Caustic oesophageal stricture treated by instrumental dilatation: A review of 6 years of practice at the pediatric university hospital charles de gaulle of Ouagadougou

Background

Oesophageal stricture is one of the most important and redoubtable complications following caustic ingestions in children. Instrumental dilatation is usually considered the first line of treatment.

Aims and Objectives

This study aims to evaluate the outcomes of caustic stenosis treatment when using Lerut dilatators.

Materials and Methods

This is a descriptive retrospective study from May 2014 to April 2020. All children under 15 years hospitalised in our department for caustic oesophageal stricture and had a gastrostomy and oesophageal dilatation with insertion of an endless wire were included.

Results

A total of 83 patients were included. The sex ratio was 2.2. The mean age was 4 years. The mean time from caustic ingestion to presentation was 90 days. Oesophageal stricture was mostly caused by caustic soda (n = 41) and potash (n = 15). We performed in total 469 dilatations and had only three oesophageal perforations. After a mean follow-up of 17 months, we had 60.2% good results (n = 50) and 7.2% (n = 6) failures. The mortality rate was 13.2% (n = 11).

Conclusion

The results of the dilations by Lerut dilatators give encouraging results in our department. It is easy to perform and its complications remain rare. Mortality could be reduced by adequate nutritional support.

The association between climate, geography and respiratory syncitial virus hospitalizations among children in Ontario, Canada: a population-based study

Background

Respiratory syncytial virus (RSV) infection is a major cause of hospitalization in young children in Canada, despite routine immunoprophylaxis in those with medical risk factors. We aimed to determine if cold temperatures are associated with RSV hospitalization.

Methods

We conducted a population-based nested case–control study of children in Ontario, Canada, using health administrative data. We compared children hospitalized for RSV between September 1, 2011 and August 31, 2012 to age and sex matched controls. We used multivariable logistic regression to identify associations between minimum daily temperature and RSV hospitalizations with adjustment for sociodemographic and environmental factors.

Results

We identified 1670 children with RSV hospitalizations during the study period and 6680 matched controls. Warmer temperatures (OR = 0.94, 95%CI: 0.93, 0.95) were associated with lower odds of RSV hospitalization. Southern ecozone (OR = 1.6, 95%CI: 1.2, 2.1), increased ozone concentration (OR = 1.03, 95%CI: 1.01, 1.06) and living in a lower income neighbourhood (OR = 1.3, 95%CI: 1.1, 1.5) significantly increased the odds of RSV hospitalization, as did living in a household with a larger number of siblings in a sub-cohort of children (OR = 1.34, 95%CI: 1.26, 1.41).

Conclusions

In Ontario, the likelihood of having an RSV hospitalization is associated with colder temperature exposures and socioeconomic factors.

Projecting the Number of Posttransplant Clinic Visits With a Rise in the Number of Kidney Transplants: A Case Study From Ontario, Canada

Background:

In Ontario, kidney transplants have risen by 4% annually in recent years. An understanding of how this will affect the future annual number of posttransplant follow-up visits informs how to organize and deliver care.

Objective:

We projected the required number of annual posttransplant follow-up nephrology visits to inform posttransplant care delivery.

Design:

Population-based retrospective cohort study.

Setting:

Linked databases from Ontario, Canada (population 14 million).

Patients:

Incident kidney transplant recipients from years 2008 to 2013.

Measurements:

Frequency, distance traveled, and current and projected visits for posttransplant follow-up.

Methods:

Assuming a graft survival of 13 years and using the mean number of posttransplant clinic visits in years 1, 2, and 3, we forecasted the number of clinic visits needed in the year 2027.

Results:

Using data from 2443 recipients, the mean (SD) number of clinic visits per recipient was 14.0 (9.2) in the first year after transplant, and 3.9 (6.2) and 3.0 (5.3) in the second and third year, respectively. If transplant rates rise by 4% per year until 2027, the estimated annual visits number will increase from 30 622 to 43 948. The median (25th, 75th percentile) distance between transplant center and patient’s home was 30 (13, 65) km. The median round-trip travel distance for these visits in the first year after transplantation was 603 km per recipient, and median driving cost was Can$344 (2017).

Limitations:

Regarding patient expense, limitations include that distances traveled were calculated orthodromically, and we did not account for patient cost of follow-up beyond that of vehicular travel. Regarding follow-up projections, limitations include the assumption that graft life span will not change, follow-up patterns do not differ between donor kidney type, and we did not survey stakeholders as to their preferred method of follow-up.

Conclusion:

We quantified the increase in posttransplant visits when regional annual rates of transplantation rise. Strategies recognizing the burden of these visits may enhance patient-centered care, as it is unclear how some patients manage costs, nor how the current health care system will manage the demand.

Hip Fractures in Older Adults in Ontario, Canada-Monthly Variation, Insights, and Implications

Background

In older adults, hip fractures have been described to peak in cooler months. Seasonal differences in patient vulnerability to fracture and social/behavioural factors might contribute to these trends.

Methods

Using linked health-care databases in Ontario Canada, we examined monthly variation in hip fracture hospitalizations in those > 65 years (2011–2015). We stratified results by age category (66–79, ≥80 years). We then examined for variation in the demographic and comorbidity profiles of patients across the months, and as an index of contributing social/behavioural factors, noted variation in health-care behaviours.

Results

There were 47,971 and 52,088 hospitalizations for hip fracture in those 66–79, and ≥80 years, respectively. There was strong seasonality in fractures in both groups. Peaks occurred in October and December when patients appeared most vulnerable. Rates fell in the summer in those 66–79 years, and in the late winter in those ≥80 years (when health-care utilization also declined). A smaller peak in fractures occurred in May in both groups.

Conclusions

Hip fractures peak in the autumn, early winter, and spring in Canada. A dip in fractures occurs in the late winter in the oldest old. Environmental factors might play a role, but seasonal vulnerability to fracture and winter isolation might also be influential.

[Epidemiology and clinic of dental extractions in University Teaching Hospital Yalgado Ouedraogo, (Burkina Faso)]

INTRODUCTION

The consequences of tooth loss are often severe for the patient: aesthetic deficit, decreased masticatory coefficient, malnutrition... The objective of this study was to describe the epidemiological and clinical aspects of dental extractions of patients attending the University Teaching Hospital Yalgado Ouedraogo (UTHYO).

PATIENTS AND METHODS

It was a descriptive cross-sectional retrospective study on a sample of 65 patients who received a dental extraction at least in dental surgery of the UTHYO.

RESULTS

The sample consisted of 33 (50.8%) patients female to 32 (49.2%) cases of male, or a sex ratio of 0.96. The average age was 36,55 year-old with extremes of 5 and 84 years. Employees and pupils were the most affected by extractions (33 cases; 47,8% and 22 cases; 33,8%). Dental extractions were more frequent in patients aged between 25 and 60 years. A total of 84 tooth extraction was performed in 65 patients, an average of 1.3 tooth extracted per patient. The most often extracted tooth was the third lower molar (17 cases, 22,95%). The canine was the less often extracted tooth (1 case, 1,35%). Dental decay and its complications (57 cases, 67,87%) and periodontal diseases (10 cases, 11,90%) were the commonest reasons for dental extractions.

CONCLUSION

Dental decay and periodontal diseases are the most important causes of dental extractions. Particular emphasis should be placed on prevention and early care of teeth.

Analyzing Thiol-Dependent Redox Networks in the Presence of Methylene Blue and Other Antimalarial Agents with RT-PCR-Supported in silico Modeling

Background

In the face of growing resistance in malaria parasites to drugs, pharmacological combination therapies are important. There is accumulating evidence that methylene blue (MB) is an effective drug against malaria. Here we explore the biological effects of both MB alone and in combination therapy using modeling and experimental data.

Results

We built a model of the central metabolic pathways in P. falciparum. Metabolic flux modes and their changes under MB were calculated by integrating experimental data (RT-PCR data on mRNAs for redox enzymes) as constraints and results from the YANA software package for metabolic pathway calculations. Several different lines of MB attack on Plasmodium redox defense were identified by analysis of the network effects. Next, chloroquine resistance based on pfmdr/and pfcrt transporters, as well as pyrimethamine/sulfadoxine resistance (by mutations in DHF/DHPS), were modeled in silico. Further modeling shows that MB has a favorable synergism on antimalarial network effects with these commonly used antimalarial drugs.

Conclusions

Theoretical and experimental results support that methylene blue should, because of its resistance-breaking potential, be further tested as a key component in drug combination therapy efforts in holoendemic areas.

Humoral and cell-mediated immunity to MSP3 peptides in adults immunized with MSP3 in malaria endemic area, Burkina Faso

We performed a single-blind, randomized phase 1 trial of the long synthetic peptide (LSP) of merozoite surface protein-3 (MSP3) in adults living in Burkina Faso. Thirty eligible volunteers were randomized to receive either the MSP3-LSP candidate vaccine or tetanus toxoid vaccine as a control. A dose of each vaccine was administered on days 0, 28 and 112 and the vaccine was formulated with aluminium hydroxide. Humoral immune responses were assessed by ELISA at days 0, 28, 56, 112, 140, 252 and 365 and cell-mediated immune responses by lymphoproliferation assay and by ELISA on days 0, 56 and 140. IgG responses to four peptides of MSP3 were similar in both vaccine groups. Higher IgG concentrations were recorded after the beginning of malaria high transmission season in both vaccine groups. The lymphocyte proliferation and the production of IFN-γ in response to stimulation with the four overlapping peptides increased following vaccination in the MSP3-LSP vaccine group, but did not change appreciably in the control group. In contrast to natural infection, MSP3-LSP did not boost humoral responses to the four overlapping peptides of MSP3 to any detectable degree in our semi-immune adult. MSP3-LSP may be more immunogenic in young children with little or no acquired immunity.

[Epidemiology and prognostic factors for sickle cell retinopathy in Ouagadougou (Burkina Faso)]

INTRODUCTION

The frequency of sickle cell disease varies from 5% to 20% in Africa.

PATIENTS AND METHOD

This retrospective study investigated 173 patients in an ambulatory setting from August 2000 to July 2006. The study included 98 women and 75 men, aged 15-62 years, with a mean age of 26.7 years.

RESULTS

Only 89 patients (71 SC and 18 SS) were seen in ophthalmology, 44 (49%) had sickle cell retinopathy with 26 (29%) cases nonproliferative and 18 cases proliferative (20%). Among the 71 SC patients, 35 (50%) had sickle cell retinopathy, with 40% the proliferative form. Of the 18 SS patients, nine had a retinopathy (50%), with four cases proliferative.

DISCUSSION

Retinopathy is a frequent complication of sickle cell disease, which can lead to blindness, and its management better accessibility to the ophthalmologic examination and preventive treatment by laser photo coagulation.

Roles of clinical and subclinical reactivated herpes simplex virus type 2 infection and human immunodeficiency virus type 1 (HIV-1)-induced immunosuppression on genital and plasma HIV-1 levels

BACKGROUND

Few longitudinal studies have described the interactions between reactivation of herpes simplex virus type 2 (HSV-2) infection (hereafter, "HSV-2 reactivation") and genital and systemic replication of human immunodeficiency virus type 1 (HIV-1).

METHODS

Women in Burkina Faso who were seropositive for both HIV-1 and HSV-2 were enrolled in a randomized placebo-controlled trial of therapy to suppress reactivation of HSV-2 infection (hereafter, "HSV suppressive therapy"). During the baseline phase, 6 enriched cervicovaginal lavage specimens were obtained over 12 weeks to detect and quantify the HIV-1 RNA and HSV-2 DNA loads.

RESULTS

Women with genital ulcer disease (GUD) detected at least once were more likely than women in whom GUD was not detected (risk ratio [RR], 1.23; 95% confidence interval [CI], 1.09-1.37) to have genital HIV-1 RNA detected during >or=1 visit. Similarly, women with genital HSV-2 DNA detected during >or=1 clinic visit were more likely than women in whom genital HSV-2 DNA was not detected (RR, 1.17; 95% CI, 1.01-1.34) to have genital HIV-1 RNA detected at least once. In addition, the mean genital HIV-1 RNA loads for women with GUD detected during >or=1 visit and women with HSV-2 genital shedding detected during >or=1 visit were greater than that for women in whom genital HSV-2 DNA or GUD was never detected. The plasma HIV-1 RNA load was increased among women for whom >or=1 visit revealed GUD (+0.25 log(10) copies/mL; 95% CI, -0.05-0.55) or genital HSV-2 DNA (+0.40 log(10) copies/mL; 95% CI, 0.15-0.66), compared with women who did not experience GUD or HSV-2 genital shedding, respectively. The association of HSV-2 reactivations on HIV-1 replication tended to be stronger in patients with a higher CD4(+) cell count (i.e., >500 cells/microL). The contribution of HSV-2 to HIV-1 replication among women with CD4(+) cell count of <or=500 cells/microL was reduced because almost all experienced HIV-1 genital shedding.

CONCLUSIONS

Both clinical and subclinical HSV-2 reactivations play a role in increasing the rate of HIV-1 replication. HSV suppressive therapy is a promising tool for HIV control. Initiation of such therapy when the CD4(+) cell count is >500 cells/microL deserves further investigation.

CLINICAL TRIALS REGISTRATION

The ANRS 1285 Study is registered with the National Institutes of Health (registration number NCT00158509).

Effect of HIV-1 and antiretroviral therapy on herpes simplex virus type 2: a prospective study in African women

OBJECTIVES

To document the natural history of herpes simplex virus type 2 (HSV-2) in relation to HIV and highly active antiretroviral therapy (HAART) in Africa, a longitudinal study was conducted of women in the placebo arms of two randomised controlled trials of HSV-suppressive therapy in Burkina Faso.

METHODS

22 HIV-uninfected women (group 1), 30 HIV-1-infected women taking HAART (group 2), and 68 HIV-1-infected women not eligible for HAART (group 3) were followed over 24 weeks. HSV-2 DNA was detected on alternate weeks using real-time PCR from cervicovaginal lavages. Plasma HIV-1 RNA was measured every month. CD4 cell counts were measured at enrollment.

RESULTS

Ulcers occurred on 1.9%, 3.1% and 7.2% of visits in groups 1, 2 and 3 (p = 0.02). Cervicovaginal HSV-2 DNA was detected in 45.5%, 63.3% and 67.6% of women (p = 0.11), and on 4.3%, 9.7% and 15.5% of visits in the three groups (p<0.001). Among HIV-infected women, cervicovaginal HSV-2 DNA was detected more frequently during ulcer episodes (adjusted risk ratio (aRR) 2.79, 95% CI 2.01 to 3.86) and less frequently among women practising vaginal douching (aRR 0.60, 95% CI 0.40 to 0.91). Compared with women not taking HAART and with CD4 cell counts of 500 cells/microl or greater, women on HAART had a similar risk of HSV-2 shedding (aRR 0.95, 95% CI 0.52 to 1.73), whereas women with CD4 cell counts of 200-500 cells/microl were more likely to shed HSV-2 (aRR 1.71, 95% CI 1.02 to 2.86).

CONCLUSIONS

HSV-2 reactivations occur more frequently among HIV-infected women, particularly those with low CD4 cell counts, and are only partly reduced by HAART. HSV therapy may benefit HIV-infected individuals during HAART.

Longitudinal effect following initiation of highly active antiretroviral therapy on plasma and cervico-vaginal HIV-1 RNA among women in Burkina Faso

BACKGROUND

Highly active antiretroviral therapy (HAART) could decrease HIV-1 transmissibility by reducing genital and plasma HIV-1 RNA.

METHODS

We evaluated the effect of HAART on genital and plasma HIV-1 RNA in a cohort of 39 antiretroviral-naïve women in Burkina Faso. Cervico-vaginal lavages were collected before HAART initiation and at six visits over 28 weeks while on HAART. Blood samples were collected at baseline and at three and four visits for CD4 and plasma HIV-1 RNA measurements, respectively.

RESULTS

Before HAART, 72% of women had detectable genital HIV-1 RNA. After 18 weeks on HAART, only one woman (2.5%) had detectable plasma HIV-1 RNA and two women (5.1%) had detectable genital HIV-1 RNA. Similar results were observed at each follow-up visit. However, 16/34 (47%) women with consistently undetectable plasma HIV-1 RNA shed HIV-1 at least once between weeks 18 and 28. In samples with detectable genital HIV-1, the mean quantity of HIV-1 RNA decreased from 3.87 prior to HAART to 3.04 log(10) copies/mL at last visit (median 29 weeks; a 6.8-fold decrease in absolute number of copies/mL) (p = 0.04). A significant median CD4 lymphocyte cell gain of 121 cells/muL (interquartile range 59 to 204) was measured between pre-HAART and last visit.

CONCLUSION

These findings suggest that HAART could play a role in reducing HIV transmission in Africa; however, they underscore the need to emphasise safe sex practices with patients taking HAART.

Caractéristiques de la population prise en charge au Service de Psychiatrie du CHU Yalgado Ouédraogo de Ouagadougou (Burkina Faso) de 1990 à 2000

Mental disorders constitute an important portion of the world sickness ratio. In developing countries, in the absence of data on morbidity, hospital statistics are worthy of interest. Our study was carried out on a population of patients under care in the department of psychiatry of the Ouagadougou Hospital between January 1st 1990 and December 31st 2000, a period of 11 years. For each patient, we noted the sociodemographical features and the clinical diagnosis referring to the ICD-10 of the WHO. Within the scope of the study, 7 313 patients (60% men and 40% women) were analysed. The average age of the patients was 31.06 +/- 13.07 years. Among these patients, 80.60% had been exclusively under ambulatory care and 19.40% had been hospitalized at least once. The main categories of the available diagnoses were listed according to recurrence: acute psychotic disorders (20.68%), schizophrenia (17.25%) and depression (15.13%). In the men, the main diagnosis was acute psychotic disorders, whereas depression came top of the list for women. In the present state of socio-economic and cultural development in Burkina Faso, we note that only very serious mental disorders and/or those who cannot obtain favourable response with the traditional care system, come to medical centers. Therefore, there is a need to investigate the population as a whole, and to assess their need for medical care in this domain.

Human papillomavirus genotype distribution and cervical squamous intraepithelial lesions among high-risk women with and without HIV-1 infection in Burkina Faso

Human papillomavirus (HPV) infection and cervical squamous intraepithelial lesions (SILs) were studied in 379 high-risk women. Human papillomavirus DNA was detected in 238 of 360 (66.1%) of the beta-globin-positive cervical samples, and 467 HPV isolates belonging to 35 types were identified. Multiple (2-7 types) HPV infections were observed in 52.9% of HPV-infected women. The most prevalent HPV types were HPV-52 (14.7%), HPV-35 (9.4%), HPV-58 (9.4%), HPV-51 (8.6%), HPV-16 (7.8%), HPV-31 (7.5%), HPV-53 (6.7%), and HPV-18 (6.4%). Human immunodeficiency virus type 1 (HIV-1) seroprevalence was 36.0%. Human papillomavirus prevalence was significantly higher in HIV-1-infected women (87 vs 54%, prevalence ratio (PR) = 1.61, 95% confidence interval (CI): 1.4-1.8). High-risk HPV types (71 vs 40%, PR = 1.79, 95% CI: 1.5-2.2), in particular HPV-16+18 (22 vs 9%, PR = 2.35, 95% CI: 1.4-4.0), and multiple HPV infections (56 vs 23%, PR = 2.45, 95% CI: 1.8-3.3) were more prevalent in HIV-1-infected women. High-grade SIL (HSIL) was identified in 3.8% of the women. Human immunodeficiency virus type 1 infection was strongly associated with presence of HSIL (adjusted odds ratio = 17.0; 95% CI 2.2-134.1, P = 0.007) after controlling for high-risk HPV infection and other risk factors for HSIL. Nine of 14 (63%) HSIL cases were associated with HPV-16 or HPV-18 infection, and might have been prevented by an effective HPV-16/18 vaccine.

Effect of temperature on vegetative growth among isolates of Metarhizium anisopliae and M. flavoviride

Effects of temperature on vegetative growth on a semi-synthetic medium of 22 isolates of Metarhizium anisopliae and 14 isolates of M. flavoviride were determined. The majority of isolates of both species grew between 11 and 32 degrees C; several isolates grew at 8 and 37 degrees C. None of the isolates grew at 40 degrees C. Relative growth rate, calculated from the maximum growth rate for each isolate, was significantly affected by temperature and isolate, with significant isolate * temperature interactions. The maximum absolute growth rates among the isolates ranged from 2.5 mm to 5.9 mm/day. Optimal temperatures were generally between 25 and 32 degrees C with several isolates exhibiting optimal growth at temperatures as high as 32 degrees C. Overall, relative growth rates were greater in isolates of M. anisopliae than M. flavoviride at temperatures of 25 degrees C or lower; conversely mean relative growth rates were greater in M. flavoviride than M. anisopliae at temperatures higher than 25 degrees C. However, the two most cold tolerant isolates at 8 degrees C were M. flavoviride and the three most heat tolerant at 35 degrees C were M. anisopliae. Since temperature growth responses varied considerably between isolates, strain selection according to thermal tolerance may be warranted when choosing a strain for development as a microbial control agent.

Decentralising tuberculosis case management in two districts of Burkina Faso

SETTING

In West Africa, national tuberculosis programmes (NTPs) face many problems due to the low performance of health care delivery systems and patients' social and cultural environment.

OBJECTIVE

To improve the case management of TB in Burkina Faso.

DESIGN

Using the operational research process as a tool, TB case management was decentralised from the district hospital to eight primary health care centres in 2003.

RESULTS

Twelve months after decentralisation, the quality of case detection remained satisfactory. The delay between the identification of TB suspects with chronic cough and the confirmation of TB was reduced from 13 to 6 days. The detection rate of TB suspects during the study (30%) was twice as high as for 2001 and 2002 (15%). However, the detection rate for smear-positive TB cases decreased from 32.3% in 2001 and 2002 to 6.5% during the year of the study.

CONCLUSION

Sufficient time and commitment are essential to obtain a case management system that is decentralised and effective. Efforts therefore need to continue to obtain more information and better results.

[HIV infection and modification of social relationships: study of 188 HIV-infected persons in Ouagadougou (Burkina Faso)]

HIV infection creates diverse representations among sick people, their families, the community and healthcare workers, representations that modify social relationships. To analyze the interpersonal relationships in families of people living with HIV, we began a cross-sectional descriptive study in 2001 of a population of HIV patients treated at an outpatient center in Ouagadougou. Our objectives were to: 1 degree) describe the changes in the social relationships between the subjects and members of their families; 2 degrees) itemize the difficulties they met within their families and identify the different types of discrimination they may suffer there. The systematic inclusion of HIV patients at the treatment center made it possible to question 188 subjects, including 122 women and 66 men aged 19 to 55 years. With the subjects' consent, 66 family members were also interviewed. According to these patients, the principal significant events experienced after disclosing their HIV status were absence of sexual intercourse with the partner (16.0%), rejection by their family (9.6%), taunting, criticism and contempt (6.4%). This conduct came from siblings (25%), other family members (20.8%), neighbours (20.8%), in-laws (16.7%), and the spouse (4.2%). Among our subjects, 74.5% informed their families that they were HIV-positive. Of the family members questioned, 82.1% considered the subject to be a victim and 17.9% considered him or her guilty. After receiving this information 21.5% of the families modified their relationships with the subjects. Despite information and awareness campaigns, HIV infection is laden with emotion and prejudice and subjects its victims to discriminatory behavior. Further public education is necessary to improve acceptance of people with this disease by their family and friends.

[People living with HIV: daily life and management of the risk of transmission in the infected person's entourage: study in Ouagadougou]

HIV infection has modified social relationships not only within various population subgroups but also at the family level. Patient management has been seriously affected. In 2001 we undertook a descriptive study among a population of PLHIV treated in an ambulatory center in order to 1(o)) describe the socio-demographical characteristics of PLHIV admitted to the center and 2(o)) identify the strategies adopted by PLHIV and their families to control the risk of HIV transmission in the entourage. Patients were systematically included over a period of two weeks. Each patient was asked to indicate the name of a family member that could be interviewed by the research team. A total of 188 PLHIV (122 women) ranging in age from 19 to 55 years were questioned. Interviews were conducted in 66 families. Most PLHIV had received some formal education ranging from primary school to university. Over one third (36.4%) had known that they were seropositive for at least one year. Almost three-fourths (73.4%) were aware that HIV was transmissible to other people. The most frequently mentioned transmission hazards were handling contaminated articles (51.5%), unprotected sexual intercourse (46.4%), contact with blood (34.8%), and sharing personal toilet articles (11.6%). The most commonly mentioned preventive measures were abstinence from sex (27.1%), use condoms (28.7%), and protection from pointed or cutting objects (19.1%). According to responding family members, the most common protective measures against HIV transmission were observing hygiene measures (36.5%), discarding any fluids from the ill person in the toilet (26.5%), wearing gloves (25%), and protecting against handling contaminated objects (5.8%). These data suggest that programs aimed at educating PLHIV and their families on the risk of HIV transmission and preventive measure has had a positive impact on the quality of life.

Review of STI and HIV epidemiological data from 1990 to 2001 in urban Burkina Faso: implications for STI and HIV control

OBJECTIVES

To better understand the sexually transmitted infection (STI)/HIV dynamics in an urban west African setting in order to adapt STI/HIV control efforts accordingly.

METHODS

Review of STI and HIV epidemiological studies performed over the past decade in Bobo-Dioulasso, the second city of Burkina Faso. Trends in STI prevalence among commercial sex workers and the general population were assessed over time through studies that used the same recruitment and laboratory diagnostic procedures. Variations in aetiologies of vaginal discharge, urethral discharge, and genital ulcers were also evaluated among patients consulting for genital infection complaints. Antenatal clinic based surveys provided data to assess HIV trend among the general population.

RESULTS

We observed an important decline of classic bacterial STI such as syphilis, Neisseria gonorrhoea, Chlamydia trachomatis, and Haemophilus ducrey infections in all study groups. Trichomoniasis also declined but to a lesser extent. HIV infection followed the same trend at the same time, with a significant decline in the 15-19 year age group of pregnant women, suggesting a possible decrease of HIV incidence. Although no evidence of a causal relation can be drawn from this review, adoption of safer sex behaviour, introduction of the syndromic management (SM) approach, or higher antibiotic use may have contributed to these changes.

CONCLUSIONS

Classic bacterial STI declined over the past decade in parallel with a stabilisation of HIV infection. Variations in syndromes aetiology and sexual behaviours should be monitored as part of STI surveillance in order to improve STI syndromic management algorithms and to adapt HIV/STI prevention efforts.

[Abruptio placentae: epidemiological, clinical and prognostic aspects with respect to a 177 case series]

OBJECTIVE

A retrospective study based on 177 cases of abruptio placentae, and describing the epidemiological, clinical and prognosis aspects.

PATIENTS AND METHODS

A hundred and seventy-seven cases, corresponding to 185 children, were registered over a five-year period in the department of gynecology and obstetrics of the CHNYO of Ouagadougou.

RESULTS

Abruptio placentae occurrence rate was about 9.6 per 1000 deliveries. In our study, this type of accident was most frequent with 30 to 34-year-old women (31.1%), with multiparous ones (56.5%), and with those suffering from arterial hypertension linked to pregnancy (31.1%). The clinical picture was most often complete, 83.1% of patients having reached grade 3 of abruptio placentae with complete symptomatology and foetal death. Vaginal delivery was preferred to cesarean section in 64.4% of the cases. Maternal death rate was about 3.9% and mainly caused by severe anemia (61.6%) and puerperal infections (7.9%). Foetal prognosis was dominated by the high rate of mortinatality (85.9%).

DISCUSSION AND CONCLUSION

To reduce maternal mortality as well as morbidity due to abruptio placentae, correct prenatal follow-up, early diagnosis and prompt evacuation of the womb are required.

[Prevalence of minor psychiatric disorders among women working in the health sector in Ouagadougou, Burkina Faso: results of an evaluation using the GHQ-28]

In a developing country like Burkina Faso, where the mental health care relates to only a minority of people affected by the mental disorders, investigations among the general population are very informative. The present study aimed to determine the prevalence of minor psychiatric disorders among the female population in the urban environment of Ouagadougou in Burkina Faso, as well as the sociodemographic factors possibly associated with mental troubles among these women. The study was a descriptive transverse investigation with single passage carried out on 227 women whose mean age was 37.38 +/- 7.50 years old. The French version of the GHQ-28 was used to evaluate minor psychiatric disorders. The prevalence of the the psychiatric disorders within the population was 33.48%. The results of the GHQ-28 showed that social abnormal operations (59.03%), anxiety and insomnia (45.37%) were the disorders most frequently detected. The importance of psychiatric morbidity within the surveyed population suggests complementary studies aiming at specifying the supporting factors among others.

Trachoma, flies and environmental factors in Burkina Faso

The presence of flies is one of the earliest risk factors for trachoma and it has been suggested that flies could act as vectors for transmission of chlamydiae. A national trachoma survey was conducted in 1997 in Burkina Faso to (i) study the relationship between trachoma occurrence, flies, dirty faces and some environmental factors, and (ii) investigate the role of flies in the presence of trachoma. The country was stratified into eight groups of provinces and a random sample of 30 clusters was selected in each group. All children aged < 10 years were examined for the diagnosis of active trachoma (trachomatous inflammation which was follicular and/or intense) and the dirtiness of the face and the presence of flies on the face were recorded. The children's carers were questioned about the number of baths given and daily face-washing. Household heads were asked about ownership of cattle and small ruminants. The presence of latrines, a stable, and garbage collection inside the yard was noted. Among 16,514 children examined, 27.0% had active trachoma and 3.3% intense inflammatory trachoma. Flies were present on 11.2% of children's faces and 82.4% and 19.7% of these children had active and intense inflammatory trachoma, respectively. Among the 30.2% of children with dirty faces, 70.2% had active and 10.2% intense inflammatory trachoma. In multivariate analysis, at least one daily bath showed a protective effect on both active and intense inflammatory trachoma. Face-washing twice daily was found to be significantly protective for active trachoma in some regions. A strong association was demonstrated between the presence of flies and dirty faces (odds ratio = 334, 95% confidence interval 202-546). The presence of flies on children's faces, dirty faces and trachoma appeared to be strongly associated. Although the presence of flies may be a marker of socio-economic status and is probably linked with other trachoma risk factors, our data indicated that interventions targeting fly control should be an important issue in controlling trachoma.

Child malaria treatment practices among mothers in the district of Yanfolila, Sikasso region, Mali

We studied child malaria treatment practices among mothers living in the District of Yanfolila in southern Mali. For sampling, we first chose five of 13 health areas with probability proportional to size. Then villages, compounds and mothers with at least one child aged 1-5 years were randomly chosen. We assessed the spleen size of one 1-5 year-old child of each mother, collected a thick blood film and recorded the body temperature of every child whose mother thought he/she was sick. 399 mothers in 28 villages were interviewed with a structured questionnaire divided into two parts. If the child had had soumaya (a term previously associated with uncomplicated malaria) during the past rainy season, we asked about signs and symptoms, health-seeking behaviour (who the mother consulted first) and treatment. If not, information about knowledge of the disease and treatment to be given was collected. 86% of the mothers interviewed stated that their child had been sick and almost half of them had had soumaya. All mothers named at least one sign by which they recognized the disease. Vomiting, fever and dark urine/yellow eyes/jaundice were the three most common signs mentioned. 75.8% managed their child's disease at home and used both traditional and modern treatment. The most common anti-malarial drug was chloroquine, often given at inappropriate dosage. The sensitivity and specificity of the mothers' diagnosis was poor, although this might be explained by the large percentage of children who had already been treated at the time of the interview. The results of our survey call for prompt educational action for the correct treatment of uncomplicated malaria/soumaya, particularly for mothers and possibly for shopkeepers. The high spleen rate (58.1%) among randomly selected children confirms that malaria is a common disease in this area. Improved case-management at home could only be beneficial.

A comparative study on the oestrous response to PGF2 alpha analogue treatment, and conception rates according to time of artificial insemination, in Zebu (Bos indicus) and Baoulé (Bos taurus) cattle

The oestrous response, interval and conception rates were studied after synchronization with a prostaglandin analogue (cloprostenol) and artificial insemination (AI) performed at different times in 50 Zebu (Bos indicus) and 83 Baoulé (Bos taurus) cattle indigenous to Burkina Faso. The overall proportion of cows responding to synchronization was 70% (93/133). Although the response was higher for the Baoulé cattle, at 73.5% (61/83), than for the Zebu, at 64% (32/50), the difference was not statistically significant (p > 0.05). The mean oestrous interval from treatment to the onset of oestrus (TOI) was shorter in the Zebu (54.1 h, SD 6.7) than in Baoulé (65.2 h, SD 12.9) cattle (p < 0.001). Of the Zebu (n = 32) that responded, 65.7% presented oestrus over a period of 12 h ranging from 48 h to 60 h after treatment. For the Baoulé cows, the highest proportion of animals in oestrus over a period of 12 h was 41% between 60 h and 72 h after treatment. The frequency distribution of onset of the oestrus indicated that up to 64.5% of the Zebu and 79.5% of the Baoulé cattle showed onset of oestrus during the daytime. For Zebu and Baoulé cows inseminated 13 h or 18 h after the onset of oestrus, conception rates were 56% and 57% (p > 0.05) and 33% and 64% (p < 0.05), respectively. Based on these findings, it appears that the oestrous response to synchronization was adequate for both Zebu and Baoulé cattle and that the time to onset of oestrus varied according to genotype. It was also concluded that conception rates were satisfactory for both genotypes but that, for Baoulé cattle, AI performed 18 h after oestrus significantly increased conception rates compared to AI at 13 h after oestrus.

[Maternal mortality in adolescents at the university hospital of Ouagadougu]

This retrospective study evaluates the adolescent mortality rate at the University Hospital of Ouagadougou in the year 1995. Twenty lethal cases were collected amongst 646 deliveries giving birth to 490 children. The in-hospital adolescent maternal mortality rate come to be 4081 for 100,000 living births (4.08%) and represented 16.3% of all maternal deaths occurring during the study period. The most frequent causes of death were related to clandestine abortion (30%) and chronic anemia due to malnutrition (30%). Pregnancy in an adolescent girl is a high-risk event that requires special care due to a precarious global health status.

[Intrapartum hemorrhages in the maternity ward of the Yalgado Ouédraogo University Hospital Center of Ouagadougou, Burkina Faso]

On 12,175 childbirth registered in 4 years, 200 cases of delivery haemorrhage have been observed giving a rate of 1.6% of these accumulated childbirth. 60 patients (30.5%) have been evacuated from region of the country. The main etiology were: placental retention (54.5%), uterine inertia (24.5%) and coagulation disorders (21%). Blood was not available for emergency transfusion of 72 patients (54.1%) 26 deplorable cases of death raised the rate of lethality by 13%. Instant research of risk factors on all parturients, recycling of all personal on elementary first aid and life saving, also an improvement of sanitary references will enable to lower incidences related to haemorrhage by delivery.

[Progressive noma: apropos of 27 cases seen at the National Hospital Center of Ouagadougou]

This retrospective study objects to report epidemiological profile, clinical display and take care of progressive noma at the National Hospital Center of Ouagadougou. We assign the term noma to the gangrenous gingivo-stomatitis occurring in a prone environment, leading in a few days into a sharp ulcer in the soft parts, accompanied by halitosis. This definition excludes noma like-lesions. 27 cases have been observed in the ENT department and the Paediatrics between 1991 and 1995. They were 17 boys and 10 girls aging between 2 and 8 years and most of them coming from families with modest income (76%). The consultation delay averaged 8 days. The research for associated pathologies showed 63% energizing and protein malnutrition. We only observed unilateral localisations and no case of extra-facial one. At the stage we received our patients, the gangrenous was formed and the aspect evoked noma right away. Quite a lot needs to be done for precocious diagnosis because it is at the beginning phase that best evolution is obtained. Even though no evidence of the responsibility of a specific pathogenic germ was established so far, nevertheless, the assumption that has more support remains that of a bacterial infection in a prone environment. The vital prognosis of the progressive noma appears to be much linked with intensive care and feeding again. The hope to see this poverty-linked pathology under control is essentially based on prevention: medical population information, medical personnel's awareness for early diagnosis and best take care of these patients, improvement of the living conditions of the people and the health care services.

[Clinical aspects of adult schizophrenia in the psychiatric service at the Yalgado Ouedraogo National Hospital Center of Ouagadougou (Burkina Faso)]

Schizophrenia is a chronic mental disease severe and disabling, which affects young adults. It is a frequent disease which, due to its disabling nature concerns as well the society, the family as the individual. We have gone throughout the files of 61 inpatients in the psychiatric department of the National Hospital Centre Yalgado Ouedraogo of Ouagadougou, using the diagnosis of schizophrenia according the criteria of the World Health Organization. The aim of our study was to draw up the socio-demographic profiles and the symptoms of these schizophrenic patients. Our results emphasize the importance of delirious productions (80.3%) and disorders of the perceptive field, particularly auditive hallucinations (51.5%) in the semiology of the disease. On the diagnostic plan, paranoid forms prevailed (74.5%) in our series. The long course of the schizophrenia process preceding the consultation often makes the diagnosis easy at the patient's arrival. Clinical forms with noisy symptomatology, usually not much tolerated by families, often ask for medical care, sometimes after unsuccessful traditional therapy.

[Evaluation of the pre-introduction of contraception by means of subcutaneous levonorgestrel implants in Burkina Faso]

It is a prospective study based on the pre introduction evaluation of Norplant implants conducted from September 92 to September 93 in the city of Ouagadougou. 197 women were selected for the study. Based on unemployed women with an average age of 31 years old. The average parity was of 5.47% of patients were multiparas. A gain of weight of an average of 2.43 kg was observed. The main side effects observed was cycle disorders and headache. The continuing rate after 12 months was 96.5%. Conclusion from this study is that Norplant Implants are well tolerated and accepted by women.

[Traditional concept of madness and therapeutic difficulties in the Moose of Kadiogo.]

The practice of psychiatry in the south of the Sahara in Africa collides with many problems of acceptability of care for the ill and their families. The frequent rejection of the psychiatrist's therapeutic approach can often be explained by the inadaptation of the etiopathogenic approach. Indeed, in black Africa, responsibility of illness differs according to the fact that one has been schooled or not. The western world teaches minorities having the chance to live there or learn about it, that the human body can be assaulted by bacteria, viruses, mycoses or be self-assaulted by changes of its own physiology. Traditional education, for its part, regards the body as a mysterious entity susceptible of being penetrated or eaten by geniuses and anthrophagic sorcerers following a mystico-religious mechanism linked to beliefs and customs. In the majority of the Moose of the Moaga plateau in Burkina Faso, especially regarding madness, these assailants are ancestral geniuses or geniuses from the bush. Psychological suffering caused by a family, social or intrapsychic conflict independent of the invisible world is ultimately delirious for them thus provoking a resistance to give up complete charge of their mentally ill to psychiatric care. For us, an analysis of probable causes of this resistance appeared necessary. Interviews have shown that the psychiatric institution is experienced by the Moose of Kadiogo as a stage in the therapeutic itinerary of their mentally ill, a stage in the course of which their demand for care is reduced to the elimination of inconvenient symptoms. For them, the elimination of the cause derives from a knowledge that psychiatry does not possess, which renders the therapeutic relationship frustrating for both parties.