[Obstetric endometritis at the UTH-Yalgado Ouedraogo of Ouagadougou (Burkina Faso): about the management of 102 cases]

This is a descriptive cross-sectional study over a nine months period conducted at the UTH-Yalgado Ouédraogo from all patients in whom the diagnosis of endometritis at obstetrical been laid. Endo-cervical and vaginal swabs were taken from all these patients. Commensal bacteria and anaerobes were investigated in the laboratory. During the study period, 102 cases of obstetric endometritis were recorded that to say a frequency of 1.4% of admissions. The average age of patients was 25.2 years [17-43]. The childbirth mean was 2.5 ± 2 [0-7]. The reason for consultation was dominated by hyperthermia in 98% of cases. The bacterial ecosystem was mainly dominated by Escherichia coli (49.2%), Staphylococcus aureus (29.5%), Streptococcus sp (4.9%). The acid + amoxicillin clavulanic showed low activity on most germs. The average hospital stay of patients was 6.30 days [1-33]. A maternal death was recorded in 3 patients that to say fatality rate of 2.9%. The lethality of endometritis at the UTH-Yalgado Ouedraogo is greater than the rate of 1% allowed by WHO. The resistance of germs is high enough with amoxicillin. The systematization of the bacteriological study is expected to guide the antibiotic to help better fight against maternal mortality.

Factors Affecting the Validity of Coverage Survey Reports of Receipt of Vitamin A Supplements During Child Health Days in Southwestern Burkina Faso

BACKGROUND

Assessment of high-dose vitamin A supplementation (VAS) coverage often relies on postevent coverage (PEC) surveys, but the validity of these methods has rarely been evaluated.

OBJECTIVES

To assess reported VAS coverage and factors associated with missed coverage and to investigate the reliability of the results.

METHODS

During a cross-sectional survey, 10 454 caregivers of children <27 months old were asked whether their child had received VAS in the past 6 months. During a 48-week longitudinal study of 6232 children 6 to 30 months old, caregivers were asked every 4 weeks if their child had received VAS in the past 4 weeks.

RESULTS

The cross-sectional study showed that 94.4% (95% confidence interval [CI]: 93.8%, 94.9%) of eligible children 6 to 26 months of age reportedly received VAS in the previous 6 months, as did 85.8% (CI: 84.5%, 87.2%) of ineligible, 0 to 5 months old children. The longitudinal study showed that 81.6% of children surveyed within 4 weeks following a VAS campaign reportedly received VAS during the campaign and 13.4% of caregivers incorrectly reported receiving VAS when no campaign had actually occurred. False-positive reporting was more likely when oral polio vaccine (OPV) was distributed during the reporting period (20.6% vs 5.4%; P < .001). Showing a photo of OPV during the interview reduced the odds ratio (OR) of false-positive reports (OR = 0.7 [0.6-0.8]).

CONCLUSIONS

The PEC surveys should include children outside the target age to assess targeting efficiency, and pictures of both VAS and oral vaccines distributed during the same period should be shown during interviews to enhance reporting accuracy.

[Eclampsia at the University hospital Yalgado of Ouagadougou (Burkina Faso) from 1 April 2013 to 31 March 2014]

The objective of this study was to describe the epidemiological, clinical, therapeutic and prognostic aspects of the eclampsia in the obstetrics and gynecology department at the University Teaching Hospital Yalgado Ouedraogo of Ouagadougou. It has been a descriptive crosssectional study over a period of 12 months from 1 April 2013 to 31 March 2014. The main criterion for inclusion in our sample was the occurrence of seizures in a pregnant more than 20 weeks of gestation or recently delivered with elevation of blood pressure and the presence of albumin in the urine. The patients were followed from the onset of the crisis until hospital discharge. Data were collected and analyzed using Epi Info 3.5.1. The significance level of 5% was used for data comparison. We identified 203 cases of eclampsia for 6063 deliveries that to say a frequency of 3.3%. The average age of patients was 27.5 years [14-46]. In socio-demographic terms, patients were housewives in 62.5% of cases, the average rate of the past-deliver number was 4.2 [0-11] and 47.7% of patients were living as married. Clinically, they were referred in 72.4% of cases and were initially admitted into the service for elevation of blood pressure in 40.3% of cases. The mean gestational age was 31.5 weeks [23-41]; diastolic blood pressure exceeded 110 mmHg in 63.1% of cases. Therapeutically, all the patients benefited from a treatment based in anticonvulsant by magnesium sulfate and antihypertensive therapy by nicardipine, clonidine or alpha-methyl-dopa. Maternal prognosis was marked by significant morbidity in 46 cases (22.6%) and mortality in 13 patients that to say a fatality rate of 6.4%. The fetal one was dominated by a perinatal lethality in 31.5% of the cases. Eclampsia is a major cause of maternal and perinatal mortality in the University Teaching Hospital of Ouagadougou. The adoption of strategies for screening during antenatal consultations and early management should contribute to the reduction of the mortality in the mother and child couple in Burkina Faso.

[Unsafe abortions in countries that restrict legal abortions. Epidemiologic, clinical, and prognostic aspects at the University Hospital Center Yalgado-Ouédraogo of Ouagadougou]

OBJECTIVE

to describe the epidemiologic, clinical, and prognostic aspects of the management of the complications of women who had unsafe (illegal) abortions.

MATERIAL AND METHODS

this prospective, descriptive cross-sectional study took place the Yalgado Ouédraogo University Hospital Center (UHC-YO) in Ouagadougou during the 12-month period from June 2012 to May 2013. The study included all women admitted to the obstetrics-gynecology department during the study period and diagnosed after clinical examination with complications of an unsafe abortion. Data were collected with standardized case report forms. The analysis was conducted with Epi Info 3.5.1 software and Student's, Fisher's, and Pearson's Chi-square tests to compare the data. The threshold for statistical significance was set at 5%.

RESULTS

during the study period, 111 women were admitted for complications of unsafe abortions, for a rate of 1 per 47 deliveries. The women's mean age was 23.6 years and ranged from 15 to 45 years. More than half the women (n=62, 55%) were pregnant for the first time. Hemorrhage was the primary reason for admission: 78 women, or 75%. Only 18 women (16%) admitted to having had an illegal intentional abortions. Complications included endometritis in 10 women (11%), anemia in 6 (5%), and hepatonephritis, also in 6 (5%). Six women died, for a mortality rate of 24%.

CONCLUSION

the epidemiologic profile of women with complications from unsafe abortions is that of a young women pregnant for the first time, who has no income-producing activity. Morbidity is dominated by infectious or hemorrhagic complications and mortality is high. Strengthening activities for prevention, health and sex education, and dissemination of knowledge of and access to contraceptive methods will help to reduce these abortions and their consequences.

[Infectious Etiologies of the acute diarrheas of the child from 0 to 5 years at the Pediatric University hospital Charles de Gaulle (Ouagadougou, Burkina Faso)]

To identify the infectious agents responsible for acute diarrheas in children from 0 to 5 years, with the aim of improving care, we led a cross-sectional prospective study at the Pediatric University hospital Charles de Gaulle from January 1st - November 30th, 2009. A sample of 103 children's stools hospitalized for acute diarrhea was analyzed. The average age of the patients was of 9.5 months and the most affected age bracket was the one from 0 to 12 months. More than half of the cases of diarrheas (60.2%) had an infectious etiology of which 33% of viral origin, 21.4% bacterial, 9.7% parasitic and in 9.7% of the cases a co-infection. In the viral diarrheas, rotavirus was observed in 17.5% of the cases and serotypes adenoviruses 40, 41 in 15.5% of the cases. The isolated bacteria were essentially represented by enteropathogenic Escherichia coli (21 cases). This bacterium had a strong resistance to amoxicillin, cotrimoxazole (90%) as well as in the amoxicillin+Clavulanic acid (57%). The ascendancy of rotavirus in the etiology of the acute diarrheas of children from 0 to 5 years hints to a need for vaccination against this infectious agent. Aside from the ineffectiveness of group A penicillins and of the cotrimoxazole against most of the isolated bacteria calls to medical prescribers to reconsider antibiotic treatment in the diarrheas of the children.

[Prevalence of tuberculosis and brucellosis in intra-urban and peri-urban dairy cattle farms in Ouagadougou, Burkina Faso]

A study of the prevalence of bovine tuberculosis and brucellosis was conducted in dairy cattle farms in and around the city of Ouagadougou, Burkina Faso. It reveals the potential economic and health impact of these two major zoonoses in the study area. Three farming systems were included in the study. A total of 1,420 cattle were tested for tuberculosis and 1,689 cattle were tested for brucellosis. The intradermal tuberculin test was used for tuberculosis, and the buffered antigen test and indirect enzyme-linked immunosorbent assay were used for brucellosis. The overall prevalence rate is estimated to be 6.05% for tuberculosis and 3.61% for brucellosis. The prevalence rates of tuberculosis and brucellosis in urban and peri-urban dairy cattle farms in Ouagadougou were found to be high. As these two production-linked diseases are zoonotic, they could pose a major risk to human health and contribute significantly to reducing animal production and productivity in the areas covered by the study. Animals should be checked systematically prior to introducing them into dairy herds, with the ultimate goal of eradicating these two zoonoses.

FcγRIIa polymorphism and anti-malaria-specific IgG and IgG subclass responses in populations differing in susceptibility to malaria in Burkina Faso

FcγRIIa is known to be polymorphic; and certain variants are associated with different susceptibilities to malaria. Studies involving the Fulani ethnic group reported an ethnic difference in FcγRIIa-R131H genotype frequencies between the Fulani and other sympatric groups. No previous studies have addressed these questions in Burkina Faso. This study aimed to assess the influence of FcγRIIa-R131H polymorphism on anti-falciparum malaria IgG and IgG subclass responses in the Fulani and the Mossi ethnic groups living in Burkina Faso. Healthy adults more than 20 years old belonging to the Mossi or the Fulani ethnic groups were enrolled for the assessment of selected parasitological, immunological and genetic variables in relation to their susceptibility to malaria. The prevalence of the Plasmodium falciparum infection frequency was relatively low in the Fulani ethnic group compared to the Mossi ethnic group. For all tested antigens, the Fulani had higher antibody levels than the Mossi group. In both ethnic groups, a similar distribution of FcγRIIa R131H polymorphism was found. Individuals with the R allele of FcγRIIa had higher antibody levels than those with the H allele. This study confirmed that malaria infection affected less the Fulani group than the Mossi group. FcγRIIa-R131H allele distribution is similar in both ethnic groups, and higher antibody levels are associated with the FcγRIIa R allele compared to the H allele.

[Practice of reconstructive plastic surgery of the clitoris after genital mutilation in Burkina Faso. Report of 94 cases]

PURPOSE OF THE STUDY

To describe and evaluate the results of reconstructive plastic surgery of the clitoris in order to promote reproductive health.

PATIENTS AND METHOD

We conducted a retrospective study from 2007 to 2010. Ninety-four women were included in our study.

RESULTS

The mean age was 32.3 years. The evaluation of the experience of sexuality before reconstruction showed that 41.5 % of patients had never had a sexual desire before surgery, more than half did not have a clitoral orgasm and dyspareunia was experienced by about a third of them. The main reason for consultation in our series was related to sexual dysfunction in more than half of our study population. All patients were operated using the technique of Dr Pierre Foldès. Evaluation with a decline of at least 6 months after surgery showed us a massive restoration of the clitoris at 89.7 %. There was a significant difference between sexual desire before and after surgery. A significant improvement in sexuality was observed in 83.6 % of patients. However, there was no significant difference between orgasm before and after surgery. This showed us that getting an orgasm is multifactorial and it is not enough to have a clitoris to have an orgasm, you have to use it.

CONCLUSION

Regardless of the anatomical and functional results, all women were satisfied with respect to body found.

Caregiver recognition of childhood diarrhea, care seeking behaviors and home treatment practices in rural Burkina Faso: a cross-sectional survey

INTRODUCTION

To design effective national diarrhea control programs, including oral rehydration solution (ORS) and therapeutic zinc supplementation, information is needed on local perceptions of illness, external care seeking behaviors, and home treatment practices.

METHODS

A cross-sectional, community-based household survey was conducted in the Orodara Health District, Burkina Faso. Caregivers of 10,490 children <27 months were interviewed to assess child diarrhea prevalence and related care practices. Characteristics of households, caregivers, children, and reported illnesses were compared for those caregivers who did or did not recognize the presence of diarrhea, as defined according to clinical criteria (≥ 3 liquid or semi-liquid stools/day). Multiple logistic regression models were used to examine factors associated with illness recognition and treatment.

RESULTS

Clinically defined diarrhea was present in 7.6% (95% CI: 7.1-8.1%) of children during the 24 hours preceding the survey but recognized by only 55% of caregivers. Over half (55%) of the caregivers of 1,067 children with a clinically defined diarrhea episode in the past 14 days sought care outside the home; 78% of those seeking care attended a public sector clinic. Care was sought and treatment provided more frequently for children with fever, vomiting, anorexia, longer illness duration, and those living closer to the health center; and care was sought more frequently for male children. 80% of children with recent diarrhea received some form of treatment; only 24% received ORS, whereas 14% received antibiotics. Zinc was not yet available in the study area.

CONCLUSIONS

Caregivers frequently fail to recognize children's diarrhea, especially among younger infants and when illness signs are less severe. Treatment practices do not correspond with international recommendations in most cases, even when caregivers consult with formal health services. Child caregivers need additional assistance to recognize diarrhea correctly, and both caregivers and health care providers need updated training on current diarrhea treatment recommendations.

[Epidemiological and clinical characteristics of dissociative disorders and somatoform disorders in Burkina Faso]

OBJECTIVE

The aim of this study was to determine the epidemiological and clinical features of dissociative and somatoform disorders in the psychiatry department of the Centre Hospitalier Universitaire Yalgado Ouédraogo, in Burkina Faso.

METHOD

We carried out a retrospective and descriptive study over five years, from January 2003 to December 2007, of patients admitted in the psychiatric department for dissociative and somatoform disorders. The data were extracted from the medical notes and registers of consultation. After identification of the patients, the medical notes were exploited with a structured collect form for data on sociodemographic characteristics, life events and ICD-10 diagnoses. All the data were recorded by the same person. Data analysis was performed with Epi info 2007.

RESULTS

During a period of 5 years, 3967 patients were registered, 179 had the diagnosis of dissociative and somatoform disorders (3.65% of the admissions) and 145 were included in our study. The majority of the patients were followed as outpatients (71%). Women were more represented with a sex ratio of four women to one man. The majority of the patients were young with an average age of 30 and mostly single (57.9%). The majority of the patients had a low academic standard, in connection with young age of the population. A striking biographic event was found in the majority of the cases; essentially family difficulties and death. Neurological symptoms were the most frequent in 63% of the cases. According to ICD-1O, dissociative disorders were most frequent (65.6%). Depression was mainly associated in15 cases.

DISCUSSION

Dissociative disorders and somatoform disorders are frequent in our hospital; we must overcome the difficulties due to the complexity of the diagnosis and the cultural resistances to modern health care to determine the real prevalence of these disorders among the population in Burkina Faso.

[Study of factors favouring the occurrence of Plasmodium falciparum in pregnant women in the health district of Bogodogo]

OBJECTIVE

The behaviour of pregnant women live in towards prevention, attitude health workers, access measures prejudices and inadequate in urban design contribute to course the persistence of malaria. Objective analyse the factors leading to occurrence of malaria in women speakers in the health district Bogodogo.

PATIENTS AND METHODS

He acts sectional study was place in the rainy season period high malaria transmission. The test rapid diagnosis (TDR) using soluble antigens (HRPII) of Plasmodium falciparum was the diagnostic method used in this work and carried on 810 pregnant women in the health area District Bogodogo in Ouagadougou, Burkina Faso. Results The overall prevalence of antigen HRPII P. falciparum was 18.6% with a CI [16.1-21.5] to 95%. It follows from this work that the risk of infection malaria was significantly higher among pregnant women: that were not educated, lived in outlying areas called "zones not off" of the town and villages nearby, who were not using net. For various reasons, the administration of sulfadoxine/pyrimethamine was not supervised and less than 50% of women regularly slept under a mosquito net.

CONCLUSION

The fight against malaria in pregnant women should focus on communication for change of behaviour of pregnant women and also of health professionals. The fight antivector must be considered in rural areas.

[Post-partum thunderclap headaches in a patient from Burkina Faso: reversible cerebral vasoconstriction syndromes]

Reversible cerebral vasoconstriction syndrome (RCVS) is considered as rare but is probably under-recognized. It is characterized by the association of acute severe headache and/or focal neurological deficits and/or seizures and segmental vasoconstriction of cerebral arteries that resolve within one to three months. The purpose of this report is to describe the first case of post-partum RCVS from Burkina Faso. Diagnosis of RCVS was based on clinical setting (post-partum), absence of vascular risk factor, sudden onset, rapid resolution of signs and symptoms within eight days, brain scan findings (spontaneous bilateral posterior low density areas of cerebral ischemia), and elimination of other possible causes, i.e., meningeal or cerebellar hemorrhage, cerebral venous thrombosis, HELLP syndrome.

[Rheumatologic diseases and haemoglobinopathies in Ouagadougou (Burkina Faso)]

The purpose of this study is the prevalence of the rheumatologic complications in the sickle cell disease and the associations between haemoglobinopathies and rheumatologic affections. It is a retrospective study from 29 February 2006 to 28 March 2008 conducted in the Internal Department of the University Hospital Yalgado-Ouédraogo. All patients received in the period of study and having an electrophoresis of haemoglobin realized in alkaline pH were included. These patients came from hematologic consultation. Two hundred and seventy-seven patients out of 1451 were included: 142 patients (51.30%) had haemoglobinopathies, including 21 (7.60%) with composite sickle cell disease SC and 17 patients (6.13%) had aseptic necrosis of the femoral head including 7 with haemoglobin SC. The other rheumatologic affections did not have a semiological particularity related to the type of haemoglobin. The prevalence of patients who have haemoglobinopathies is important in rheumatologic practice. The sickle cell disease is strongly associated to osteonecrosis.

[Change of antimalarial first-line treatment in Burkina Faso in 2005]

Burkina Faso has recently changed the antimalarial drug policy to artesunate/amodiaquine or artemether/lumefantrine as the first-line antimalarial drug and sulfadoxine/pyrimethamine for the intermittent preventive treatment in pregnant woman. Before the implementation of this new strategy we conducted an in vivo efficacy study with chloroquine or sulfadoxine/pyrimethamine for treatment of uncomplicated Plasmodium falciparum malaria in urban area of Burkina from September to December 2003. Chloroquine (25 mg/kg over 3 days) or sulfadoxine/pyrimethamine (25 mg/kg + 0.025 mg/kg single dose) was administered respectively to 137 and 125 children aged from 6 to 59 months old in a randomized, opened study. Follow up extended over 28 days using modified WHO protocol. After adjusting the results by PCR, treatment failures rates were 63.4% (83/131) and 13.8% (17/123) respectively for chloroquine and sulfadoxine/pyrimethamine. These results with other observations have justified the change of malaria therapy policy in Burkina Faso in 2005.

[Comparative impact of three malaria preventive regimens during pregnancy on maternal anemia due to malaria in Burkina Faso]

OBJECTIVES

The main objective of this study was to compare the efficacy of three regimens of malaria prevention during pregnancy for the reduction of anemia between the first and third antenatal consultations. The first treatment arm was the classical weekly chemoprophylaxis with chloroquine; the other two were the intermittent preventive treatment using either three doses of chloroquine or sulfadoxine-pyrimethamine.

DESIGN

We conducted an open, randomized, three-arm study in a rural district of Burkina Faso. A cohort was constituted by 648 pregnant women of any parity.

RESULTS

The hemoglobin gain was more significant with the intermittent preventive treatment using sulfadoxine-pyrimethamine compared to the other treatment arms. The hemoglobin increased from 10.3g/dl (at the first antenatal consultation) to 11.4 g/dl (at the third antenatal consultation). In the three arms of treatment, the chemoprophylaxis reduced the prevalence of moderate anemia and severe anemia. The reduction of moderate anemia was more substantial in the sulfadoxine-pyrimethamine arm (65.6 to 36.7%) at second antenatal consultation (p=0.069) and third antenatal consultation (p=0.014). Conversely, in the two chloroquine arms, there was no significant reduction either at second antenatal consultation (p=0.72) or third antenatal consultation (p=0.55). The prevalence of peripheral parasitemia decreased in all treatment groups. However, it was significantly higher in the sulfadoxine-pyrimethamine group (44.3%).

CONCLUSIONS

Intermittent preventive treatment with three doses of sulfadoxine-pyrimethamine is a more effective strategy to prevent maternal anemia during pregnancy in Burkina Faso.

[Secondary school teachers' smoking in Ouagadougou, Burkina Faso]

This study was carried out among teachers of 10 secondary schools in Ouagadougou, Burkina Faso, in order to contribute to the development and implementation of a tobacco control programme in the school setting. The study had the following objectives: 1) to determine the extent of teachers' smoking addiction in the secondary schools in the city of Ouagadougou, 2) to describe the perceptions, attitudes and behaviour of teachers in the secondary school setting when confronted with smoking in the city's schools, 3) to determine the teachers' level of knowledge with respect to the harmful effects of smoking. The study was carried out from May 25 to June 30, 2001, and it included 300 teachers, 218 of which were men and 82 women. The study demonstrated that it is important to inform and sensitise teachers based upon their attitudes and perceptions with respect to tobacco.

[Features of hysterosalpingography performed in Burkina Faso]

PURPOSE

The goal of this study was to describe the distinctive hysterosalpingographic features of women with infertility in Burkina Faso.

MATERIALS AND METHODS

We performed a retrospective study of 1019 women who were referred for infertility between January 1996 to June 1997 at the National Hospital Centre of Ouagadougou. Clinical and radiological features were reviewed and statistical data analysed on the software EPI Info 5.0.

RESULTS

The mean age of the patients was 28+/-0,3 years. Primary infertility was found in 34.4% and secondary infertility in 65.6%. Abnormalities on plain film were present in 6.9% of the cases. Hysterosalpingography was abnormal in 62.1% of the cases. Tubal abnormalities were found in 62% and uterine lesions in 38.3%. The main hysterosalpingographic abnormalities were tubal obstructions, hydrosalpinx, uterine fibromas, and trauma sequelae in 25,9%, 25,3%, 16,5% and 10% of cases respectively. Seventy one percent of tubal and uterine lesions represent outcomes of chronic infections and underground abortions.

CONCLUSION

In Burkina Faso, hysterosalpingographic abnormalities are characterized by the predominance of infectious and traumatic sequelae. Such a frequency could be reduced by active politics against underground abortion and information about genital infections.

[Etiologies of ocular and eyelid trauma in Burkina Faso]

PURPOSE

To identify the epidemiological features of ocular traumas in Burkina Faso.

METHODS

A retrospective study was conducted in the eye department of the National Hospital of Ouagadougou, from January 1995 to 31 December 1997. All cases of eye trauma during this period were included.

RESULTS

The study showed that ocular traumas represented 9.80% of the reasons for consultation in the unit. 73% of the patients were male. The median age was 21. School children and students were the most frequently involved 25.8%) and 58.9% of the patients came from Ouagadougou while 41.1% came from the rural areas. Public thoroughfare accidents (were the main causes of the trauma (25%). Among the traumatic agents, 26% involved vegetal materials.

CONCLUSION

Ocular traumas are a major cause of blindness in Western Africa and concern mostly young people. Prevention strategies based on education and information about road safety could reduce the incidence of ocular traumatisms.

[Huntington disease in Burkina Faso]

Four cases of Huntington's disease in two families seen in Burkino Faso, a country in western Africa, are described. All four patients were black Africans aged 43, 42, 38 and 33 years. The clinical presentation was typical with chorea and episodes of psychiatric disorders. Molecular genetics of one family showed abnormal expansion of CAG repeats on IT15 in three patients. Separate mutations are likely to be the origin of Huntington's disease in Burkino Faso.

[Fetal weight gain curve for a cohort of 126 pregnant women at Ouagadougou, Burkino Faso]

We carried out a prospective study at Ouagadougou, from March 1 1997 to April 30 1998, in which we plotted curves of fetal weight gain, estimated by ultrasound biometry, with the aim of comparing our results to those of other authors and establishing a local chart. We established a growth curve from 936 fetal weights estimated during the follow up of 126 pregnant women. The mean age of the women included was 26 +/- 0,8 years and 52.4% were of the mean socioeconomic level. We identified significant differences between our weight gain curve and those of other authors. The factors involved in this difference are unclear but may be nutritive, ecological and ethnic in nature. Further work is required to produce local charts, to optimize the estimation of fetal weight.

[The current situation with regard to nicotine addiction in Burkina Faso: tobacco supply and data from the KAB-P survey of young people in Ouagadougou]

Smoking is a worldwide phenomenon and many studies have demonstrated that tobacco use is a risk factor for morbidity and mortality. We investigated aspects of the supply of, and demand for, tobacco in Burkina Faso, with a view to helping the public authorities design strategies to combat this phenomenon. We used data on the importation of tobacco and the making of cigarettes in Burkina Faso and carried out a survey of adolescents and young adults (n = 289) with a mean age of 20.9 years. In 1997, Burkina Faso imported 1,905, 214 metric tons of tobacco of all kinds, with a CAF value of 5,808, 905,269 CFA francs. In the survey, 30.7% of those interviewed said that they smoked. These individuals gave various reasons for their use of tobacco including imitating friends (38.6%) and personal liberty (14.1%). These young people were generally aware of the risks of tobacco use, but this did not deter them from smoking. In countries like Burkina Faso, which is faced with many challenges, controlling tobacco advertising and providing ways and means to help young people to stop smoking or to deter them from starting to smoke are of major importance for future public health.

[Ultrasound foetal biometry in the town of Ouagadougou, Burkina Faso. Report of a cohort of 126 pregnant women]

PURPOSE

This inquiry on the ultrasound fetal biometry in the town of Ouagadougou aimed to study the fetal growth through the ultrasound biometry in order to compare it with other authors's works and to lay down a local chart.

PATIENTS AND METHODS

This prospective study led from March 1997 to April 1998 The follow-up of 126 pregnant women allowed to lay down the graphs of following elements: biparietal diameter, cephalic circumference, transverse abdominal diameter, abdominal circumference and femur.

RESULTS

The average age of the subjects was 26 years old+/-0.8 and 52.4% of them belonged to an average socio-economic level. All the studied parameters were closely connected with the age of pregnancy. The DAT and the abdominal circumference presented the greatest correlation (0.998). The comparison of our growth graphs with those of others authors led to notice significant differences as well as with African, European and American graphs.

CONCLUSION

There is a need to lay down local charts in order to have a best estimation of the pregnancy age and the fetal growth.

[Contraception with levonorgestrel (Norplant) subcutaneous implants. African experience in Burkina Faso]

The subcutaneous implants from the levonorgestrel (Norplant) has been introduced in Burkina Faso in September 1992 within the context of a project assisted by a non-governmental organization (the Population Council). The aim was to reinforce the family planning programme in Burkina Faso by increasing the number of family planning methods available for the clients. 4 years after its introduction, we propose to make a report of our experience in terms of the contraception through subcutaneous implants in order to better set up an IEC campaign on this method. Within 4 years, 1,660 users benefitted from that contraceptive method. They were housewives in 65% of the cases. The age-group of 30-34 years old most used this method with 28.6%. Multipares most benefitted from this method with 64.3%. In 72% of the cases, the insertion was made during the premenstrual period. On the whole, 247 withdrawals have been made before the fourth years for various reasons. Among those reasons are cycle disorders (60 withdrawals), medical reasons (53 withdrawals), personal conveniences (47 withdrawals), weight gaining (14 withdrawals), failures (2 withdrawals). Regarding the side effects, they were mainly represented by the menstrual cycle disorders such as amenorrhoea, spotting, hypermenorrhoea in 51% of the cases. A good information and sensitization campaign should reduce the number of implants withdrawals before the fourth year of use. Moreover, a perfect knowledge of contraindications is indispensable before any prescription.

[Screening of post-partum depressive states in the Yalgado Ouedraogo National Hospital Center maternity ward in Ouagadougou Burkina Faso]

OBJECTIVES

Depression is a frequent early complication of the post-partum period. It affects the mother's own psychological function and has an important impact on the mother-child relation.

PATIENTS AND METHODS

We recruited a successive series of 34 women (mean age 27.4 +/- 4.5 years) who delivered at the Yalgado Ouedraogo University Hospital maternity ward. Patients were evaluated with the Beck Depression Inventory on day 3 and 8 post-partum and a questionnaire was used to record social, demographic and sanitary data.

RESULTS

Average Beck Depression Inventory scores on day 3 and 8 were 9.3 +/- 4.5 and 13.5 +/- 6.2. In our series, the state of depression was the same on day 3 and 8 in 78.6% of the mothers. Mood disorders were significantly correlated with parity and the sex of the child. Other variables studies (age, occupation, matrimonial status, mode of nursing) did not influence significantly the development of a mood disorder.

CONCLUSION

The psychosocial environment plays a determining role in the development of depressive states. Adequate management requires cooperative care by the obstetrician, psychiatrist and pediatrician.

[Prevalence of endemic goiter in the health sector of Zitenga (Burkina Faso)]

The prevalence of iodine deficiency disorders (IDD) was studied in the health district of Zitenga village (Oubritenga province, Burkina Faso), as part of an assisted development program. The study was designed to assess the prevalence of IDD in a population of more than 2,000 people. A multistage cluster sample of 210 people was randomly selected. The women in the sample were aged 0 to 45 years and the men, 0 to 25 years. Clinical and laboratory results (circulating TSH concentration, T4 and iodine excretion in urine), and dietary intake were recorded. The prevalence of goiter (all grades) was 55.2%. The values recorded for iodine excretion in urine showed that there was moderate iodine deficiency in this area. Blood thyroxine levels were below the laboratory reference range for 63% of the subjects, whereas TSH levels were above the laboratory reference range for 69.3% of the subjects. There was no correlation between hormone status, iodine excretion and goiter. The entire population of this area was deficient in iodine; some individuals had clinical signs of iodine deficiency, such as goiter. Further studies are required to investigate the factors responsible for goiter in this area and iodine supplementation should be provided for the population.

[Eighty cases of uterine rupture at the maternity service of the National Hospital Center of Ouagadougou , Burkina Faso]

In this retrospective study, we recall the frequency of uterine ruptures within a national health center of West Africa and propose solutions in order to reduce the incidence. This very high frequency was 23/1000, i.e. one uterine rupture for 44 deliveries. The feto-maternal prognosis was poor with a high stillbirth rate and maternal mortality. Maternal mortality which was 35% of cases represented 22.7% of the causes of maternal mortality observed within the unit during the survey. The stillbirth rate was 95% representing 145/1000 of the hospital stillbirth rate recorded during the survey. Maternal morbidity was also high because 14% of those who survived presented a parietal suppuration with the release of suture during the immediate postsurgical period. The seriousness of the feto-maternal prognosis is linked to a lack of adequate patient management. The importance of uterine ruptures in the obstetrical activity of the unit needs a joint and urgent action of all intervening parties within the sanitary system in order to contend with this scourge, which is the sign of poor quality health care in Obstetrics.

[Large dams, health and nutrition in Africa: beyond the controversy]

The population in sub-Saharan Africa is growing faster than increases in food production, resulting in a net decrease in food production per capita. The Food and Agriculture Organization has stated that there is a "risk of widespread hunger" which could be prevented by "effective planning of water resources". However, the potential effects of such schemes on the human population are often inadequately assessed and the effect of large dams on human health is not clear. The potential risk to human health of water resources was emphasized a few years ago but no effective preventive programs were implemented, probably because of inadequate availability of information and lack of awareness. The effects on health of "large" water resource projects are not uniform within a population. Decision-makers have tended to focus on the positive effects, to obtain support for their plans. These include: 1) improvement in the well-being of the population (safe water more readily available, new infrastructure, better access to health care) and 2) increases in the food supply (more vegetables and fish available due to irrigation). Thus, there has been a logical expectation that more, better quality food will become available as a result of these schemes, whereas in fact, health and nutrition has often worsened, particularly in young children. Most of the diseases associated with water resource management are communicable, including diseases directly related to the presence of large quantities of water, such as: malaria, which increases in incidence immediately after the building of the dam, after which a new balance develops between the human population and the parasites, schistosomiasis, the disease which increases most in response to the building of dams, particularly in its most severe gastrointestinal form, diarrhea, as water is a major means of dissemination for many organisms, including those causing digestive tract infections and gastroenteritis (amebiasis, salmonellosis, cholera), due to poor sanitation, other parasitic infections, such as onchocerciasis and trypanosomiasis, which should be monitored as they may also threaten the population. Other communicable diseases may appear or increase in incidence with the influx of migrants to the irrigated area. Sexually-transmitted diseases and HIV infection are a particular problem. The large numbers of insects (mosquitoes, blackflies) may also have harmful effects on populations adapting to the new environment. These effects are related to each other and to the environmental changes. New types of food affect people's feeding habits and generate new sources of income. However, they may also lead to new and higher expenditure. There are also likely to be major socio-demographic changes associated with changes in reproductive behavior and women's activities. The location and nature of new homes and infrastructure (e.g. schools, health centers, roads) also contribute to the success or failure of the dam project. There are many constraints to be considered and a more comprehensive approach to the problem is required. Health and nutritional status may be used as simple indicators of the ability of the population to adapt to a new environment. This makes it possible to construct a causal model to identify the most effective and relevant areas of intervention. Health and nutrition issues are of vital importance and scientific findings should be used in decision-making processes for planning future large dam schemes.

[Epidemiology of enuresis in children and adolescents aged 5-16 years in Ouagadougou (Burkina Faso)]

BACKGROUND

Enuresis is a frequent manifestation with important psychological and social consequences in Africa. In order to help the public authorities to plan monitoring actions and better targeted health interventions, we carried out this prospective study in one district of Ouagadougou. The aim of this study was to describe and analyze enuretic children and teenagers' profile from 5- to 16-years old, and their parents' attitude toward the disorder.

POPULATION AND METHODS

A cross-sectional study was conducted among 1,575 children and teenagers of this age group. Those children and teenagers were chosen from a random sample of 645 households. Sociodemographic and medical data were obtained from respondents by using a written questionnaire.

RESULTS

The rate of young people affected was 12.95%. Among them, 78.9% had primary enuresis; 50.5% of them were not treated. Those with secondary enuresis were more easily treated than those with primary stage. 87.3% were traditionally treated and 3.4% of enuretic children were essentially submitted to fluid restrictions. In about 27% of the cases, children were punished by their parents.

CONCLUSION

Sociodemographic characteristics of our sample were similar to those in the literature. However, the parents in our study rarely used modern treatment and had inappropriate attitudes toward the disorder. We recommend that the most important factors to be taken into account in the secondary prevention of enuresis are the parents' ignorance and/or their scepticism toward the modern therapeutic possibilities.

[Gynecology-obstetrics at the Yalgado-Ouédraogo National Hospital Center. Eclampsia: epidemiologic, clinical and prognostic aspects]

We present the results of a retrospective study carried out between 1992 and 1995 aimed at describing the epidemiological, clinical and developmental profile of eclampsia in an African maternity unit towards the end of the 20th Century. The incidence of eclampsia was 108 cases in 12,175 births (0.89%), mostly in young patients during their first pregnancy. 40.7% of the patients were less than 20 years old and 59.3% were expecting their first child. Eclampsia occurred between the 28th and 37th weeks of amenorrhea in 37% of cases. Thirty four patients (31.5%) had had at least three episodes of eclampsia prior to admission. Diastolic arterial blood pressure was higher than 120 mmHg in 25.9% of cases. Eclampsia occurred before labor in 30.6% of cases, during labor in 38% of cases and after giving birth in 31.5% of cases. Postpartum episodes occurred an average of 67 +/- 18.7 hours after the birth. There were complication with infection in 7 cases, renal insufficiency in 14 cases and one case of retro placental hematoma. Seventeen patients died, giving a death rate of 15.7%. During the same period, 3.4% of maternal deaths were due to eclampsia. The perinatal mortality rate was 23.1%. A quantitative and qualitative improvement in prenatal consultations should make it possible to reduce the incidence of eclampsia. Measuring arterial blood pressure daily for at least 14 days after the birth appears to be necessary for diagnosis and treatment of all cases of hypertension.

[Gynecology-obstetrics at the Yalgado-Ouédraogo (Ouagadougou) National Hospital Center. Cancer of the cervix uteri: epidemio-clinical and anatomopathologic aspects]

We report the findings of a 3-year retrospective study aimed at describing the epidemiological, clinical, anatomical and pathological profile of cervical cancers in an African country. We studied 46 cases of invasive cervical cancer. This type of cancer accounts for 31.7% of female genital cancers. The mean waiting time for a consultation was 7 +/- 2.4 months. The average age of the patients was 48 +/- 3.7 years. They were mostly women who had had several pregnancies without paid work. The main reasons for seeking medical help were metrorrhagia (95.6%), pelvic pain (58.7%) and purulent discharge (45.6%). In 89.1% of the cases, the cancer was inoperable. Pathology results were available in 37 cases. We found 36 cases (97.3%) of epidermoid carcinoma and a single case (2.7%) of adenocarcinoma. There were associated condylomatous lesions in 21.6% of cases. These results demonstrate the importance of making cervical smear tests a routine part of medical examination and of making the public aware of the importance of screening for cervical cancer.