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Objective:To explore the relationships between dental problems and underweight status among rural women in Burkina Faso by using nationally representative data.Design:This was a cross-sectional secondary study of primary data obtained by the 2013 WHO Stepwise Approach to Surveillance survey conducted in Burkina Faso. Descriptive and analytical analyses were performed using Student’s t test, ANOVA, the χ2 test, Fisher’s exact test and logistic regression.Setting:All thirteen Burkinabè regions were categorised using quartiles of urbanisation rates.Participants:The participants were 1730 rural women aged 25–64 years.Results:The prevalence of underweight was 16·0 %, and 24·1 % of participants experienced dental problems during the 12-month period. The women with dental problems were more frequently underweight (19·9 % and 14·7 %; P < 0·05) and had a lower mean BMI (21·1 ± 3·2 and 21·6 ± 3·7 kg/m2, P < 0·01) than those without dental problems. More risk factors for underweight were observed in less urbanised regions among elderly individuals (> 49 years old) and smokeless tobacco users. Age > 49 years, professions with inconsistent income, a lack of education, smokeless tobacco use and low BMI were factors that were significantly associated with dental problems, while residency in a low-urbanisation area was a protective factor.Conclusion:The prevalence of underweight in rural Burkinabè women is among the highest in sub-Saharan Africa, and women with dental problems are more frequently affected than those without dental problems. Public health measures for the prevention of these disorders should specifically target women aged over 49 years and smokeless tobacco users.

Background Malaria in pregnancy remains a public health problem in sub-Saharan Africa. Identifying risk factors for malaria in pregnancy could assist in developing interventions to reduce the risk of malaria in Burkina Faso and other countries in the region. Methods Two cross-sectional surveys were carried out to measure Plasmodium falciparum infection using microscopy in pregnant women in Saponé Health District, central Burkina Faso. Data were collected on individual, household and environmental variables and their association with P. falciparum infection assessed using multivariable analysis. Results A total of 356 pregnant women were enrolled in the surveys, 174 during the dry season and 182 during the wet season. The mean number of doses of sulfadoxine–pyrimethamine for Intermittent Preventive Treatment in pregnancy (IPTp-SP) was 0.4 doses during the first trimester, 1.1 doses at the second and 2.3 doses at the third. Overall prevalence of P. falciparum infection by microscopy was 15.7%; 17.8% in the dry season and 13.7% in the wet season. 88.2% of pregnant women reported sleeping under an insecticide-treated net (ITN) on the previous night. The odds of P. falciparum infection was 65% lower in women who reported using an ITN compared to those that did not use an ITN (Odds ratio, OR = 0.35, 95% CI 0.14–0.86, p = 0.02). IPTp-SP was also associated with reduced P. falciparum infection, with each additional dose of IPTp-SP reducing the odds of infection by 44% (OR = 0.56, 95% CI 0.39–0.79, p = 0.001). Literate women had a 2.54 times higher odds of P. falciparum infection compared to illiterate women (95% CI 1.31–4.91, p = 0.006). Conclusions The prevalence of P. falciparum infection among pregnant women remains high in Burkina Faso, although use of IPTp-SP and ITNs were found to reduce the odds of infection. Despite this, compliance with IPTp-SP remains far from that recommended by the National Malaria Control Programme and World Health Organization. Behaviour change communication should be strengthened to encourage compliance with protective malaria control tools during pregnancy.

The ability to prevent, promptly detect, and appropriately respond to a public health threat is essential for health security. Field epidemiology training has helped increase the quality and quantity of the public health workforce to strengthen disease surveillance, outbreak preparedness and response, and general public health capacity. We conducted a desk review on the status of the Field Epidemiology and Laboratory Training Program model in 16 countries in West Africa. We also developed a questionnaire and shared it with West African Health Organization (WAHO) member states to document their experiences and the status of training in their countries. WAHO organized a regional 3-day consultative meeting with major stakeholders in the region to examine progress, gaps, and challenges, and outline a roadmap to strengthen the Field Epidemiology and Laboratory Training Program. Stakeholders shared their experiences, engaged in discussions to identify strengths and gaps, and made plans on a way forward. Member states are at different levels of implementing field epidemiology and laboratory training programs in their countries, and, therefore, major gaps remain in the number and distribution of trained epidemiologists throughout West Africa. Member states implement different variants of the program and in some instances the same cadre of health workers are trained in different but comparable programs with different funding streams. Two member states had not begun implementing the training program. Developing regional centers of excellence was recommended in the long term while collaboration among member states to train the required number of epidemiologists to fill the acute needs could be helpful in the short and medium term. Curriculum harmonization and expansion, deployment and use of trained epidemiologists, accreditation of training institutions, and generation of indigenous funding streams are recommended to improve the Field Epidemiology and Laboratory Training Program in West Africa.

Background: Many policy makers deliberating on comprehensive sexual and reproductive health and rights services need reliable evidence to make choices that benefit women, adolescents, children and the wider society. While universal health coverage discourse provides an opportunity to expand access through evidence based interventions, many gaps exist. Research prioritization has proved to be very helpful in identifying relevant areas especially in constrained resource settings. The purpose of this paper is to present the results of the World Health Organization Africa Region research prioritization for sexual and reproductive health and rights. These priorities hope to guide the region for the next three years. Methods: We used the Child Health and Nutrition Research Initiative approach to identify priority questions among many potential areas for research prioritization on sexual and reproductive health and rights. The implementation process was organized in three phases. The first phase involved sending out an online survey to various experts with experience in sexual and reproductive health rights. These questions were received by a technical team from World Health Organization headquarters for review. 634 questions were identified for potential research and grouped into 12 themes. The second phase involved experts who reviewed the questions. The team merged questions with duplications, removed the questions that were out of scope and finally refined the wordings. In the final phase, experts worked in groups to score and rank top ten priority questions for each of the 12 thematic areas. Results: A list of 120 priority questions for sexual and reproductive health and rights were prioritized by 67 participants drawn from 16 organizations. Most of the priority research questions (45%) focused on the theme of gender-based violence, 35% prioritized services in sexual and reproductive health and rights in humanitarian settings while 15% prioritized preventing unsafe abortion. 5% of the participants prioritized cervical cancer prevalence, prevention and treatment as a thematic area out of the questions in the top 20 research priority questions. Conclusions: Key priority research questions in sexual and reproductive health and rights were identified around five themes. The priority list will be of significance to World Health Organization regional Office for Africa and her stakeholders for the next three years.

Background: There is an increasing emphasis on conducting research to identify gender based violence issues to enable development of appropriate programs and interventions. However, these efforts are mixed in quality and often raise ethical questions. The increased pressure on policy makers to move to a more evidence-based approach in addressing gender based issues creates the need for this research prioritization activity. Inadequate evaluative evidence in this area poses a challenge in the planning for responsive interventions especially in resource limited settings. The purpose of this paper is to present gender based violence research priority areas for the WHO Africa Region. Methods: We utilized a modified version of the Child Health and Nutrition Research Initiative approach to reach consensus on research priorities on the thematic area of gender based violence. In three phases, we first conducted an online survey with sexual and reproductive health and rights experts in academia, ministries of health, non-governmental organizations and other health actors with a wide range of experiences. These questions were consolidated by three experts from World Health Organization headquarters into themes. Secondly, experts were invited in a meeting in Cape Town South Africa to analyze and generate relevant areas of research based on the themes. Finally, a smaller group of experts prioritized research areas based on agreed criteria. Results: A list of 10 priority research questions for addressing gender based violence were scored and ranked. Four priority research questions scored 30 points out of the possible 30 points and were thus ranked as the highest priority. These included questions that “engage young adolescents in behavioral interventions to influence gender roles”, “determinants of gender based violence analysis”, “both long and short term complications of gender based violence on survivors” and “assessment of men’s involvement in addressing gender-based violence against women”. The second most highly ranked question was on the assessment of the extent and strategies to prevent gender-based violence in the context of humanitarian crises. Conclusions: Priority research questions for addressing gender based violence were identified. This exercise provides a three year investment case for research with high potential of effectively identifying interventions with high impact on addressing gender based violence.

Background: The use of mobile phones continues to rise rapidly in the provision of health related services. Many countries have adopted the use of mobiles to provide sexual and reproductive health and rights and especially among the adolescents where specific messages are tailored for various audiences with specific messages. The purpose of this paper is to present the results of a research priority setting exercise on mHealth and innovative strategies. Methods: We adapted Child Health and Nutrition Research Initiative methodology to identify and set research priorities on mHealth and innovative strategies that respond to sexual and reproductive health and rights services. General potential research questions were gathered online from multiple stakeholders in the region and sent for consolidation consolidated to technical experts in World Health Organization headquarters. The second phase involved a meeting with experts to review and thematically analyze the questions list of 33 questions producing a list of 22 research questions. The questions were scored against a six point criteria and ranked accordingly. Ten top priority research questions were identified. Results: Lists of 33 priority research questions for mHealth and innovative strategies were proposed for discussions by 67 stakeholders. The questions were reviewed, scored and ranked in a technical meeting by experts. The highest ranking questions at 87% include evaluation of mHealth for data management and sexual and reproductive health and rights decision making, assessment of innovative local financing techniques to support community based sexual reproductive health and rights and evaluation of the role of mobile technologies in referral and counter referral. Conclusions: Information and communication technology is developing drastically and has a great potential in improving health especially in sexual and reproductive health and rights service delivery. This potential must be demonstrated with more relevant and quality research on mHealth and innovative strategies priorities identified.

Background: Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive ages. It is classified as a main cause of maternal mortality and morbidity. This paper has considered questions that have the greatest potential to successfully reduce unsafe abortions in the resource poor settings. Methods: We adapted the Child Health and Nutrition Research Initiative (CHNRI) to identify and prioritize many competing sexual and reproductive health and rights research ideas that impact the health of the populations. The implementation was done in three phases which included generation and collection of research ideas from various experts virtually in August 2019 consolidation of the potential questions through thematic analysis conducted in September 2019. Finally, scoring and ranking of the research questions was done in a workshop of experts. Results: Out of a list of 45 priority research questions, two questions were ranked the highest scoring 28 out of the possible 30. The research priorities include: “The effectiveness of interventions (e.g. counseling or incentives or home visits) to increase post abortion uptake and continuance”, “Reducing repeat abortion on improving maternal health outcomes” and “Evaluation of community-based awareness programs to reduce unwanted pregnancies and encourage women to seek help early”. Conclusions: Ten key research priorities in preventing unsafe abortion were identified. The priority list covers areas of focus that could effectively impact preventing unsafe abortions while also acting as a knowledge base for researchers, policy makers and other interested stakeholders who would want to invest in this area.

Introduction: Cirrhosis represents 27.63% of the hepatobiliary diseases in Burkina Faso. We aimed at studying the therapeutic and evolutionary features of the cirrhosis. Patients and methods: We implemented a cross-sectional and descriptive study, collecting retrospectively the data from 1st January 2012 to 31st March 2014. The diagnosis of cirrhosis was based on 1) clinical criteria (an edema-ascitic syndrome with a heterogeneous hepatomegaly with a sharp inferior border or atrophic liver and a portal hypertension); 2) biological criteria (a hepatocellular insufficiency syndrome); and 3) ultrasound imaging suggesting cirrhosis. Qualitative variables were presented as frequencies and percentages while quantitative ones were presented as means. Results: The data of 273 patients representing 33.9% of all hospitalizations were analyzed. The hepatobiliary diseases represented 74.7% of all diagnosis. The participants’ mean age was 46.9 years and the sex ratio, 2.7. The HBs antigen and anti-HCV antibodies were positive in 76.5% and 14.6% of the cases, respectively. Ascites was treated with puncture in 40.2% of patients, a salt-free diet (38.8%) and diuretics (54.2%). Hepatic encephalopathy was treated with lactulose in 73.6% of patients and two patients (1.3%) underwent esophageal varices ligation to treat their gastrointestinal bleeding. Lamivudine, tenofovir, and lamivudine-tenofovir combination were administered to 57.4%, 32.8%, and 10% of HBs Antigen positive patients, respectively. Conclusion: Cirrhosis still mostly affects the young and active male population at the gastro-enterology department of the university teaching hospital Yalgado Ouedraogo. Patients show up at a very advanced stage of the disease in poorly prepared health centres. In this context, prevention by the anti-hepatitis B immunization and early systematic screening with treatment when indicated are very efficient weapons at our disposal.

Introduction: The HbsAg prevalence in Burkina Faso was 9.1%. We aimed at describing the therapeutic features and the clinical outcome for the patients taking antiretroviral treatment. Materials and Methods: We implemented a cross-sectional study from January 1st, 2004 to December 31st, 2015. Patients aged more than 15 years with positive hepatitis B surface antigen for over six months and positive hepatitis B e-antigen were included. Results: We analyzed the data of 148 participants for a sex ratio of 3; sixty-three patients including 49 men (77.8%) were on treatment. and 81.5% had inflammatory activity greater than one. Under tenofovir, the normalization of ALT was observed in 42 (84%) patients while HBV-DNA became undetectable in 24/33 patients. HBeAg negativation was observed in 16/25 (64%) patients after seven years of treatment. With lamivudine, 2/9 patients had a complete virologic response and six had a normalization of their ALT. Two and 9 patients lost HBeAg after 7 and 9 years of treatment, respectively. Overall 63% and 27% of the patients were in the high or low-adherence group, respectively. In the low-adherence group, all patients had normal or abnormal ALT, but detectable HBV DNA. Ten patients taking lamivudine developed resistance including primary resistance in three patients. No resistance has been observed with tenofovir. Conclusion: The management of the viral hepatitis B includes often a long follow up period without any medication. When antiviral is indicated, the adherence to the treatment is crucial to a long-term control of the virus. In our setting, the low purchase power of the patients may jeopardize their therapeutic future and there is a need to support this group of patients with free-of-charge medicines as it is provided for the HIV infected people.

Background: Despite increased recognition of the need for sexual and reproductive health and rights in humanitarian settings, evidence focusing on mainstreaming reproductive health services such as maternal, neonatal mortality, human immunodeficiency virus transmission and unsafe abortion still remains inadequate. The ability to understand the magnitude of the needs and highlight existing gaps is supported by improved data which is critical to informing effective policies, programming and funding decisions. The purpose of this report is to present the results of a research prioritization exercise on sexual and reproductive health and rights services in humanitarian settings for the WHO Africa region for the next three years. Methods: We adapted the Child Health and Nutrition Research Initiative method in three phases. Experts from the region participated in an online survey to identify key areas for research in sexual and reproductive health and rights. To identify potential areas for research, the experts ensured answerability, effectiveness, deliverability, equity and potential impact of the questions. The research areas they identified were reviewed by World Health Organization technical team from headquarters. In a meeting of 67 participants, the questions were subjected to further review and analysis. Using a modified for scoring criteria, the questions were scored and ranked to provide the top ten priority questions to address sexual and reproductive health and rights services in humanitarian settings. Results: A list of 21 priority research questions on sexual and reproductive health and rights services in humanitarian settings were scored and ranked. Top ten priorities research questions were identified. Those that scored highly by scoring 30 points out of the possible maximum of 30 include: “determining the prevalence and associated factors of unwanted pregnancies and abortions performed in emergency and humanitarian settings”, “evidence on gender-based violence in humanitarian situations and its associated factors” and “defining an optimal model for coordinating sexual and reproductive health and rights interventions and responses in crisis situations”. Conclusions: Top ten research priorities in sexual and reproductive health and rights services in humanitarian settings were identified. The priority research areas have the potential to identify the best areas for programming of services in humanitarian settings. It is our hope that the identified research areas will be prioritized to support programming of services in humanitarian settings based on scientific evidence.

Introduction: The treatment of viral hepatitis B is based on nucleotide analogs(s). In Burkina Faso, tenofovir is the most widely used because of its effectiveness and cost. The aim of this study was to describe viral hepatitis B under tenofovir in Ouagadougou. Material and Method: This was a longitudinal study, carried out in the outpatient department of the University Hospital of Tengandogo from May 1, 2013 to September 31, 2020, i.e. a period of seven (07) years and five (05) months. All patients with chronic hepatitis B virus who had been taking tenofovir for at least one year were included in the study. Cases of hepatocellular carcinoma and co-infections with hepatitis D, C and human immunodeficiency viruses were excluded from the study. Results: Of 321 patients with hepatitis B, 120 were on tenofovir and 34 were included in our study. These were 24 men and 10 women with an average age of 39 years. Hepatitis B was most often discovered following systematic or voluntary screening (44.1%) or pain in the right hypochondrium (23.5%). The mean initial viral load was 7.9 log. Ten patients had moderate compliance and four were non-compliant. No side effects were reported in 91.3% of cases. The virologic response was complete in 72.7% of patients after six months. Nine out of ten patients showed a biochemical response after 16 months. A histological response was observed in 19/27 patients within a mean of 26.7 months. HBs seroconversion was found in 2/24 patients. Conclusion: Tenofovir is effective in the treatment of viral hepatitis B, but HBs seroconversion is rarely achieved.

Background: Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interventions that respond to sexual and reproductive health and rights services particularly in cervical cancer prevalence, prevention and treatment have not adequately taken into account research based evidence to respond appropriately. Methods: We adapted the Child Health and Nutrition Research Initiative method. A wide range of stakeholders identified potential research areas in an online survey. A technical working group comprising of 67 participants reviewed the questions for modification and removal of out scope questions. Finally, scoring and ranking was done to provide the top ten priorities questions. Results: “Cost-benefit analysis of systematic human papillomavirus vaccination compared to the current cost of cervical cancer in public health care systems” scored 27. This was followed by two research questions ranked at 24 points: “assessment of women’s and girls’ knowledge on the importance of early cervical cancer screening,” and “human papilloma virus vaccination and contributions of new technologies to the supply and storage of vaccines, including human papillomavirus vaccine”. Conclusion: The study identified 10 priority research questions that can guide the agenda for cervical cancer prevalence, prevention and treatment in the WHO Africa region. The identified priorities will be of use to policy makers, researchers and programmers and other stakeholders who can invest in areas that greatly affect cervical cancer prevalence, prevention and treatment.

Background The current paper examines the level of use of evidence and factors affecting the use of evidence by frontline maternal, newborn and child health (MNCH) and reproductive and child health (RCH) staff in practice decisions in selected health facilities in Ghana. Methods Data on use of evidence and its correlates was collected from 509 frontline healthcare staff drawn from 44 health facilities in three regions in Ghana. Means were used to examine the level of use of evidence, whiles cross-tabulations and Partial Least Squares-based regression were used to examine factors associated with the use of evidence in practice decisions by frontline MNCH/RCH staff. Findings The findings suggest a high level of use of evidence by frontline MNCH/RCH staff in practice decisions (score of 3.98 out of 5), albeit that evidence use is skewed towards the use of practice guidelines and policies. For the antecedents of evidence use, attitude had the highest score (3.99), followed by knowledge (3.8), access to evidence (3.77) and organizational structure (3.57), using a threshold of 5. The regression results indicate that attitudes and knowledge of frontline MNCH/RCH staff, organizational structure (strongest association), years of experience, being a male and working in a mission health facility are significantly positive correlated with evidence use, whiles working in a private health facility or in the post-natal clinic is negatively correlated with the use of evidence. Conclusion We argue that any effort to improve the use of evidence by frontline MNCH/RCH staff in practice decisions should focus on improving attitudes and knowledge of staff as well as challenges related to the structure of the organisation. Given however that the score for attitude was relatively high, emphases to improve evidence use should be on access to evidence and organizational structure in particular, which had the lowest score even though it has the strongest association with the use of evidence.

Background Prostate cancer (Pca) is a public health problem that affects men, usually of middle age or older. It is the second most common cancer diagnosed in men and the fifth leading cause of death. The RNASEL gene located in 1q25 and identified as a susceptibility gene to hereditary prostate cancer, has never been studied in relation to prostate cancer in Burkina Faso. The aim of this study was to analyze the carriage of RNASEL R462Q and D541E mutations and risks factors in patients with prostate cancer in the Burkina Faso. Methods This case–control study included of 38 histologically diagnosed prostate cancer cases and 53 controls (cases without prostate abnormalities). Real-time PCR genotyping of R462Q and D541E variants using the TaqMan® allelic discrimination technique was used. Correlations between different genotypes and combined genotypes were investigated. Results The R462Q variant was present in 5.3% of cases and 7.5% of controls. The D541E variant was present in 50.0% of cases and 35% of controls. There is no association between R462Q variants (OR = 0.60; 95%IC, 0.10–3.51; p = 0.686) and D541E variants (OR = 2.46; 95%IC, 0.78–7.80; p = 0.121) and genotypes combined with prostate cancer. However, there is a statistically significant difference in the distribution of cases according to the PSA rate at diagnosis (p ˂ 0.001). For the Gleason score distribution, only 13.2% of cases have a Gleason score greater than 7. There is a statistically significant difference in the Gleason score distribution of cases (p ˂ 0.001). Conclusions These variants, considered in isolation or in combination, are not associated with the risk of prostate cancer.

Aims: The aim of this study was to assess the impact of hemoglobin polymorphisms and G6PD deficiency on the course of uncomplicated malaria infection in children aged from 2 to 10 years in Burkina Faso. Study Design: The study was conducted as a longitudinal study in Banfora health district. A total of 150 children aged from 2 to 10 years was enrolled and followed up between May 2015 and February 2016. Blood samples were collected at four different time points: before infection (Visit 1), during asymptomatic parasitemia (Visit 2), during symptomatic parasitemia (Visit 3) and three weeks after treatment (Visit 4). Clinical examination, hematology parameters and malaria diagnosis using microscopy were performed. Hemoglobin and G6PD typing were done using PCR-RFLP. Hemoglobin AA genotypes were defined as normal hemoglobin while Hemoglobin AC, AS and SS were defined as abnormal hemoglobin (hb non-AA). Results: The prevalence of hemoglobin (hb) genotypes was 81.21% for AA while hb non-AA genotypes were estimated at 18.79% (12.08% for hbAC, 6.04% for hbAS and 0.67% for HbSC). The prevalence of G6PD genotypes was 89.26% and 10.74% for normal G6PDn and G6PD deficiency respectively. The prevalence of asymptomatic carriers of P. falciparum was not affected neither by the genotypes of Hemoglobin, nor by the G6PD deficiency. Conversely, the risks of developing uncomplicated malaria in G6PD deficiency (G202A) group, was significantly lower (p = 0.04). The results showed a significant difference (p˂0.0001) in the means of P. falciparum parasite densities between asymptomatic and symptomatic phase in Hemoglobin AA genotypes carriers while the means of parasite density was comparable in non-Hemoglobin AA carriers. Conclusion: Our study showed that G6PD deficiency protects against clinical malaria while P. falciparum parasite density increasing was correlated with carrying hemoglobin genotypes AA.

A recent randomized controlled trial, the WANECAM (West African Network for Clinical Trials of Antimalarial Drugs) trial, conducted at seven centers in West Africa, found that artemether-lumefantrine, artesunate-amodiaquine, pyronaridine-artesunate, and dihydroartemisinin-piperaquine all displayed good efficacy. However, artemether-lumefantrine was associated with a shorter interval between clinical episodes than the other regimens. In a further comparison of these therapies, we identified cases of persisting submicroscopic parasitemia by quantitative PCR (qPCR) at 72 h posttreatment among WANECAM participants from 5 sites in Mali and Burkina Faso, and we compared treatment outcomes for this group to those with complete parasite clearance by 72 h. Among 552 evaluable patients, 17.7% had qPCR-detectable parasitemia at 72 h during their first treatment episode. This proportion varied among sites, reflecting differences in malaria transmission intensity, but did not differ among pooled drug treatment groups. However, patients who received artemether-lumefantrine and were qPCR positive at 72 h were significantly more likely to have microscopically detectable recurrent Plasmodium falciparum parasitemia by day 42 than those receiving other regimens and experienced, on average, a shorter interval before the next clinical episode. Haplotypes of pfcrt and pfmdr1 were also evaluated in persisting parasites. These data identify a possible threat to the parasitological efficacy of artemether-lumefantrine in West Africa, over a decade since it was first introduced on a large scale.

International audience; Background: The World Health Organization (WHO) recommends a first hepatitis B vaccine dose within 24 h of birth (HepB-BD) to prevent mother-to-child transmission. Evidence for this strategy's economic value in Africa is limited. We assessed the costs and cost-effectiveness of adding HepB-BD to the current three-dose pentavalent schedule (HepB3) in the Dafra district of the Hauts-Bassins Region in Burkina Faso.Methods: Using a decision tree combined with a Markov model, we estimated the expected number of life-years (LY) and disability-adjusted life-years (DALYs) saved, incremental costs, and incremental cost-effectiveness ratios (ICER) of HepB-BD + HepB3 versus HepB3 alone in Dafra's 2017 birth cohort (n = 11,462). Institutional delivery rates, vaccine coverage, and vaccination costs from a health system perspective were estimated from field-collected data. We estimated the effectiveness of HepB-BD, age-specific transition probabilities, and horizontal transmission risks using data from previous African studies. Costs and health outcomes were discounted at an annual rate of 3%. We conducted one-way and probabilistic sensitivity analyses to assess uncertainty.Results: In the base-case analysis without discounting, HepB-BD + HepB3 yielded a net cost saving of US$18,979 and saved 163 DALYs compared with HepB3 alone. With discounting, HepB-BD + HepB3 compared with HepB3 resulted in an incremental cost of US$554 and 31 DALYs averted, translating into an ICER of US$18/DALY averted. In one-way sensitivity analyses, HepB-BD + HepB3 remained cost-effective (at the cost-effectiveness threshold of US$671 i.e. the Burkina Faso per-capita gross domestic product) for all parameter changes. However, results were very sensitive to variations in HepB-BD unit cost per vaccinated neonate and perinatal transmission risk in mothers carrying the hepatitis B e antigen. The probabilities of HepB-BD + HepB3 being cost-effective were 71.7% and 86.7%, at the cost-effectiveness thresholds of US$335 and US$671, respectively.Conclusion: Introducing HepB-BD in Burkina Faso is likely to be cost-effective.

Introduction Our study aimed to describe epidemiological and diagnostic features in an outpatient's cohort with chronic HBeAg-negative hepatitis B. Patients and methods A cross-sectional descriptive study with a retrospective data collection was implemented from January 2004 to April 2016 in the hepato-gastroenterology department of the University Teaching Hospital Yalgado Ouedraogo (CHU-YO) in Burkina Faso. Results Overall 325 HBeAg negative patients met the inclusion criteria. The sex ratio was 1.5 and the mean age 38.7 years. The most frequent circumstance of diagnosis was the health check-up (54.5%). The mean HBsAg concentration and viral load were 7861.6 IU/mL and 32 237.20 IU/mL, respectively. Low or moderate inflammatory activity was found in 44% and 24% of patients, respectively at the liver biopsy; 32% presented a portal fibrosis with some septa (F2). 43.9% and 41.6% had low (A1) or moderate (A2) inflammatory activity, respectively at the hepatic fibrosis blood test, while 59.1% and 20.4% had low (F1) or moderate (F2) fibrosis stage, respectively. Of the five biochemical and virological profiles among the untreated patients, the profile 1 represented 67.2% of the sample. Conclusion The proportions of negative HBeAg in chronic hepatitis B patients are increasing in Burkina Faso. Most of the patients have a high viral load, a low to moderate inflammatory activity or fibrosis stage.

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.

Free movement between countries without a visa is allowed within the 15-country Economic Community of West African States (ECOWAS) region. However, little information is available across the region on the International Health Regulation (IHR 2005) capacities at points of entry (PoE) to detect and respond appropriately to public health emergencies such as Coronavirus Disease 2019 (COVID-19). ECOWAS and the member states can better tailor border health measures across the region by understanding public health strengths and priorities for improvement at PoEs. A comprehensive literature review was combined with a self-assessment of capacities at PoEs across the fifteen member states from February to July 2020. For the assessment, the member states completed an adapted World Health Organization (WHO) self-assessment checklist by classifying capacity for seven domains as fully, partially, or not implemented. The team implemented three focus group discussion (FGD) sessions and 13 key informant interviews (KII) with national-level border health stakeholders. Univariate analysis was used to summarize the assessment data and detailed content analysis was applied to evaluate FGD and KII results. Of the 15 member states, 3 (20%) are landlocked; 3 (20%) have more than one seaport. Eleven (73%) countries have 1 designated airport, 3 (20%) have two airports, and only one country (6.7%) has three airports. Two hundred and seventy-eight designated ground crossings were identified in 12 countries (80%). Strengths across the PoE were existence of decrees and ministerial acts in some ECOWAS countries and establishment of national taskforces for the COVID-19 response at PoE in ECOWAS. Major challenges were porous borders, poor intersectoral coordination, lack of harmonized traveler screening measures, shortage of staff, and inadequate financial resources. Despite all these challenges, there are opportunities such as leveraging the regional cross-border poliomyelitis coordination and control mechanism, and existence of networks of infection prevention and control specialists and field epidemiologists. However, political instabilities in some countries pose a threat to government commitments to PoE activities. The capacity to respond to public health emergencies at PoE in the ECOWAS region is still below IHR standard. Public health capacities at a majority of IHR-designated PoE in the 15-country region do not meet required core capacities standards.

Since the beginning of the COVID-19 pandemic in West Africa, the region has faced a coexistence of epidemics raising questions about the management of the coexistence between COVID-19 and other epidemic prone diseases. We undertook a cross-sectional study covering the period from February to August 2020 in which an extensive desk review was completed and questionnaire was submitted to National Public Health Institutes. In addition, we conducted online interviews with 10 West African countries to discuss in-depth the strategies and challenges in managing the coexistence of epidemics. Eight epidemics coexisted with COVID-19 in West Africa. These epidemics were yellow fever and measles in five countries; meningitis in 4 countries; vaccine derived poliomyelitis and dengue fever in two countries; Lassa fever, Crimean Congo Hemorrhagic fever and hepatitis E virus in one country. COVID-19 pandemic has brought both positive and negative effects to the management of other epidemics. The management of coexistence was similar in most ECOWAS countries with different incident management systems set up to manage separate outbreaks. The experience in managing the coexistence of epidemics led ECOWAS Regional Center for Surveillance and Disease Control to recommend to member states that they should reinforce regular disease surveillance for seasonal outbreaks and country specific epidemiological diseases profile while not forgetting other emerging and remerging infectious diseases.

Introduction: Hepatitis C virus (HCV) infection remains a major public health problem worldwide. In Burkina Faso, nearly 720,000 people are living with HCV, and each year about 900 people die from complications of cirrhosis or hepatocellular carcinoma. This study was planned to determine the HCV seroprevalence, characterize circulating genotypes, and monitor HCV viral loads in patients under treatment with antivirals. Methods: A total of 4,124 individuals and 167 patients in the pre-therapy program were recruited. The “SD Bioline HCV” kit was used for rapid screening of anti-HCV antibodies. Viral load and genotyping were performed in 167 HCV patients on antivirals using the “Iontek HCV Quant” and “Iontek genotyping” kits. Results: Prevalence of HCV was 1.65% (68/4,124), and the median viral load of participants was 5.37 log10/mL (1.32–7.67 log10/mL). Genotype 2 was predominant with a frequency of 86.23% (144/167) and appeared to be more active with higher viral load compared to 13.77% (23/167) for genotype 1 (p < 0.001). After 24 weeks of pan-genotypic direct-acting antivirals, such as sofosbuvir/daclatasvir and sofosbuvir/velpatasvir, the viral loads of all patients became undetectable. Conclusion: The responses to antivirals by the circulating genotypes indicate that the results are very satisfactory. Therefore, the prevalence of HCV in the population can be reduced through identification of cases and treatment.

International audience; The clinical utility of quantifying hepatitis B surface antigen (qHBsAg) levels in African subjects with chronic hepatitis B virus (HBV) infection has been poorly documented. From a multicentre cohort of 944 HBV-infected African patients, we aimed to assess whether qHBsAg alone can accurately identify i) those in a HBeAg-negative chronic HBV infection phase at low risk of liver disease progression and ii) those in need of antiviral therapy according to the 2017 EASL guidelines. We analysed 770 HBV mono-infected treatment-naïve patients, mainly males (61%) from West Africa (92%), median age 35 years (IQR: 30-44), median HBV DNA: 95.6 IU/ml (10.0-1,300.0), median qHBsAg 5,498 IU/ml (1,171-13,000) and HBeAg-pos 38 (5%). A total of 464/770 (60.2%) patients were classified as HBeAg-negative chronic infection (median age 36 years (31-46), median ALT 23 IU/l (18-28), median HBV-DNA 33.5 IU/ml (3.8-154.1), median LSM 4.8 kPa (4.1-5.8)) and qHBsAg levels had poor accuracy to identify these subjects with an AUROC at 0.58 (95%CI: 0.54-0.62), sensitivity 55.0% and specificity 55.6%; 118/770 (15.3%) patients were eligible for treatment according to the 2017 EASL criteria. qHBsAg correlated poorly with HBV DNA and had poor accuracy to select patients for antiviral therapy with an AUROC at 0.54 (0.49-0.60), sensitivity 46.6% and specificity 46.9%. In African treatment-naïve HBV-infected subjects, the clinical utility of qHBsAg to identify subjects in HBeAg-negative infection phase or subjects eligible for antiviral therapy seems futile. Whether qHBsAg levels can be used as a predictor of long-term liver complications in Africa needs to be further investigated.

Background: Vitamin A deficiency (VAD) is still a public health problem across the globe and also in Burkina Faso, especially for under-five-years-old children. Since less information is available about the prevalence of VAD among the primary school children, this study aimed to study this area. Methods: A randomised double-blind placebo-controlled trial was conducted to assess the effect of high dose of vitamin A (VA) and daily zinc versus high dose of VA and daily zinc placebo (6 days per week) during four months among the primary school children. Of the total number of 200 school children, 100 were allocated to two random groups. Participants’ gender, age, weight, and height were measured, a blood smear was performed for malaria diagnosis, stool samples were collected for intestine parasites’ assessment, and blood samples were collected for haemoglobin and serum retinol measurement. Results: Baseline data of 183 school children were analysed and the findings showed that 20.6% of the school children were underweight (23.2% in girls vs. 16.5% in boys; P = 0.043). Anemia affected 36.2%, 39% had Plasmodium Falciparum, and 37.6% had intestine parasites. Furthermore, VAD prevalence was 46.1% (51.0% in boys vs. 41.2% in girls; P = 0,072). Conclusion: Among primary school children in the Western part of Burkina Faso, VAD is not only higher than other regions of the country, but also twice the critical level and defined as a severe public health problem by WHO. This result calls for action among the primary school children and recalls the importance of taking strategies against VAD among under-five-year-old children.

Background Prevention of mother-to-child transmission (PMTCT) is a challenge for controlling the hepatitis B epidemic. In Sub-Saharan countries, pilot interventions including the screening of pregnant women for HBsAg, implementation of anti-HBV therapy and infant immunization within 24 hours of life are initiated and need to be evaluated. This pilot study aimed to describe the cascade of care for hepatitis B PMTCT in a real life situation, and to identify sociodemographic factors associated with adequate management of pregnant women and infants. Method The study was conducted from October 1st, 2014 to February 28th, 2016 in the antenatal clinics (ANCV) of Baskuy district which comprises nine first-level public health centres. Univariate and multivariate logistic regression analysis were used to identify sociodemographic factors associated with the likelihood of retention in the cohort, HBV DNA testing, birth dose delivery and HBsAg testing of the children at 6 months of age; P ˂ .05 was selected as cut off for significance. Results In this prospective cohort study, of 5200 pregnant women consulting for the antenatal visit, 2261 (43.5%) were proposed pre-test counselling and HBsAg screening and 2220 (98.2%) have agreed to screening. Among 1580 (71.2%) women that came back for the post-counselling interview, 75 were positive for HBsAg (4.8%), 73 (97.3% of the women provided HBsAg result) consented to medical consultation with hepatogastroenterologists and 53 (72.6%); performed the HBV DNA testing. Forty-seven out of 60 (78.3%; 65.8-87.9) children born alive were immunized for HBV within 24 hours of life. Retention in care was associated with the level of education of the infant's father, secondary school or higher was associated with a better retention in care of the women (OR: 6.6; P = .03). Conclusion Our study shows large gaps in HBV PMTCT. Resources for hepatitis B screening, care and prevention including universal access to the vaccine birth dose should be allocated to reduce infection in HBV exposed infants born in Burkina Faso.

International audience

BACKGROUND: Our previous study developed Liaoning score as a non-invasive approach for predicting esophageal varices (EVs) in liver cirrhosis. This nationwide multicenter cross-sectional study aimed to externally validate the diagnostic accuracy of Liaoning score and further evaluate its performance for predicting high-risk EVs. METHODS: Cirrhotic patients with acute gastrointestinal bleeding (GIB) without history of endoscopic variceal therapy who underwent endoscopic examinations at their admissions were included. Liaoning score and several non-invasive liver fibrosis scores, including aspartate aminotransferase (AST) to platelet ratio index (APRI), AST to alanine aminotransferase ratio (AAR), fibrosis 4 index (FIB-4), King, and Lok scores, were evaluated. Area under curves (AUCs), cut-off value, sensitivity, and specificity were calculated. RESULTS: Overall, 612 patients were included. The prevalence of EVs and high-risk EVs was 96.2% and 95.6%, respectively. In overall patients, the AUCs of Liaoning score for predicting EVs and high-risk EVs were higher than non-invasive liver fibrosis scores (0.737 versus 0.626–0.721; 0.734 versus 0.611–0.719). The cut-off value of Liaoning score for high-risk EVs was 0.477 with a sensitivity of 81.96% and a specificity of 65.22%. In patients with hematemesis, Liaoning score could significantly predict EVs and high-risk EVs (AUCs =0.708 and 0.702, respectively), but not non-invasive liver fibrosis scores. The cut-off value of Liaoning score for high-risk EVs was 0.437 with a sensitivity of 83.16% and a specificity of 60%. CONCLUSIONS: Liaoning score should be a non-invasive alternative for predicting EVs and high-risk EVs in cirrhotic patients with acute GIB.

Introduction Health technology assessment (HTA) is an effective tool to support priority setting and generate evidence for decision making especially en route to achieving universal health coverage (UHC). We assessed the capacity needs, policy areas of demand, and perspectives of key stakeholders for evidence-informed decision making in Nigeria where HTA is still new. Methods We surveyed 31 participants including decision makers, policy makers, academic researchers, civil society organizations, community-based organizations, development partners, health professional organizations. We revised an existing survey to qualitatively examine the need, policy areas of demand, and perspectives of stakeholders on HTA. We then analyzed responses and explored key themes. Results Most respondents were associated with organizations that generated or facilitated health services research. Research institutes highlighted their ability to provide expertise and skills for HTA research but some respondents noted a lack of human capacity for HTA. HTA was considered an important and valuable priority-setting tool with a key role in the design of health benefits packages, clinical guideline development, and service improvement. Public health programs, medicines and vaccines were the three main technology types that would especially benefit from the application of HTA. The perceived availability and accessibility of suitable local data to support HTA varied widely but was mostly considered inadequate and limited. Respondents needed evidence on health system financing, health service provision, burden of disease and noted a need for training support in research methodology, HTA and data management. Conclusion The use of HTA by policymakers and communities in Nigeria is very limited mainly due to inadequate and insufficient capacity to produce and use HTA. Developing sustainable and institutionalized HTA systems requires in-country expertise and active participation from a range of stakeholders. Stakeholder participation in identifying HTA topics and conducting relevant research will enhance the use of HTA evidence produced for decision making. Therefore, the identified training needs for HTA and possible research topics should be considered a priority in establishing HTA for evidence-informed policy making for achieving UHC particularly among the most vulnerable people in Nigeria.

Background A community-based dengue fever intervention was implemented in Burkina Faso in 2017. The results achieved vary from one area to another. The objective of this article is to analyze the implementation of this intervention, to better understand the process, and to explain the contextual elements of performance variations in implementation. Methodology The research was conducted in the former sector 22 of the city of Ouagadougou. We adapted the Consolidated Framework for Implementation Research (CFIR) to take into account the realities of the context and the intervention. The data collected from the participants directly involved in the implementation using three techniques: document consultation, individual interview, and focus group. Results Two dimensions of CFIR emerge from the results as having had a positive influence on the implementation: (i) the characteristics of the intervention and (ii) the processes of the intervention implementation. The majority of the CFIR constructions were considered to have had a positive effect on implementation. The quality and strength of the evidence received the highest score. The dimension of the external context had a negative influence on the implementation of the intervention. Conclusion The objective of the study was to analyze the influence of contextual elements on the implementation process of a community-based dengue fever intervention. We used the CFIR framework already used by many studies for implementation analysis. Although it was not possible to test this framework in its entirety, it is useful for the analysis of the implementation. Its use is simple and does not require any special skills from users. Usability is indeed an essential criterion for the relevance of using an analytical framework in implementation science.

Background: The Anonymous Screening and Information Centre (CADI) is the oldest screening centre of HIV from Burkina Faso. Since its opening, no analysis on the evolution of Human Immunodeficiency Virus (HIV) prevalence has been carried out. Objective: The study aimed to describe the dynamics of HIV infection when managing centres offering voluntary counselling and testing to client, such as the Screening and Counselling Centre (CADI), in Bobo Dioulasso, Burkina Faso. Patients and Methods: A cross-sectional study was performed including people screened at the CADI from May 1996 to June 2014. Pearson khi2 test and Cuzick trend test were used with a 5% significance level. Results: From 7.1% of the 11,451 cases analyzed, the average age of clients screened was 30 ± 10.83 year-old. There was a female predominance (sex ratio = 0.8). The 16.4% (15.7 - 17.1) of the cases from the 11,451 clients included in our study were tested HIV positive. The global prevalence rate of HIV in the centre has significantly decreased from 46.2% in 1996 to 1.5% in 2014 (p < 0.0001). In 1999, 2001, and 2006, the peaks of the HIV prevalence rates were noted: 22.9%, 34.1%, and 22.8% respectively. CADI’s customers’ profile has significantly changed. Therefore between 1996 and 2000, people with HIV symptoms were more common at the centre (42.7%). From 2001 to 2008, physician-prescribed screenings were best predominant (83.95%). From 2008 to 2014, a total of 72.7% people reported with reason for the screening a desire to know their serological status. Conclusion: The behaviour change could be a justification for the decline in HIV prevalence at the centre, hence the importance of sensitization campaigns.

Background: Infectious Diseases are responsible for nearly 17 million annual deaths worldwide. Burkina Faso, like the majority of poor countries, remains vulnerable to infectious diseases. The objective of the present study was to analyze the profile of inpatients, including the mortality and causes of death, in the Infectious Diseases Department of Souro Sanou teaching hospital (Bobo-Dioulasso, Burkina Faso). Methods: We carried out a cross-sectional study based on medical records of all inpatients from 2011 to 2015. Results: We included 1169 patients. The gender ratio was 0.8. The age group 30 to 39 was more represented (30.2%) as well as housewives and farmers (73.7%). Over one-thirds of the patients (35.3%) were consulted within an average of 7 days. The most common reason for consultation was fever (65.1%). Around 62.0% of inpatients were infected by the Human Immunodeficiency Virus (HIV). Digestive diseases ranked first (21.8%) followed by nervous system disorders (19.4%) and tuberculosis (17.8%). Overall morbidity rate was 31.3%. About 42% were admitted to the emergency ward while 83.3% already arrived with poor health condition. And 82.1% of deaths occurred on pathological grounds of which 66.7% were related to HIV. Main causes of death included nervous system diseases (28.6%), tuberculosis (21.9%) and gastrointestinal diseases (18.3%). Conclusion: Infectious diseases remain a major public health issue. Further efforts are needed to improve their management in Burkina Faso.

In sub-Saharan Africa, where people living with HIV are frequently stigmatized, the intake of antiretroviral treatment (ART) remains a critical issue for many patients. Although the secret intake of ART may hinder the adherence to treatment, data on its specific impact on therapeutic effectiveness are lacking. We therefore assessed the association between secret intake of ART (i.e., hidden from family) and HIV-1 viremia among patients treated in a public routine clinic in Burkina Faso. We performed a cross-sectional study from December 2012 to September 2013 among patients on ART at the Day Care Unit in Bobo Dioulasso. Patients were eligible for the study if they were 15 years old or over, infected with HIV-1 or HIV-1 + 2, and on ART for at least six months. HIV-1 viral load was measured using Biocentric or Abbott Real Time assay. Study-specific data were collected by social workers using face-to-face interviews, and medical data using the routine electronic database. The association between secret intake of ART and viral load >300 copies/mL was assessed using a multivariate logistic regression. Of 771 patients (women 81.4%; median age 41 years; median time on ART 51 months), 408 reported secret intake of ART and 363 declared open intake. Compared to the latter, patients who hid their intake were younger, more likely to be women and to be involved in a polygamist or in a non-cohabiting union. Viremia was observed in 4.4% of patients hiding ART intake and 9.4% of those taking it openly. By multivariate analysis, secret intake of ART was significantly associated with a lower risk of viremia (adjusted odds ratio 0.41, 95% confidence interval 0.22-0.76). The unexpected relation between secret intake of ART and viremia found in this study requires further investigations. Quantitative and qualitative studies need to be performed.

According to WHO, eating at least five portions of fruit and vegetables a day at an early age is protective against cancers, cardiovascular diseases and diabetes. The purpose of this study was to determine among secondary school pupils in the city of Bobo-Dioulasso, the level of observation of this recommendation and the associated factors. Methods: This was a cross-sectional study conducted from March to April 2016, among secondary school pupils in 1st Form, 4th Form and 7th Form of public and private secondary schools. The diet survey methods were the recalling of the last 24 hours associated with intake frequency questionnaire. An intake of less than one fruit (or a slice of a big fruit) per day and for vegetables, less than one portion of raw or cooked vegetables per day was considered insufficient. Results: A total of 1993 pupils were surveyed. The mean age was 17.5 ± 3.6 years and the sex ratio 0.7; 75.4% and 90.0% of pupils had insufficient daily intake of fruit and vegetables respectively. The determinants of this consumption deficiency were: Sex (male, OR = 1.7 (1.3 - 2.2)), secondary school (public, OR = 1.6 (1.3 - 2.0)), class (4th Form, OR = 2.5 (1.5 - 4.2)/7th Form, OR = 3.7 (2.7 - 5.1)), the mother (thin build, OR = 3.2 (2.0 - 5.3)/overweight/obesity, OR = 2.8 (1.6 - 4.7)) and physical inactivity (OR = 1.5 (1.2 - 2.0)). Conclusion: The promotion of a healthy diet among secondary school pupils should take into account the type of school, sex, educational level, physical activity and mothers’ influence.

Several studies have shown the importance of therapeutic education in the management of diabetes. Its implementation requires a prior assessment of the level of patients’ knowledge. The objective of this study was to assess the level of diabetics’ knowledge about their disease. Methods: This was a cross-sectional study conducted between 2013 and 2015; consenting diabetics, followed for at least one year in medicine department of Souro Sanou Hospital, have been surveyed. The data were collected using a 51-item questionnaire, adapted from “Audit of Diabetes Knowledge” and administered by an interviewer. The level of knowledge was satisfactory/good if at least 80% of the set items or a topic were known. Results: A total of 268 diabetics were surveyed. Their mean age was 54.3 ± 1.4 years and the sex ratio 0.8. The majority (80.9%) lived in urban areas and half (50.4%) were uneducated. Type 2 diabetics accounted for 93.3% of the population; the average seniority was 6.0 ± 0.7 years. The level of knowledge was generally insufficient, with an average total score of 25.4 ± 1.0/51. The topics which were not well mastered related to diet (0.8%), glycated haemoglobin (4.5%), and signs of hypoglycemia (7.8%). The main relatively well-known topics related to the effect of physical exercise on glycemia = 37.7%, the effect of food on glycemia = 36.9% and glycemia target = 32.8%. Conclusion: This study revealed a lack of knowledge from diabetic patients who are followed in the medicine department of the Teaching Hospital Souro SANON (CHUSS). The implementation of a therapeutic education program for diabetics is necessary and urgent.

Introduction: Diet is a determinant of chronic non transmissible diseases. The aim of this study was to describe pupils’ diet in the city of Bobo-Dioulasso (Burkina Faso). Methods: This was a descriptive cross-sectional study that took place from March to April 2016, among 1st, 4th and 7th form pupils of public and private schools in the city of Bobo-Dioulasso. Diet survey methods were a reminder of the last 24 hours and the questionnaire of consumption frequency. Results: A total of 1993 pupils were surveyed. The mean age was 17.5 ± 3.6 years and the sex ratio 0.7. The majority of pupils (90.5%) reported eating at least 3 meals a day. Dietary recommendations were different according to food groups. For example, vegetables (90.0%), fruits (75.4%) and dairy products (79.3%) were the least well consumed foods compared to recommendations. Protein and starch intake were inadequate among these pupils with 39.7% and 58.2% respectively. Almost 1/4 had a regular weekly alcohol consumption (23.4%) while an excessive consumption of sweet drinks and fried foods was noted in 12.7% and 28.2% of them, respectively. Conclusion: This study has revealed a general insufficiency in the recommended dietary intakes of fruit, vegetables, proteins, starchy foods and dairy products among pupils, and on the other hand, a regular consumption of fatty, sugary and alcoholic foods for about a fifth of them. An intervention program such as “Communication for Continuous Behavior Change” would help improve these habits.

Introduction: Nutrition, particularly when too sweet or too fatty, is a major determinant of chronic diseases. This study aims to determine the frequency and associate factors of the excessive consumption of sweet drinks and fried food among secondary school pupils. Methods: It is cross-sectional study which was conducted from March to April 2016 among 1st, 4th and 7th form pupils of public and private schools in the city of Bobo-Dioulasso. Nutritional investigation methods consisted in a reminder of the last 24 hours associated with a questionnaire on food consumption frequency. Excessive consumption of sweet drinks was defined as a consumption of more than 3 sweet drinks (soda) or sugary juice per day (~33 cl × 3); and excessive consumption of fried food as a consumption of more than 1 intake of fried food per day. Results: In total, 1993 pupils were interviewed. The mean age was 17.5 ± 3.6 years and sex-ratio 0.7. Excessive consumption of sweet drinks and fried food was recorded in 12.7% (n = 253) and 28.2% (n = 561) of pupils, respectively. The factors associated with excessive consumption of sweet drinks were: sex/female, sedentarily, desire to gain weight, lean or normal corpulence of the mother and breakfast intake; those associated with excessive consumption of fried food were: sex/female, being in 1st or 4th form, physical exercise practice and breakfast intake. But the fact to attend a private secondary school, to have a mother of normal corpulence and a concordance between self-image and actual weight status, were protective against excessive consumption of fried foods. Conclusion: This study has displayed prominently the fact that eating too sweet and too fatty concerned respectively 1/10 and 3/10 of pupils in the city of Bobo-Dioulasso. The main modifiable factors of these eating habits included the level of education, the composition of breakfast and the influence of mothers. An intervention program in the form of a Communication for Continuous Behavioral Change intended for pupils and their mothers could help to improve this situation.

Background People with disabilities represent approximately 6% of the Senegalese population. They face significant barriers to accessing health care. Although several initiatives have been implemented to improve access to health care for this vulnerable population, few studies have examined the effects of these initiatives. We conducted a mixed methods study in three neighborhoods in Saint-Louis City (Senegal) to assess the impact of health systems and social assistance programs aimed at improving access to health care for people with disabilities. Methods Data were collected from 105 people living with disabilities aged 1–49 years (or their caregivers). Interviews were also conducted with key stakeholders in the health and welfare sectors. Global Positioning System (GPS) coordinates of all the health and social services within the city were obtained. We also conducted observations in the main regional hospital, the district health center and three level-one health facilities to assess physical accessibility as well as interactions between patients living with disabilities and health and social workers. Descriptive and multivariate analyses were performed using Sphinx software. Spatial data were used to make cartographic representations of the proximity to basic social services using Arc GIS software. Results Seventy-nine percent of survey respondents reported difficulty obtaining treatment. Key barriers to care included the high cost of care, as well as ill-treatment by health workers. Limited human resources and low levels of financial support, combined with logistical challenges were reported to hamper the success of social welfare initiatives that aim to facilitate access to health care for people with disabilities. Conclusion Our results suggest that initiatives to increase access to health care among people with disability in Saint-Louis have had limited impact. Study findings underscore the importance of strengthening social assistance schemes within the health system and the need for social workers and health workers to collaborate to improve access to health care for people with disabilities.

Background: There is increasing recognition worldwide that health policymaking process should be informed by best available evidence. The purpose of this study was to review the policy documents on maternal, newborn and child health (MNCH) in Nigeria to assess the extent evidence informed policymaking mechanism was employed in the policy formulation process. Methods: A comprehensive literature search of websites of the Federal Ministry of Health(FMOH) Nigeria and other related ministries and agencies for relevant health policy documents related to MNCH from year 2000 to 2015 was undertaken. The following terms were used interchangeably for the literature search: maternal, child, newborn, health, policy, strategy,framework, guidelines, Nigeria. Results: Of the 108 policy documents found, 19 (17.6%) of them fulfilled the study inclusion criteria. The policy documents focused on the major aspects of maternal health improvements in Nigeria such as reproductive health, anti-malaria treatment, development of adolescent and young people health, mid wives service scheme, prevention of mother to child transmission of HIV and family planning. All the policy documents indicated that a consultative process of collection of input involving multiple stakeholders was employed, but there was no rigorous scientific process of assessing, adapting, synthesizing and application of scientific evidence reported in the policy development process. Conclusion: It is recommended that future health policy development process on MNCH should follow evidence informed policy making process and clearly document the process of incorporating evidence in the policy development.

There is increasing evidence that women with the ability to exercise control over their sexual and reproductive lives have greater access to prompt prevention and treatment of maternal health disorders, resulting in a concomitant reduction in maternal morbidity and mortality. This study assessed the association between indices of women’s empowerment and utilization of skilled antenatal, intrapartum and postnatal maternity care in two rural Local Government Areas in Edo State, Nigeria. Data were taken from a household survey conducted in July and August 2017, and the study sample comprised 1245 ever-married women currently in a union who had given birth in the 5 years preceding the survey. A Gender Roles Framework guided the selection of independent women’s empowerment variables. Using hierarchical logistic regression, the likelihood of receiving all three levels of skilled maternal health care service (antenatal, intrapartum and postnatal) by women’s empowerment variables, grouped into resource, decision-making and influencer domains following the model of Anderson and Neuman, was assessed. Of the resource domain variables, respondent’s education and respondent’s participation in payment for their own health care positively predicted their use of all three levels of skilled maternal care, whereas their ownership of land negatively predicted this. Two decision-making domain variables were significantly associated with respondent’s use of all three levels of service: those who made decisions alone about major household purchases were twice as likely to use all three levels of services than when decisions were made by their partners or others, while respondent making decisions alone about what food to cook each day was a negative predictor. Of the influencer variables, religion and a large spousal education gap were strong positive factors, whereas living in a consensual union rather than being legally married was a negative factor. Although health system factors are important, interventions geared towards changing gender norms that constrain women’s empowerment are critical to achieving maternal health-related development goals in Nigeria. A composite strategy that targets all women’s empowerment indices is recommended, as Nigeria strives towards achieving SDG-3.

Introduction:among the most critical health systems components that requires strengthening to improve maternal, newborn and child health (MNCH) outcomes in Nigeria is the concept of equity. UNICEF has designed the equitable impact sensitive tool (EQUIST) to enable policymakers improve equity in MNCH and reduce disparities between the most marginalized mothers and young children and the better-off. Methods:using the latest available DHS data sets, we conducted EQUIST situation and scenario analysis of MNCH outcomes in Nigeria by sub-national categorization, wealth and by residence. We then identified the intervention package, the bottlenecks and strategies to address them and the number of deaths avertible. Results:EQUIST profile analysis showed that the number of under-five deaths was considerably higher among the poorest and rural population in Nigeria, and was highest in North-West region. Neonatal causes, malaria, pneumonia and diarrhoea were responsible for most of the under-five deaths. Highest maternal mortality was recorded in the North-West Nigeria. Ante-partum, intrapartum and postpartum haemorrhages and hypertensive disorder, were responsible for highest maternal deaths. EQUIST scenario analysis showed that an intervention package of insecticide treated net can avert more than 20,000 under-five deaths and delivery by skilled professionals can avert nearly 17,000 under-five deaths. While as many as 3,370 maternal deaths can be averted by deployment of skilled professionals. Conclusion:scaling up integrated packages of essential interventions across the continuum of care, addressing the human resource shortages in rural area and economic/social empowerment of women are policy recommendations that can improve MNCH outcomes in Nigeria.

International audience

Background: The introduction of implementation science into maternal, newborn and child health (MNCH) research has facilitated better methods to improve uptake of research findings into practices. With increase in implementation research related to MNCH world-wide, stronger scientific evidence are now available and have improved MNCH policies in many countries including Nigeria. The purpose of this study was to review MNCH implementation studies undertaken in Nigeria in order to understand the extent the evidence generated informed better policy. Methods: This study was a systematic review. A MEDLINE Entrez PubMed search was performed in August 2015 and implementation studies that investigated MNCH in Nigeria from 1966 to 2015 in relation to health policy were sought. Search key words included Nigeria, health policy, maternal, newborn, and child health. Only policy relevant studies that were implementation or intervention research which generated evidence to improve MNCH in Nigeria were eligible and were selected. Results: A total of 18 relevant studies that fulfilled the study inclusion criteria were identified out of 471 studies found. These studies generated high quality policy relevance evidence relating to task shifting, breastfeeding practices, maternal nutrition, childhood immunization, kangaroo mother care (KMC), prevention of maternal to child transmission of HIV, etc. These indicated significant improvements in maternal health outcomes in localities and health facilities where the studies were undertaken. Conclusion: There is a dire need for more implementation research related to MNCH in low income settings because the priority for improved MNCH outcome is not so much the development of new technologies but solving implementation issues, such as how to scale up and evaluate interventions within complex health systems.

Irene Agyepong and colleagues share experiences and ideas to strengthen capacity for health research co-production in low and middle income countries

The low rate of screening for hepatitis B virus (HBV) in pregnant women is a highrisk factor for its vertical transmission. The objectives of this study were: i) to screen pregnant women for HBV infection; ii) vaccinate all children from birth against HBV regardless their mother HBV status; and iii) evaluate after 7 months of birth the level of their AbHBs among babies who received HBV vaccine at birth. Serological markers of HBV (HBsAg, HBeAg, AbHBs, AbHBe, and AbHBc) were determined on venous blood samples from 237 pregnant women and their children using the Abon Biopharm Kit. One hundred and two (102) children received the three doses of the EUVAX B® vaccine respectively at birth, two months and four months of life. Seven months after delivery, venous blood samples were collected from mothers and their children. Antibodies against hepatitis B surface antigen (AbHBs) were measured in vaccinated children using the ELISA Kit AbHBs Quantitative EIA. DNA extraction was performed on samples from HBV-seropositive mothers and their children using the Ribo Virus (HBV Real-TM Qual) Kit and for Real Time PCR, the HBV Real-TM Qual Kit was used. Serological diagnosis in pregnant women revealed 22 (9.28%) hepatitis B surface antigen (HBsAg) positive samples of which 21 were positive for viral DNA by real-time PCR. Among the 22 HBsAg+ women, five (05) transmitted the virus to their children with a vertical transmission rate of 22.73%. A transmission rate of 23.81% (5/21) was found with the PCR method. Analysis of AbHBs levels revealed that 98.31% of the children had an average concentration of 218.07 ± 74.66 IU/L, which is well above the minimum threshold for protection (11 IU/L). This study has confirmed that vertical transmission of HBV is a reality in Burkina Faso and that vaccination at birth would significantly reduce this transmission.

Background The paper carries out a situational analysis to examine the production, dissemination and utilisation of reproductive and child health-related evidence to inform policy formulation in Ghana’s health sector. Methods The study used Wald’s model of knowledge production, transfer and utilisation as a conceptual model to collect relevant data via interviews and administration of questionnaire to a network of persons who either previously or currently hold policy-relevant positions in Ghana’s health sector. Additional data was also gathered through a scoping review of the knowledge transfer and research utilisation literature, existing reproductive and child health policies, protocols and guidelines and information available on the websites of relevant institutions in Ghana’s health sector. Results The findings of the study suggest that the health sector in Ghana has major strengths (strong knowledge production capacity, a positive environment for the promotion of evidence-informed policy) and opportunities (access to major donors who have the resources to fund good quality research and access to both local and international networks for collaborative research). What remains a challenge, however, is the absence of a robust institutional-wide mechanism for collating research needs and communicating these to researchers, communicating research findings in forms that are friendlier to policy-makers and the inability to incorporate funding for research into the budget of the health sector. Conclusion The study concludes, admonishing the Ministry of Health and its agencies to leverage on the existing strengths and opportunities to address the identified challenges.

Introduction:l’halitose, état morbide caractérisé par une mauvaise haleine, présente à la fois un aspect pathologique et social. Dans notre contexte, l’halitose pose de nombreux problèmes de prise en charge aux plans diagnostique et thérapeutique en pratique clinique. Le but de notre travail était d’étudier les aspects diagnostiques et thérapeutiques de l’halitose. Méthodes:il s’agit d’une étude transversale sur une année. Ont été inclus, les patients âgés de plus de 15 ans qui ont consulté pour halitose au centre hospitalier universitaire Yalgado Ouédraogo. Ont été exclus les patients avec mauvaise haleine mais consultant pour un autre motif. L’haleine a été évaluée par un praticien selon le test organoleptique de Rosenberg. Résultats:au total 35 patients ont été inclus pour un sex-ratio de 1,2. L’âge moyen était de 31,9 ans. Dans 57,1% des cas, la plainte venait du patient lui-même. La durée moyenne de l’halitose était de 4,3 ans. Dix-neuf patients avaient un score de Mel Rosenberg ≥ 2. La carie dentaire (07 cas), la sinusite (07 cas), l’infection àHelicobacter pylori(09 cas) et l’ulcère gastro-intestinal (10 cas) étaient associés à l’halitose. Le traitement a été étiologique dans 82.9% des cas avec une amélioration satisfaisante à deux semaines de l’ordre de 71,8%. Conclusion:l’halitose reste une pathologie peu étudiée et pose un problème de diagnostic positif, mais aussi étiologique dans notre contexte. Le rôle de l’odontologiste est crucial dans la recherche de la cause de l’halitose. Cependant, une prise en soins pluridisciplinaire de l’halitose permettra d’y apporter une réponse plus efficace.

The treatment of chronic hepatitis B (CHB) has increased significantly in recent years. In patients affected by HBeAg-negative CHB, it is necessary to distinguish the inactive carriers (low viral DNA 2000 IU/mL, normal ALT, histological lesions absent or minimal) who does not need treatment, and patients suffering from active CHB (DNA > 2000 IU/ml, high transaminases or fluctuating, significant fibrosis and/or necro-inflammatory activity > 1) who must be treated. The main purpose of treatment is to obtain a long-lasting viral suppression to improve the histological lesions and reduce the risk of evolution towards cirrhosis, liver failure and hepatocellular carcinoma (HCC). It about an indefinite treatment (unless HBsAg seroclearance) expensive and often inaccessible for the majority of our patients. Our study aimed to report the results of four years follow-up of HBeAg-negative patients treated by Nucleos(t)ide analogues (NAs) in Ouagadougou (Burkina Faso). It was a clinical observational study with 133 patients including 95 men; the average age was 41.2 years, completing the criteria of treatment. One hundred and twelve patients were treated by tenofovir (TDF), fourteen by lamivudine and seven co-infected HIV/HBV patients by Atripla&reg (combination TDF, Emtricitabine and Efavirenz). Virological and biochemical responses were respectively 100% and 94% after 4 years. The rate of HBsAg seroclearance was 1.5%. Twelve of fourteen patients (85.7%) had lamivudine resistance and no cases of resistance in the TDF and Atripla&reg groups. One co-infected patient developed HCC during treatment. Among patients treated by TDF, two cases of hypophosphatemia were noticed and no case of kidney failure. The treatment of CHB is certainly progressing; updated guidelines (EASL, AASLD) exist but should be adapted to the African context.

Background: Prevalence of Peptic Ulcer Disease (PUD) is decreasing in developed countries since the use of the treatments for eradication of Helicobacter pylori. Objectives: To revalue the sociodemographic, clinical and evolutionary aspects of the PUD among hospitalized patients in CHUYO. Methodology: This prospective study is related to 65 files of patients hospitalized in hepato-gastroenterology and general surgical services of the CHUYO between March 1st and August 31st, 2015. Results: Hospital utilization rate was 6.59%. The average age of patients was 40.6 years with extremes of 17 and 80 years. The sex ratio was 9.8. The location of the ulcer was 69.23% in stomach. A notion of taking aggressive gastrointestinal products was found in 62 patients (95.4%). The clinical picture was represented by diffuse abdominal pain (76.92%), peritoneal irritation syndrome (64.61%) and epigastric pain (56.92%), anemia (23.07%). Gastric perforations (64.61%) and gastrointestinal bleeding (12.30%) were the main complications. Consumption of non-steroidal anti-inflammatory drugs (NSAIDs) was found in 81.5% of cases. The management was medical and/or surgical with an overall mortality rate of 7.7%. Conclusion: The PUD rate decreased from 10.12% to 6.59% in 5 years. The complications are dominated by stomach perforations. They are relative increase and seem related to NSAIDs. Better management of this disease requires awareness of the population to self-medication.