Nutritional status on admission and hospital mortality of under-five year old children with infectious diseases in Ouagadougou,Burkina Faso

BACKGROUND: It is known that malnutrition in childhood interacting with infectious diseases contributes to increase mortality. In Burkina Faso, infectious pathologies and malnutrition are public health problems. We examined the impact of malnutrition status, using the Weight-for-age (WA) index, on mortality of children hospitalized for infectious diseases. METHODS: This retrospective study uses a systematic sample derived from the year 1999 hospital register. In total data of 1573 children from 0 to 59 months were analyzed. The association between mortality and dependent variables was measured by relative risks (RR) in univariate analysis. A logistic regression was realized and attributable risk percent (etiologic fraction among exposed) of death was calculated. RESULTS: The total intra-hospital lethality amounted to 15.3%. Age, diagnosis, type of care recourse and malnutrition (low WA index) on admission were associated to mortality. The logistic regression model confirmed the high risks of deaths for young children (0-11m), children in malnutrition (low WA index) and those with severe malaria. The attributable risk percent of death indicates that, 87% of deaths are statically attributable to severe malnutrition (WA Z-score<=-3) and 64.3% of deaths are statically attributable to moderate malnutrition (WA Z-score]-3, -2]). CONCLUSION: Nutritional status evaluation would allow to select children at risk and reduce mortality by including nutritional intervention in standard treatment of children hospitalized for infectious diseases.     

Efficacy of chloroquine and sulfadoxine/pyrimethamine for the treatment of uncomplicated falciparum malaria in Koumantou, Mali

We report the results of an in vivo antimalarial efficacy study with chloroquine (CQ) and sulfadoxine/pyrimethamine (SP) conducted between 2003 and 2004 in Koumantou, southern Mali. A total of 244 children were included in the study; 210 children were followed-up for 28 days according to WHO recommendations, with PCR genotyping to distinguish late recrudescence from re-infection. Global failure proportions at Day 14, without taking into account re-infections, were 44.2% (95% CI 34.9-53.5%) in the CQ group and 2.0% (95% CI 0.0-4.8%) in the SP group. PCR-adjusted failure proportions at Day 28 were even higher in the CQ group (90.5% (95/105), 95% CI 84.8-96.2%) and relatively low in the SP group (7.0% (7/100), 95% CI 1.9-12.1%). These results show that CQ is no longer efficacious in Koumantou. The use of SP in monotherapy is likely to compromise its efficacy. We recommend the use of artemisinin-based combination therapy as first-line treatment for uncomplicated Plasmodium falciparum malaria in Koumantou.     

Monitoring the referral system through benchmarking in rural Niger: an evaluation of the functional relation between health centres and the district hospital

Background  

The main objective of this study is to establish a benchmark for referral rates in rural Niger so as to allow interpretation of routine referral data to assess the performance of the referral system in Niger.     

Amodiaquine metabolism is impaired by common polymorphisms in CYP2C8: implications for malaria treatment in Africa

Metabolism of the antimalarial drug amodiaquine (AQ) into its primary metabolite, N-desethylamodiaquine, is mediated by CYP2C8. We studied the frequency of CYP2C8 variants in 275 malaria-infected patients in Burkina Faso, the metabolism of AQ by CYP2C8 variants, and the impact of other drugs on AQ metabolism. The allele frequencies of CYP2C8*2 and CYP2C8*3 were 0.155 and 0.003, respectively. No evidence was seen for influence of CYP2C8 genotype on AQ efficacy or toxicity, but sample size limited these assessments. The variant most common in Africans, CYP2C8(*)2, showed defective metabolism of AQ (threefold higher K(m) and sixfold lower intrinsic clearance), and CYP2C8(*)3 had markedly decreased activity. Considering drugs likely to be coadministered with AQ, the antiretroviral drugs efavirenz, saquinavir, lopinavir, and tipranavir were potent CYP2C8 inhibitors at clinically relevant concentrations. Variable CYP2C8 activity owing to genetic variation and drug interactions may have important clinical implications for the efficacy and toxicity of AQ.     

Anti-Pfs25 Human Plasma Reduces Transmission of Plasmodium falciparum Isolates That Have Diverse Genetic Backgrounds

Pfs25 is a leading candidate for a malaria transmission-blocking vaccine whose potential has been demonstrated in a phase 1 trial with recombinant Pfs25 formulated with Montanide ISA51. Because of limited sequence polymorphism, the anti-Pfs25 antibodies induced by this vaccine are likely to have transmission-blocking or -reducing activity against most, if not all, field isolates. To test this hypothesis, we evaluated transmission-blocking activities by membrane feeding assay of anti-Pfs25 plasma from the Pfs25/ISA51 phase 1 trial against Plasmodium falciparum parasites from patients in two different geographical regions of the world, Thailand and Burkina Faso. In parallel, parasite isolates from these patients were sequenced for the Pfs25 gene and genotyped for seven microsatellites. The results indicate that despite different genetic backgrounds among parasite isolates, the Pfs25 sequences are highly conserved, with a single nonsynonymous nucleotide polymorphism detected in 1 of 41 patients in Thailand and Burkina Faso. The anti-Pfs25 immune plasma had significantly higher transmission-reducing activity against parasite isolates from the two geographical regions than the nonimmune controls (P < 0.0001).     

Comparison of Physicochemical and Functional Properties of Flour and Starch Extract in Different Methods from Africa Locust Bean (Parkia Biglobosa) Seeds

Background

African locust bean tree is an important food tree for both human and livestock such as husks and pods. It plays a very vital role in the rural areas. The aim of this study was to evaluate some physicochemical, mineral characteristics and functional properties of flour and starch extract produced from Parkia biglobosa seeds, using different methods.

Materials and Methods

Three different methods were used for starch extraction in other to get the Starch yield (%),composition analysis for; moisture, protein, fat, ash and fiber contents of flour and starch extracts from Parkia biglobosa were determined on dry basis (db), by AACC method, color and PH value measurements was carried out using color flex spectrocolorimeter, and the official method of AOAC respectively. Pasting properties was determined and X-ray powder starch diffraction was used to examine the crystalline property of flour and starch extract. Gelatinization characteristics and in vitro starch digestibility were also determined, test results were processed using one-way analysis of variance (ANOVA).

Results

Flour showed higher (P < 0.05), moisture content, fat, carbohydrate, amylopectine, and protein content than starch, while amylose content of this starch was higher (P<0.05). Phosphorus, sodium, magnesium, and potassium minerals content were higher in flour than starch. Pasting properties, gelatinisation, color, pH values, water and oil absorption capacity content of the flour were found to be higher than that of starch. The pasting characteristics showed a decrease of viscosity, final viscosity, set back value, breakdown, and pasting temperature of flour when compared to that of starch.

Conclusion

From our results, we speculate that flour from native Parkia biglobosa grown in Guinea under controlled environmental conditions could be considered as an ideal RS material, whereas the extract Parkia starch could be an ideal SDS material. Therefore, these may offer an interesting alternative for food developers, depending on their characteristics and functional properties.     

Malaria, environmental change, and an [corrected] historical epidemiology of childhood 'cold fevers': popular interpretations from southwestern Burkina Faso

We examine how southwestern Burkina Faso populations interpret political ecological and social change for the past 40 years to assert a changing epidemiology of childhood "cold fevers"-malaria-like illnesses. Lay knowledge about "cold fevers" is historically produced, reflecting political economic, social, ecological and biomedical changes, and the historical consciousness of people living with these illnesses. While informants insisted that dislocations wrought by a post-colonial irrigation scheme increased cold fevers, they offered different explanations for their increased incidence and intensity. This historical epidemiology of cold fevers may influence parents' care decisions, but global public health interventions are rapidly changing therapeutic access.