric measurements using weight-for-age criterion were employed to assess the nutritional status. The study showed that 31% of the children were undernourished, some (6%) of them severely. Children 2 - 3 years old were the most affected. Breastfeeding duration of more than one year was common among the mothers. Fifty-four percent of the mothers weaned their children as early as two months after birth. The most common type of weaning food was maize porridge (gruel) mixed with cow's milk (46%). Generally, 87% of households were facing some degree of food insecurity where some of them either experienced food shortage for 3-4 months (40%) or reported to eat less than three meals per day (75%). An educated mother was less likely to have an undernourished child, while a child from a teenage mother was more likely to be undernourished. Small size of a household was in favour of nutrition status. There is a great need to undertake interventions through community education to rescue the situation in Simanjiro district. Efforts should also be undertaken to mobilize the community members to adopt practices that favour good nutrition of children.     

Microbial quality assessment of some street food widely consumed in Ouagadougou,Burkina Faso

The major part of the population of Ouagadougou, Burkina Faso, have their breakfast, dinner and lunch in street food shops. The characteristics of street food vendors are indicated. It appeared clearly that women play a major part (75%) in street food sale. Vendors have only a slight knowledge of food processing and of hygienic practices. There is a high proportion (about 50%) of people among them. This dietary habit has some negative aspects on the consumers' health. Ours studies clearly showed that hygienic practices during sales operations are not respected by all categories of vendors of food products. Also, it was observed that street food vendors sometimes sit close to the waste water drainage system and solid wastes. Sometimes, the food is not covered and it is manipulated by consumers in areas infested by flies and others insects. The water used to wash the materials is of poor quality. The second aspects of our studies showed that, in most cases, when the safety and hygienic practices were not respected, the food became a true microorganism culture medium under tropical climatic conditions. A table reports microbial analysis and contamination rates of some important street foods consumed in Ouagadougou. In general these results showed the failure of microbial quality of some food which is not preheated (milk product, fruit juice, vegetable, fruit) and in the case of food which is not reheated after a long time of exposition (dry meat and meat on sticks). The presence of Salmonella and Shigella species in some food represents a serious danger for consumers. These aspects were observed with most street food vendors. It probably makes street food the source of most diseases caused by bacteria and other microorganisms.     

Pericarditis in HIV infected patients: retrospective study of 40 cases in Ouagadougou, Burkina Faso

Incidence of pericarditis has increased in sub-Saharan Africa, because of the HIV infection pandemia. We have done a retrospective study in the cardiology unit of the national hospital of Ouagadougou (Burkina Faso), in order to describe epidemiological, clinical, and therapeutic aspects of pericarditis occurring in HIV infected patients. Inclusion criteria were pericarditis proved by echography, and positive HIV serology. We have included forty patients (28 men and 12 women), mean aged of 34.45 years. General signs were fever (87.5%), and weight loss (70%). Thirty-six patients (90%) were in CDC stage C AIDS classification, three (7.5%) in stage B, and one (2.5%) in stage A. The symptoms described by the patients were dyspnea (92.5%), cough 77.5%), chest pain (65%), liver effort pain (27.5%), and palpitations (20%). Heart failure was present in 80% of the patients who had myocarditis. Pericardial effusion was small in 21%, moderate in 31,6%, and large in 47.4% of the patients. Tamponade occurred in for cases (10%). The etiology was tuberculosis in 75% of cases. Pericardial puncture (done in six patients) showed purulent fluid in two cases. Before hospital discharge, eight patients died, giving a mortality rate of 20%. Symptomatic pericardial involvement is frequently associated with stage C of HIV infection. Myocarditis is often associated (37.5%). Mortality rate is high.     

Nutritional status and associations with falls,balance, mobility and functionality during hospital admission

Objectives  

To explore associations between nutritional status, falls and selected falls risk factors amongst older hospitalized people. Lengths of stay amongst fallers and the malnourished were assessed.     

Nutritional status of under-five children living in an informal urban settlement in Nairobi, Kenya

Malnutrition in sub-Saharan Africa contributes to high rates of childhood morbidity and mortality. However, little information on the nutritional status of children is available from informal settlements. During the period of post-election violence in Kenya during December 2007-March 2008, food shortages were widespread within informal settlements in Nairobi. To investigate whether food insecurity due to post-election violence resulted in high prevalence of acute and chronic malnutrition in children, a nutritional survey was undertaken among children aged 6-59 months within two villages in Kibera, where the Kenya Medical Research Institute/Centers for Disease Control and Prevention conducts population-based surveillance for infectious disease syndromes. During 25 March-4 April 2008, a structured questionnaire was administered to caregivers of 1,310 children identified through surveillance system databases to obtain information on household demographics, food availability, and child-feeding practices. Anthropometric measurements were recorded on all participating children. Indices were reported in z-scores and compared with the World Health Organization (WHO) 2005 reference population to determine the nutritional status of children. Data were analyzed using the Anthro software of WHO and the SAS. Stunting was found in 47.0% of the children; 11.8% were underweight, and 2.6% were wasted. Severe stunting was found in 23.4% of the children; severe underweight in 3.1%, and severe wasting in 0.6%. Children aged 36-47 months had the highest prevalence (58.0%) of stunting while the highest prevalence (4.1%) of wasting was in children aged 6-11 months. Boys were more stunted than girls (p < 0.01), and older children were significantly (p < 0.0001) stunted compared to younger children. In the third year of life, girls were more likely than boys to be wasted (p < 0.01). The high prevalence of chronic malnutrition suggests that stunting is a sustained problem within this urban informal settlement, not specifically resulting from the relatively brief political crisis. The predominance of stunting in older children indicates failure in growth and development during the first two years of life. Food programmes in Kenya have traditionally focused on rural areas and refugee camps. The findings of the study suggest that tackling childhood stunting is a high priority, and there should be fostered efforts to ensure that malnutrition-prevention strategies include the urban poor.     

0～5岁住院儿童营养状况及影响因素分析

目的分析西藏自治区昌都市人民医院5岁以下住院儿童营养不良和贫血状况及其影响因素,为制定儿童营养相关策略和政策提供科学依据。方法采用整群随机抽取法抽取1 208名住院儿童,用Z评分法和血红蛋白值评价儿童营养和贫血状况,用Logistic回归分析可能的影响因素,运用SPSS 13.0软件进行统计学分析。结果住院儿童的生长迟缓率为12.2%、低体重率为8.2%、消瘦率为6.8%、贫血率为20.2%,儿童生长迟缓率、低体重率、消瘦率和贫血率在各月龄组间差异均有统计学意义(P0.01),其中24~36月龄组生长迟缓率最高,低体重率、消瘦率和贫血率的患病高峰在6~12月龄,各月龄组性别间差异均无统计学意义(P0.05)。多因素分析结果表明,儿童生长迟缓的影响因素是出生体重(OR=1.001),低体重的影响因素有月龄(OR=1.018)、出生体重(OR=1.001),消瘦的影响因素有月龄(OR=1.052)和出生体重(OR=1.001),贫血的影响因素为月龄(OR=1.028)。结论西藏自治区昌都市人民医院5岁以下住院儿童营养不良和贫血状况仍然较为严重,应针对各年龄段儿童营养不良状况特点制定相应干预措施,从而改善当地儿童营养健康状况。     

Patterns of adult and old-age mortality in rural Burkina Faso

Based on a demographic surveillance population from 39 villages in rural Burkina Faso, we describe mortality patterns in adults (15-59 years) and older people (> or = 60 years), and discuss seasonal trends in mortality. During the study period 1993-1998, 589 deaths in adults and 593 deaths in older people were recorded from an average adult and older people population of 13 550. The crude all-cause mortality rate per 1000 for adults was 7.3 (95 per cent confidence interval (CI) 6.7-7.8) and for older people 55.8 (95 percent CI 51.3-60.3). The probability of dying before age 60 after reaching age 15 was 34 percent for males and 32 percent for females. Malaria and diarrhoea, recorded through verbal autopsy, accounted for 21 percent of total deaths in adults and 22 per cent in older people. A seasonal trend in mortality for older people with a peak in February was identified. The study shows that malaria is an important cause of death in adulthood.     

Risk factors of infant and child mortality in rural Burkina Faso

OBJECTIVE: The aim of the study was to quantify the effect of risk factors for childhood mortality in a typical rural setting in sub-Saharan Africa. METHODS: We performed a survival analysis of births within a population under demographic surveillance from 1992 to 1999 based on data from a demographic surveillance system in 39 villages around Nouna, western Burkina Faso, with a total population of about 30000. All children born alive in the period 1 January 1993 to 31 December 1999 in the study area (n = 10 122) followed-up until 31 December 1999 were included. All-cause childhood mortality was used as outcome variable. FINDINGS: Within the observation time, 1340 deaths were recorded. In a Cox regression model a simultaneous estimation of hazard rate ratios showed death of the mother and being a twin as the strongest risk factors for mortality. For both, the risk was most pronounced in infancy. Further factors associated with mortality include age of the mother, birth spacing, season of birth, village, ethnic group, and distance to the nearest health centre. Finally, there was an overall decrease in childhood mortality over the years 1993-99. CONCLUSION: The study supports the multi-causation of childhood deaths in rural West Africa during the 1990s and supports the overall trend, as observed in other studies, of decreasing childhood mortality in these populations. The observed correlation between the factors highlights the need for multivariate analysis to disentangle the separate effects. These findings illustrate the need for more comprehensive improvement of prenatal and postnatal care in rural sub-Saharan Africa.     

Season of death and birth predict patterns of mortality in Burkina Faso

BACKGROUND: Mortality in developing countries has multiple causes. Some of these causes are linked to climatic conditions that differ over the year. Data on season-specific mortality are sparse. METHODS: We analysed longitudinal data from a population of approximately 35,000 individuals in Burkina Faso. During the observation period 1993-2001, a total number of 4,098 deaths were recorded. The effect of season on mortality was investigated separately by age group as (i) date of death and (ii) date of birth. For (i), age-specific death rates by month of death were calculated. The relative effect of each month was assessed using the floating relative risk method and modelled continuously. For (ii), age-specific death rates by month of birth were calculated and the mean date of birth among deaths and survivors was compared. RESULTS: Overall mortality was found to be consistently higher during the dry season (November to May). The pattern was seen in all age groups except in infants where a peak was seen around the end of the rainy season. In infants we found a strong association between high mortality and being born during the time period September to February. No effect was seen for the other age groups. CONCLUSIONS: The observed excess mortality in young children at or around the end of the rainy season can be explained by the effects of infectious diseases and, in particular, malaria during this time period. In contrast, the excess mortality seen in older children and adults during the early dry season remains largely unexplained although specific infectious diseases such as meningitis and pneumonia are possible main causes. The association between high infant mortality and being born at around the end of the rainy season is probably explained by most of the malaria deaths in areas of high transmission intensity occurring in the second half of infancy.     

2019年四川省5岁以下儿童营养状况分析

目的 了解四川省5岁以下儿童营养状况,为卫生行政决策提供参考和依据。 方法 采用随机整群抽样方法,在四川省范围内抽取7534名5岁以下儿童,测量血红蛋白和身高体重,采用2006年世界卫生组织（WHO）生长发育评价标准进行评价,并与2012年调查情况进行对比。结果 四川省5岁以下儿童生长迟缓率为5.09%、低体重率为1.76%、超重发生率为15.65%、肥胖发生率为5.44%、贫血患病率为6.16%。生长迟缓率男性高于女性（〖XC小五号.EPS;P〗=10.60,P=0.01）、农村高于城市（〖XC小五号.EPS;P〗=82.07,P<0.01）;低体重发生率农村高于城市（〖XC小五号.EPS;P〗=66.86,P<0.01）、婴儿组低体重发生率最高;贫血患病率农村高于城市（〖XC小五号.EPS;P〗=31.42,P<0.01）、婴儿组贫血患病率最高;城市超重发生率高于农村（〖XC小五号.EPS;P〗=82.74, P<0.01）,但农村的肥胖发生率高于城市（〖XC小五号.EPS;P〗=30.86,P<0.01）。结论 四川省不同性别营养健康状况差异在逐渐减少,但农村地区儿童营养问题仍然突出、超重和肥胖问题日益凸显,探索有效的控制多种形式营养不良的综合防控策略和措施是下一步工作重点。     

Molecular characterization and genetic susceptibility of sapovirus in children with diarrhea in Burkina Faso

Sapoviruses (SaVs) are a common cause of gastroenteritis in children. In sub-Saharan Africa, there is a scarcity of information regarding SaV as an etiological agent of diarrhea. Here, we investigated the prevalence, molecular characterization and clinico-epidemiological features of SaV infections in children less than 5 years of age with diarrhea in Burkina Faso. We further investigated the role of type 1 histo blood group antigens as susceptibility factors. In total, 309 fecal and 208 saliva samples from diarrheal children in Ouagadougou, Burkina Faso, were collected between May 2009 and March 2010. SaV was detected using real-time PCR, and genogrouped/genotyped by PCR or sequencing. Saliva samples were ABO, Lewis and secretor phenotyped using in house ELISA assays. We found a high prevalence (18%) and large genetic diversity with all 4 human genogroups, and 9 genotypes/genoclusters circulating during the study period. The SaV infections were generally associated with milder symptoms, and neither ABH, Lewis or secretor phenotypes affected susceptibility to SaV infections.     

Estimation of maternal and child mortality one year after user-fee elimination: an impact evaluation and modelling study in Burkina Faso

Objective

To estimate the impact on maternal and child mortality after eliminating user fees for pregnant women and for children less than five years of age in Burkina Faso.

Methods

Two health districts in the Sahel region eliminated user fees for facility deliveries and curative consultations for children in September 2008. To compare health-care coverage before and after this change, we used interrupted time series, propensity scores and three independent data sources. Coverage changes were assessed for four variables: women giving birth at a health facility, and children aged 1 to 59 months receiving oral rehydration salts for diarrhoea, antibiotics for pneumonia and artemesinin for malaria. We modelled the mortality impact of coverage changes in the Lives Saved Tool using several scenarios.

Findings

Coverage increased for all variables, however, the increase was not statistically significant for antibiotics for pneumonia. For estimated mortality impact, the intervention saved approximately 593 (estimate range 168–1060) children’s lives in both districts during the first year. This lowered the estimated under-five mortality rate from 235 deaths per 1000 live births in 2008 to 210 (estimate range 189–228) in 2009. If a similar intervention were to be introduced nationwide, 14 000 to 19 000 (estimate range 4000–28 000) children''s lives could be saved annually. Maternal mortality showed a modest decrease in all scenarios.

Conclusion

In this setting, eliminating user fees increased use of health services and may have contributed to reduced child mortality.     

The effect of distance to health-care facilities on childhood mortality in rural Burkina Faso

This study aims to investigate the relation between distance to health facilities, measured as continuous travel time, and mortality among infants and children younger than 5 years of age in rural Burkina Faso, an area with low health facility density. The study included 24,555 children born between 1993 and 2005 in the Nouna Health and Demographic Surveillance System. The average walking time from each village to the closest health facility was obtained for both the dry and the rainy season, and its effect on infant (<1 year), child (1-4 years), and under-5 mortality overall was analyzed by Cox regression. The authors observed 3,426 childhood deaths, corresponding to a 5-year survival of 85%. Walking distance was significantly related to both infant and child mortality, although the shape of this effect varied distinctly between the 2 age groups. Overall, under-5 mortality, adjusted for confounding, was more than 50% higher at a distance of 4 hours compared with having a health facility in the village (P < 0.0001, 2 sided). The region of residence was an additional determinant for under-5 mortality. The findings of this study emphasize the importance of geographic accessibility of health care for child survival in sub-Saharan Africa and demonstrate the need to improve health-care access to achieve the Millennium Development Goals.     

传染病医院接诊传染病病种分布

目的分析传染病医院接诊传染病病种分布,为传染病的防治提供依据。方法对医院2008-2012年接诊的各类传染病共19 779例患者进行病种分析,数据采用Excel 2007软件进行统计分析。结果血源及性传播疾病、呼吸道传染病和肠道传染病分别占59.73%、18.73%、18.47%;病毒性肝炎新发病例数呈下降趋势,但仍居传染病的首位,占63.0%;麻疹的发病水平呈明显的下降趋势,布鲁氏菌病新发病例数逐年增加,其他病种较为稳定;各个病种均有明显的季节性,除麻疹出现全年散发,其余病种月份分布较为稳定。结论血源及性传播是传染病的主要传播途径,其次为呼吸道和肠道;其中病毒性肝炎的发病率显著高于其他病种,应作为预防治疗重点。     

Characterization of Salmonella enterica and detection of the virulence genes specific to diarrheagenic Escherichia coli from poultry carcasses in Ouagadougou, Burkina Faso

One hundred chicken carcasses purchased from three markets selling poultry in Ouagadougou, Burkina Faso, between June 2010 and October 2010 were examined for their microbiological quality. The presence of Salmonella was investigated using standard bacteriological procedures, and the isolates obtained were serotyped and tested for antimicrobial susceptibility. The presence of virulence-associated genes of the five main pathogroups of diarrheagenic Escherichia coli-Shiga toxin-producing E. coli (STEC), enteropathogenic E. coli (EPEC), enteroaggregative E. coli (EAEC), enterotoxigenic E. coli, and enteroinvasive E. coli-was investigated using 16-plex polymerase chain reaction (PCR) on the mixed bacterial cultures from the poultry samples. Of the 100 chicken carcasses studied, 57 were contaminated by Salmonella; 16 different serotypes were identified, the most frequent being Salmonella Derby, found in 28 samples. Four Salmonella strains were resistant to tetracycline, and two were resistant to streptomycin. Based on the PCR detection of the virulence genes, in total, 45 carcasses were contaminated by three pathogroups of E. coli: STEC, EPEC, or EAEC. The STEC and EPEC virulence genes were detected on six and 39 carcasses, respectively. EAEC virulence genes were only detected in combination with those of EPEC (on 11 carcasses) or STEC (on two carcasses). The STEC-positive carcasses contained the genes stx(1), stx(2), eaeA, escV, and ent in different combinations. None of the EPEC-positive carcasses contained the bfp gene, indicating that only atypical EPEC was present. EAEC virulence genes detected were aggR and/or pic. The high proportion of chicken carcasses contaminated by Salmonella and diarrheagenic E. coli indicates a potential food safety risk for consumers and highlights the necessity of public awareness of these pathogens.