A Qualitative Study of the Experience of COVID-19 Patients in Burkina Faso

In Burkina Faso, the health system is characterized by systemic insufficient and antiquated health-care infrastructures. Consequently, few health-care establishments have the required resources to diagnose and manage patients with COVID-19, and fewer still have intensive care facilities for severely ill patients with COVID. Furthermore, there is a widespread scarcity of qualified health-care staff. The aim of this study was to explore the experiences of patients with COVID-19 who recovered after being cared for in Bobo Dioulasso and Ouagadougou. Using individual semistructured interviews, we performed a cross-sectional qualitative, descriptive study from June 12 to 30, 2020 with the aid of 13 well-educated patients who had survived COVID-19. The results reveal that prior to hospital admission, the main reason that prompted patients to seek care was onset of symptoms of COVID-19, regardless of whether they had been in contact with suspected or confirmed cases. Transmission was mainly believed to have occurred in the community, in the hospital, and during travel. Patient management was punctuated by frequent self-medication with medicinal plants or pharmaceutical drugs. The participants reported a negative perception of hospitalization or home-based management, with several forms of stigmatization, but a positive perception influenced by the satisfactory quality of management in health-care centers. This report of patient experiences could be helpful in improving the management of COVID-19 in Burkina Faso, both in the health-care setting and in home-based care.

An emerging clade of Chikungunya West African genotype discovered in real-time during 2023 outbreak in Senegal

Chikungunya (CHIKV) is a re-emerging endemic arbovirus in West Africa. Since July 2023, Senegal and Burkina Faso have been experiencing an ongoing outbreak, with over 300 confirmed cases detected so far in the regions of Kédougou and Tambacounda in Senegal, the largest recorded outbreak yet. CHIKV is typically maintained in a sylvatic cycle in Senegal but its evolution and factors contributing to re-emergence are so far unknown in West Africa, leaving a gap in understanding and responding to recurrent epidemics. We produced, in real-time, the first locally-generated and publicly available CHIKV whole genomes in West Africa, to characterize the genetic diversity of circulating strains, along with phylodynamic analysis to estimate time of emergence and population growth dynamics. A novel strain of the West African genotype, phylogenetically distinct from strains circulating in previous outbreaks, was identified. This suggests a likely new spillover from sylvatic cycles in rural Senegal and potential of seeding larger epidemics in urban settings in Senegal and elsewhere.

Widening the lens of population-based health research to climate change impacts and adaptation: the climate change and health evaluation and response system (CHEERS)

Background

Climate change significantly impacts health in low-and middle-income countries (LMICs), exacerbating vulnerabilities. Comprehensive data for evidence-based research and decision-making is crucial but scarce. Health and Demographic Surveillance Sites (HDSSs) in Africa and Asia provide a robust infrastructure with longitudinal population cohort data, yet they lack climate-health specific data. Acquiring this information is essential for understanding the burden of climate-sensitive diseases on populations and guiding targeted policies and interventions in LMICs to enhance mitigation and adaptation capacities.

Objective

The objective of this research is to develop and implement the Change and Health Evaluation and Response System (CHEERS) as a methodological framework, designed to facilitate the generation and ongoing monitoring of climate change and health-related data within existing Health and Demographic Surveillance Sites (HDSSs) and comparable research infrastructures.

Methods

CHEERS uses a multi-tiered approach to assess health and environmental exposures at the individual, household, and community levels, utilizing digital tools such as wearable devices, indoor temperature and humidity measurements, remotely sensed satellite data, and 3D-printed weather stations. The CHEERS framework utilizes a graph database to efficiently manage and analyze diverse data types, leveraging graph algorithms to understand the complex interplay between health and environmental exposures.

Results

The Nouna CHEERS site, established in 2022, has yielded significant preliminary findings. By using remotely-sensed data, the site has been able to predict crop yield at a household level in Nouna and explore the relationships between yield, socioeconomic factors, and health outcomes. The feasibility and acceptability of wearable technology have been confirmed in rural Burkina Faso for obtaining individual-level data, despite the presence of technical challenges. The use of wearables to study the impact of extreme weather on health has shown significant effects of heat exposure on sleep and daily activity, highlighting the urgent need for interventions to mitigate adverse health consequences.

Conclusion

Implementing the CHEERS in research infrastructures can advance climate change and health research, as large and longitudinal datasets have been scarce for LMICs. This data can inform health priorities, guide resource allocation to address climate change and health exposures, and protect vulnerable communities in LMICs from these exposures.

Effect of personalized home-based support for pregnant women on pregnancy outcomes: a cluster randomized trial

Background

Anemia during pregnancy has been linked to higher maternal and perinatal morbidity and mortality. The purpose of this study is to examine the impact of individualized home-based care for pregnant women on pregnancy outcomes.

Methods

This was a cluster-randomized experiment done in Burkina Faso’s Sindou health area between 2015 and 2016. The intervention included a monthly home-based visit focused on nutritional counseling and pregnancy monitoring for pregnant women, and a training on nutrition for pregnant women, prevention of anemia in pregnancy, and management of anemia in pregnancy for health facility teams. In the control group, prenatal care was administered in accordance with national program guidelines. The primary outcome was the reported prevalence of anemia in pregnancy. The secondary outcomes of stillbirth, preterm birth, low birth weight, and abortion were evaluated using a difference in differences analysis and mixed models across the two groups. The sample consisted of 617 pregnant women, with 440 women assigned to the intervention group and 177 assigned to the control group. No maternal fatalities occurred in either group. The intervention decreased stillbirths by -1.6% (95% confidence interval: -3.1% to - 0.1%). It had no impact on the rates of low birth weight, premature birth, and abortion.

Conclusion

In rural Burkina Faso, personalized support of pregnant women at home, in conjunction with appropriate prenatal care, reduced stillbirths, but not the rates of low birth weight, preterm birth, or abortion.

Safety of Chloroquine or Hydroxychloroquine Plus Azithromycin for the Treatment of COVID-19 Patients in Burkina Faso: An Observational Prospective Cohort Study

INTRODUCTION

Though chloroquine derivatives are used in the treatment of coronavirus disease 2019 (COVID-19) in many countries worldwide, doubts remain about the safety and efficacy of these drugs, especially in African communities where published data are scarce.

METHODS

We conducted an observational prospective cohort study from April 24 to September 03, 2020, in Burkina Faso to assess (as primary outcome) the clinical, biological, and cardiac (electrocardiographic) safety of chloroquine or hydroxychloroquine plus azithromycin administered to COVID-19 patients. The main secondary outcomes were all-cause mortality and median time of viral clearance.

RESULTS

A total of 153 patients were enrolled and followed for 21 days. Among patients who took at least one dose of chloroquine or hydroxychloroquine (90.1% [138/153]), few clinical adverse events were reported and were mainly rash/pruritus, diarrhea, chest pain, and palpitations. No statistically significant increase in hepatic, renal, and hematological parameters or electrolyte disorders were reported. However, there was a significant increase in the QTc value without exceeding 500ms, especially in those who received chloroquine phosphate. Three adverse events of special interest classified as serious (known from chloroquine derivatives) were recorded namely pruritus, paresthesia, and drowsiness. One case of death occurred. The average onset of SARS-CoV-2 PCR negativity was estimated at 7.0 (95% CI: 5.0-10.0) days.

CONCLUSION

Hydroxychloroquine appeared to be well tolerated in treated COVID-19 patients in Burkina Faso. In the absence of a robust methodological approach that could generate a high level of scientific evidence, our results could at least contribute to guide health decisions that should be made based on different sources of scientific evidence including those from our study.

Effect of Personalized Support at Home on the Prevalence of Anemia in Pregnancy in Burkina Faso: A Cluster Randomized Trial

Burkina Faso has high prevalence of anemia in pregnancy (hemoglobin < 11 g/dL), despite the implementation of the WHO recommended guidelines. This study aimed to test the effects of personalized support for pregnant women at home on the trend of anemia prevalence in pregnancy. A cluster randomized trial was conducted from January 2015 to August 2016 at Sindou health district in Burkina Faso. Data were collected from 617 women in their first or second trimester of pregnancy, including 440 and 177 women in the intervention and control groups, respectively. The intervention consisted of a monthly home-based visit to the pregnant woman, focusing on nutritional counseling and pregnancy management, alongside an improvement antenatal visit quality. Compared with the prevalence of anemia in pregnancy in the control group [64.0% (95% confidence interval [CI]: 52.1-74.4%)], that of the intervention group was significantly lower from the fifth home visit onward [36.8% (95% CI: 32.1-41.8%)] (P < 0.001). The adjusted difference-in-differences in anemia prevalence between the two groups was -19.8% (95% CI: -30.2% to -9.4%) for women who received more than four home visits (P < 0.001). The corresponding difference in hemoglobin levels was 0.644 g/dL (95% CI: 0.309-0.167; P < 0.001). Personalized support for pregnant women at home, combined with appropriate antenatal care, can significantly reduce anemia prevalence during pregnancy in rural Burkina Faso.

Prevalence and factors associated with anaemia in pregnant women in Cascades Region of Burkina Faso in 2012

Introduction

anaemia in pregnancy is a public health concern in Burkina Faso. This study aims at identifying the factors associated with the prevalence of anaemia in pregnant women at a regional level in Burkina Faso.

Methods

we conducted a cross-sectional study in the region called “Cascades”, located at the Western part of Burkina Faso. The study population included all pregnant women who attended antenatal care clinics in all public peripheral health facilities (districts) between May and June 2012 and agreed to participate in the study. They provided blood sample from which we measured the haemoglobin concentration using the Hemocue® system. The factors associated with anaemia in the study population were identified through multiple logistic regressions.

Results

the prevalence (95% CI) of anaemia in pregnancy in the Cascades region was 58.9% (56.6% - 61.2%). Anaemia in pregnancy was more common in district of Banfora (OR = 1.40; 95% CI: 1.07-1.83), among housewives (OR = 2.96; 95% CI: 1.10-8.0), in the Mossi ethnic group (OR = 1.39; 95% CI: 1.04-1.85) and among the wives of farmers and artisans (OR = 2.55; 95% CI: 1.59-4.07). Anaemia in pregnancy was less frequent among women who drank local beer (OR = 0.68; 95% CI: 0.49-0.94).

Conclusion

the prevalence of anaemia in pregnancy is high in Burkina Faso. Improving women's income level may contribute to reduce it. Further studies are needed to elucidate the link between the consumption of local beer, the local diet practices and anaemia in pregnant women.

[Ameloblastomas of the jaws: clinical and computed tomography analysis in 15 patients at the university hospital Sourô Sanou in Bobo-Dioulasso]

INTRODUCTION

Ameloblastoma is a locally aggressive and relatively scarce odontogenic benign tumor. Bone swelling is the most common clinical expression. Computed tomography is a considerable diagnostic contribution. This work reports the clinical and computed tomography characteristics of ameloblastomas of the jaws.

PATIENTS AND METHODS

a retrospective analysis of the medical records of patients with histologically confirmed ameloblastoma between January 2014 and December 2018 was carried out.

RESULTS

The incidence of ameloblastoma was 3 patients per year. Of the 15 patients, there were 7 men (46.7%) and 8 women (53.3%), giving a sex ratio of 0.87. The age of the patients varied between 9 and 56 years with an average age of 33.7 years. All patients had bone swelling. Mandibular localization predominated with a frequency of 86.7%. Heterogeneity, sharpness of contours and setting of the contrast product were the predominant CT characteristics, each observed in more than 4/5 of the patients.

CONCLUSION

The development of imaging techniques such as CT has significantly changed the diagnostic approach and the management of ameloblastoma.

[Surgical site infections at Bocar Sidy Sall University Hospital Center of Kati]

INTRODUCTION

Surgical site infections (SSI) are frequent and dangerous in the surgical ward. They represent an obsession for the surgeon. The objectives were to determine the frequency of ISOs and risk factors, to identify the germs and to study their sensitivity to different antibiotics.

MATERIALS AND METHODS

This was a cross-sectional study with prospective data collection, performed at the general surgery department of the Bocar Sidy Sall University Hospital Center (Kati CHU) from January 2015 to December 2018.

RESULTS

During this period of study we recorded 55 cases of ISO out of 650 operated patients with a frequency of 8.46%. 450 patients were operated on the cold operating program (69.23%) and 200 patients on emergency (30.77%). The average age was 39, the sex ratio was 2.66. Among the 55 cases of ISO, 60% of these patients were operated in emergency and 40% in the operating program. The most common strains found were Escherichia coli (E. coli) in 38.3% of cases, Staphylococcus aureus in 23.4% and Klebsiella pneumonia in 13.3%. Hemoglobin levels were normal in 70% of cases. 4 of our patients or 7.27% were diabetic. We did not have any cases of obesity. Of the 55 cases of ISO, 66% were of class 3 and 4 of Altemeier, 59% were of ASA score 2 and ASA 3, 55% were of score 2 of NNISS (National Nosocomial Infection Surveillance System), 5.45% were NNISS score 3 or 3 cases and these 3 cases developed ISO. The ISOs were parietal in 49 cases, ie 89%. The recovered germs were 100% sensitive to imipenem. The most informative interventions of the ISOs were peritonitis 25 cases (45.45%), intestinal occlusions 12 cases (21.82%), appendicular abscess 8 cases (14.55%). We had 2 death cases, 3.64%, the average hospital stay was 13 days.

CONCLUSION

Escherichia coli was the common germ found in the ISO in general surgery at Kati BSS Hospital. The usual resistance to antibiotics must provoke effective preventive actions.

[The Ileal Neobladder With The Hautmann Technic At The Urology Depatment Of University Hospital Pr. Bocar S. SALL Of Kati]

Radical cystectomy is the standard treatment for bladder tumors infiltrating the bladder muscle, for patients who have tumors without invasion of neighboring organs and without metastasis. After radical cystectomy, the urinary diversion is a challenge for any urologist. Ileal neo bladder is a rare surgery in our country. The ileal neo bladder is recommended in these patients. We report a case of ileal neo bladder in a 42-year-old woman with a bladder tumor. We discuss the clinical, diagnostic and therapeutic aspects.

[Governance of HIV/AIDS organizations in Bobo-Dioulasso (Burkina Faso)]

INTRODUCTION

Although HIV/AIDS organizations continue to play a major role in the fight against pandemic HIV infections, they are still faced with enormous governance challenges that impair their operations / interventions and their sustainability. The objective of this study was to develop an inventory of the quality of governance within HIV/AIDS organizations in Bobo-Dioulasso.

METHODS

This qualitative research was conducted in 40 organizations from Bobo-Dioulasso. Qualitative data were collected over a 45-day period using an interview guide. Thematic analysis of the data was performed and the results were reported.

RESULTS

Although all 40 organizations had established good governance mechanisms, only fifteen complied with the major rules of democratic functioning and the roles of the various bodies. The majority of these organizations (29/40) ignored many democratic rules. The number of members required for the Executive Board was not met in 29/40 organizations resulting in monopolization of decision-making by a handful of people. Technical and financial reports were not published, resulting in limited access to information on the organization's activities. Gender equality also constituted a weakness.

DISCUSSION

Application of good governance principles was limited in these organizations. Organization members, leaders and technical and financial partners must reinforce good governance efforts in order to improve good governance in these organizations.

[The Burkinabe experience of the creation of a Community Advisory Committee to improve the support of HIV research projects]

INTRODUCTION

Community Advisory Committees (CAC) have become indicators of good community involvement in health research all over the world. CACs have been developed only recently in several Sub-Saharan African countries. Many countries wonder about how to create and ensure good functioning of a community advisory committee. The objective of this article is to describe the creation of two CACs in Burkina Faso.

METHODS

This qualitative study comprised a literature review phase, a data collection phase conducted on a sample of 27 subjects (research scientists, representatives of AIDS associations or networks and the local technical and/or financial partners of these associations) and an implementation phase. Study participants were selected on a rational basis, the study complied with the ethical principles of research and data were transcribed and analysed manually.

RESULTS

Scientists and/or community workers may initiate the creation of a CAC based on the following main elements: the profile of individuals and/or structures, the dynamism of CAC members, reinforcement of their skills and capacities. The CAC must be independent of research scientists and must be designed to be sustainable.

DISCUSSION

The difficulties of sustainability and the poor perception of CACs remain major challenges. Continuing collaboration between CAC members and research scientists improves their knowledge in the field of research ethics, allowing the community to perceive CACs as supporters of research.

[Volvulus of sigmoid colon: surgical treatment and prognosis in the services of General Surgery of the Point G Teaching Hospital]

OBJECTIVE

To study the therapeutic aspects and prognosis of volvulus of the sigmoid colon in surgical departments.

PATIENTS AND METHODS

Our study was retrospective from January 2000 to December 2009 (10 years). All patients who underwent sigmoid volvulus in the Point G teaching hospital surgical departments were taken into account.

RESULTS

We recorded 96 patients operated for volvulus of sigmoid over 882 cases of bowel obstruction, a rate of 10.9%. The average age was 47.2 years ± 18.9. In per-operative, there was a necrosis of the colon rate of 16.7% (14 cases). Performed surgical treatment modalities were: sigmoidectomy with primary anastomosis in 29.2% of cases (28), sigmoidectomy followed by colostomy and secondary anastomosis in 60.4% of patients (58) and 10.4% rare of simple devolvulation. The immediate postoperative period were marked by a morbidity rate of 7.3% (7 cases) and a mortality rate of 7.3% (7 cases).

CONCLUSION

In spite of various therapeutic modalities of volvulus of the sigmoid colon, the rates of postoperative morbidity and mortality are rising in the general surgery of the Point G teaching Hospital.

[Postoperative peritonitis in the Surgery B department of the Point G hospital]

OBJECTIVE

To determine the incidence of postoperative peritonitis, and describe their clinical, paraclinical and therapeutic aspects.

PATIENTS AND METHODS

This was a retrospective study conducted between 1980 and 2010 in the Department of Surgery B of the Point G University Hospital. It focused on all patients who underwent surgical intra-abdominal in the Surgery B department.

RESULTS

We collected 25 cases of postoperative peritonitis, 84% were male subjects. The average age of patients was 37.2 years ± 17.0. The clinical picture was dominated by abdominal pain (92%), abdominal defense (92%), and fever (84%). Abdominal ultrasound played an important role in diagnosing 72% of cases. Etiologies were dominated by anastomotic leak (32%), infection of the collection phrenic, iatrogenic perforation (28%). Interventions made at surgery were: suture of the perforation or anastomotic recovery plus peritoneal cleansing and drainage in 36% of cases, peritoneal cleansing and drainage in 36%. There were postoperative complications in five patients. The mortality rate was 4%.

CONCLUSION

Postoperative peritonitis are rare in our service. When they occur their rate of morbidity and mortality are high.

[Acute generalized peritonitis in Sominé Dolo's Hospital of Mopti: Epidemiologic and therapeutic aspects]

Acute generalized peritonitis requires precocious diagnosis and immediate treatment.

MATERIALS AND METHODS

The purpose of this study is to determine hospital case frequency, to describe the clinical and therapeutic aspects and to evaluate the operating suites. We conducted a prospective study, lasting 16 months, from January 2005 to April 2006, looking at 40 cases of generalized acute peritonitis operated in several services, including a general surgery department, of the Sominé Dolo's hospital of Mopti.

RESULTS

We noted a hospital admittance rate of 3.1% with an average age of 26.3 years old and a 1.66 men to women ratio. Peritonitis at the Sominé Dolo hospital was dominated by intestinal perforation. The diagnosis was essentially made using the clinical approach. The treatment was medico-surgical. Operative mortality was recorded in 7 cases (17.5%) with 7 cases of inner-wall abscesses. The delay of consultations and the Mannheim score were the main factors causing bad prognostics. Excision - sutures associated with a cleansing drainage of the abdominal cavity was the most practised surgical procedure.

CONCLUSION

Mortality remains high. The two factors for a bad prognostic are the delay of consultation and the lack of means for reanimation.

[Comparaison between the association of chlorhydrate ketamin-magnesium sulfate ketamin chlorhydrate and in paracetamol aving in visceral surgery]

AIM

To compare paracetamol saving followed by the association of ketamine chlorhydrate - magnesium sulfate to ketamine chlorhydrate and analyze cost after the 2 protocols administration.

MATERIAL AND METHODS

We conducted this comparative study from June 2005 to January 2006 in the services of anesthesiology and resuscitation and visceral surgery of the teaching hospital Gabriel Touré, Bamako. 80 patients were split into 2 groups - group A receiving: 0,25mg/kg of ketamine chlorhydrate plus 50mg /kg of magnesium sulfate, group B receiving: 0,25mg/kg of ketamine chlorhydrate.

RESULTS

The 2 groups were compared by anthropometrical and clinical data (age, sex, weight) and ASA. The reduction of paracetamol dosage was 57, 50 % of the 4 g actually used per day in A group against 48, 50% in B group.

CONCLUSION

Ketamin chlorhydrate associated to magnesium sulfate insure a post-operative analgesic saving in visceral surgery. Cost of analgesia actually used is reduced.

[Role of ultrasonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review]

Axillary lymph nodes metastases are an important prognostic factor in patient with breast cancer. Even the diagnosis of metastatic invasion of axilla is perfomed by histologic exam, the preoperative diagnosis on ultrasonography is evoked in literature. The aim of this study was to evaluate through systematic review, the accuracy of ultrasonography in the diagnosis of axillary lymph node invasion in patients with breast cancer. 132 articles were consulted. We included in the study articles in which the invasion of axilla was proved by histology and additionally, studies in which sensibility, specificity and accuracy parameters of ultrasonography can be calculated. The Chi square test was used to evaluate the hetegenicity between studies. Twelve articles with above criteria were included in the study and divided in two groups: group 1: studies on breast cancer with palpable and non palpable axillary lymph node; group 2 : studies on breast cancer in which axillary lymph node biopsy was guided by ultrasonography. In group I, when lymph node size, more than 5 mm was taken as presumption criteria of invasion, sensibility and specificity of ultrasonography varied from 66.1 to 87.1% (p > 0.05) and from 44.1 to 97.9% (p < 0.05) respectively; when the lymph node morphology was the mean criteria of axilla invasion, these parameters varied respectively from 40.5 to 92.3% (p < 0.05) and from 55.6 to 95.2% (p < 0.05). In group II, sensibility and specificity of ultrasonography in diagnosis presumption of axillary lymph node invasion in patient with breast cancer varied respectively from 43.5 to 94.9 (p < 0.05) and from 96.9 to 100% (p > 0.05). In conclusion, according to the sanitary and psychological impact of lymph node invasion in patient with breast cancer, axillary ultrasonography is helpful in the management of this pathology.

[Imaging of pediatric urinary tract malformations: a series of 32 cases]

PURPOSE

To determine the incidence of pediatric malformative uropathies and to point out the radiological aspects.

MATERIAL AND METHODS

Exploratory studies of 32 cases of malformative uropathies were assessed between January 1998 to June 1999 in the Radiology Departement of Gabriel Touré Hospital of Bamako. Patients aged from 3 days to 15 years underwent sonographic and radiological examinations.

RESULTS

The sex ratio was 4 males to 1 female. The main findings were: prune belly syndrome (6 cases), posterior urethral valves (13 cases), bladder exstrophy (3 cases), renal ectopy (6 cases), ureterocele (1 case), hypospadias (1 case), megauretere (1 case) and pyelo-ureteral junction syndrome (1 case). Radiological signs were mainly related to hydronephrosis and bladder lesions.

CONCLUSION

Malformations of the urinary tract are frequent in daily practice. Imaging plays a key role in the assessment and diagnosis.

Contribution of CT scan in the nursing of cranial traumatism in Bamako

Objectives : The aims of this study was to describe the clinical, CT scan and prognosis aspects of cranial traumatism in our practice. Material and method : This study was a descriptive and prospective one concerning 324 cases of cranial traumatism. Patients were hospitalized in the emergency unit of Gabriel Touré hospital from January to August 2004. We graded them into 2 groups according to the realization (group 1) or not (groupe 2) of computerized tomography. These 2 groups are equivalent as far as the Glasgow coma scale was concerned. Results : About 324 patients with cranial traumatism,we included 153 (116 males, 37 females) in our study. The mean age was 20.2 years (average 1-69 years). In the group 1 (153 patients) the injury was located in cerebral or pericrebral tissue in 88.2% (cerebral lesion in 58.8%, pericebral in 32,6%, mixed in 8.6%) bone or soft tissue in 24.8%. 6.5% of these patients was operated. 15% of group 1 and 26.3% of group 2 died (X2 : 6.18; p < 2%) In conclusion we believe that computerized tomography allows to improve the prognosis of cranial traumatism.

[Ultrasonographic aspects of urinary schistosomiasis in children of the Dogon plateau and the Niger office; impact of praziquantel treatment]

Urinary bilharziasis is a parasitic infection responsible for vesical, urethral and renal lesions. The authors demonstrate the importance of ambulatory echography on a large scale and describe various echographic lesions. Vesical attacks occurred in 27% of the wall irregularity, 44% of the masses and polyps. Pyelic and urethral abnormalities occurred in 16.6% and 29.9% of cases respectively at the baseline in 1991. These prevalence rates decreased after seven years, in 1998. The authors discuss the utility of chemotherapy with praziquantel and the necessity of a periodical mass treatment in the areas with high bilharziasis endemicity in Mali.

[Prevalence of serologic markers of the hepatitis B virus in pregnant women of Bamako, Mali]

A prospective study of the serological markers of hepatitis B virus (HBV) including hepatitis B virus surface antigen (HBsAg) and hepatitis B surface antibody (anti HBs) was conducted over 5 years in Bamako. The aims of this study were to assess the prevalence of HBsAg in pregnant women and to determine the risk of HBV infection for this population. The study involved 829 pregnant women for whom blood samples were collected after the first quarter of pregnancy. HBsAg and anti HBs were detected in all cases by radioimmunoassay. The prevalence of HBsAg and anti HBs in pregnant women was respectively 15.5% and 16.9%. This prevalence of HBsAg, higher than in the general population, points to the fact that pregnant women are a high risk group for hepatitis B infection. In addition, scarification and tattooing practices increase significantly the risk of infection by hepatitis B virus (OR = 2.03; 1.07 < OR < 3.82; chi 2 = 5.62; p: 1%). Thus, we can presumably conclude that infants and new borns in such conditions are largely exposed to hepatitis B virus infection, even though hepatitis B core antibody and hepatitis B e antigen were not investigated for technical reasons. In conclusion, the authors believe that infants and new borns must be systematically immunised against hepatitis B virus infection in Bamako.

[Atypical forms of Mayer-Rokitansky-Kuster-Hauser syndrome: role of echocardiography]

We present three cases with atypical presentation of the Mayer-Rokitansky-Kuster-Hauser syndrome observed by US between August 1994 and December 1997. In two cases we observed complete absence of the uterine. In the last case, an uterus remnant was present. In all cases, both ovaries were normal and the three women reported "normal" sexual activity. An ectopic kidney was present in one patient with complete absence of the uterus. Atypical forms of Mayer-Rokitansky-Kuster-Hauser syndrome with normal vagina can be diagnosed at US. In the cases presented here, US allowed a clear description of the anatomy and provided a comprehensive evaluation of the patients.

[Malignant pancreatic non-hodgkin's lymphoma manifesting as severe acute pancreatitis]

Primary non-Hodgkin's lymphoma of the pancreas is a rare disease. Its diagnosis is difficult without histological examination. In fact, clinical and imaging findings are not pathognomonic. Acute pancreatitis associated with pancreatic lymphoma is extremely rare. We have found only 7 case reports in literature. We report herein a new case of pancreatic lymphoma which was revealed by a severe pancreatitis.