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Syphilis continues to be a public health problem, and its diagnosis still has limitations. Molecular diagnosis provides an alternative for rapid and effective management. The objective is to determine the accuracy of tests in the molecular diagnosis of syphilis.We searched PubMed and Web of Sciences for articles related to molecular detection of syphilis from January 1, 2009, to December 31, 2019. The bivariate Reitsma model and the hierarchical receiver operating characteristic curve model were used to evaluate the diagnostic performance of molecular tests at a 95% confidence interval. A subgroup meta-analysis was performed to explore sources of heterogeneity.Forty-seven articles were identified for qualitative synthesis, of which 23 met the inclusion criteria for meta-analysis. The pooled sensitivities in conventional polymerase chain reaction (PCR) and real-time PCR were 77.52 (59.50-89.01) and 68.43 (54.96-79.39), respectively. The pooled specificities were 98.00 (90.73-99.59) and 98.84 (97.55-99.46), respectively. Ulcer samples had a better performance (sensitivity of 79.88 [69.00-87.62] and specificity of 98.58 [97.25-99.27]), and the major target genes were the polymerase A gene and tpp47 gene.Our work showed that conventional PCR was more widely used than real-time PCR in the diagnosis of syphilis, and ulcers were the best specimens. Sample types and target genes are factors that may influence the quality of the different tests. These results could provide evidence for further work in the direction of providing a more efficient diagnostic test.

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 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.

To evaluate the implementation of a screening strategy for the partners and children of pregnant women with hepatitis B virus (HBV) attending antenatal care.We identified pregnant women positive for HBV surface antigen (HBsAg) at antenatal consultation in Ouagadougou, Burkina Faso. At post-test counselling, women were advised to disclose their HBV status to partners and to encourage their partner and children to be screened for HBsAg. We used multivariable logistic regression to explore factors associated with uptake of screening and HBsAg positivity among family members.Of 1000 HBsAg-positive women, 436/1000 partners and 215/1281 children were screened. HBsAg was detected in 55 (12.6%) partners and 24 (11.2%) children. After adjusting for confounders, uptake of screening was higher in partners who were married, who attended the woman's first post-test consultation and to whom the woman had disclosed her HBV status. In children, HBsAg positivity was associated with being born before the introduction of infant hepatitis B vaccination in Burkina Faso (not significant in the multivariable analysis), having a mother positive for HBV e-antigen (adjusted OR: 8.57; 95% CI: 2.49-29.48) or having a mother with HBV DNA level ≥ 200 000 IU/mL (OR: 6.83; 95% CI: 1.61-29.00).In low-income countries, the antenatal consultation provides a cost-effective opportunity to identify HBV-infected household contacts and link them to care. Children born before the introduction of infant hepatitis B vaccination and whose mother has higher viral load or infectivity should be a priority for testing and linkage to care.Évaluer la mise en œuvre d'une stratégie de dépistage chez les partenaires et enfants de femmes enceintes porteuses du virus de l'hépatite B (VHB) faisant l'objet de soins prénatals.Nous avons identifié des femmes enceintes positives à l'antigène de surface du VHB (Ag HBs) dans le cadre de consultations prénatales à Ouagadougou, au Burkina Faso. Parallèlement aux conseils prodigués après le test, les femmes ont été incitées à informer leur partenaire de leur statut sérologique et à l'encourager, ainsi que leurs enfants, à se soumettre à un dépistage du Ag HBs. Nous avons employé un modèle de régression logistique multivariée pour examiner les facteurs associés à la participation au dépistage et à la positivité au Ag HBs parmi les membres d'une même famille.Pour 1000 femmes positives au Ag HBs, 436 partenaires sur 1000 et 215 enfants sur 1281 ont été dépistés. Le Ag HBs a été détecté chez 55 partenaires (12,6%) et 24 enfants (11,2%). Après ajustement en fonction des variables confusionnelles, la participation au dépistage s'est révélée plus élevée chez les partenaires mariés, ceux ayant assisté à la première consultation post-test de la femme et ceux à qui la femme avait dévoilé son statut sérologique. Chez les enfants, la positivité au Ag HBs était liée à une naissance avant l'instauration de la vaccination des nourrissons contre l'hépatite B au Burkina Faso (non significative dans l'analyse multivariée), au fait d'avoir une mère positive à l'antigène e du VHB (OR ajusté: 8,57; IC de 95%: 2,49–29,48) ou au fait d'avoir une mère dont le taux d'ADN du VHB ≥ 200 000 IU/mL (OR: 6,83; IC de 95%: 1,61–29,00).Dans les pays à revenu faible, la consultation prénatale offre une occasion peu coûteuse d'identifier les contacts infectés par le VHB au sein des foyers et de favoriser leur suivi médical. Les enfants nés avant l'instauration de la vaccination des nourrissons contre l'hépatite B ainsi que ceux dont la mère présentait une plus forte charge virale ou infectiosité doivent être prioritaires en matière de dépistage et de prise en charge.Evaluar la aplicación de una estrategia de cribado para las parejas y los hijos de las mujeres embarazadas con el virus de la hepatitisSe identificaron mujeres embarazadas positivas al antígeno de superficie del VHB (HBsAg) en la consulta prenatal en Ouagadougou, BurkinaDe 1000 mujeres positivas para el HBsAg, se analizaron 436/1000 parejas y 215/1281 hijos. Se detectó el HBsAg en 55 (12,6 %) parejas y 24 (11,2 %) hijos. Luego de ajustar por variables de confusión, la aceptación del cribado fue mayor en las parejas que estaban casadas, quienes asistieron a la primera consulta de la mujer posterior a la prueba y a quienes la mujer había revelado su estado de VHB. En los niños, la positividad del HBsAg se asoció con el hecho de haber nacido antes del inicio de la vacunación infantil contra la hepatitis B en Burkina Faso (no fue significativo en el análisis multivariable), tener una madre positiva al antígeno En los países de ingresos bajos, la consulta prenatal ofrece una oportunidad rentable para identificar a los contactos familiares infectados por el VHB y vincularlos a la atención. Los niños nacidos antes del inicio de la vacunación infantil contra la hepatitis B y cuyas madres tienen una carga viral o infectividad más elevada deberían ser objeto prioritario de pruebas de detección y vinculación a la atención sanitaria.الغرض تقييم تنفيذ استراتيجية فحص للشركاء وأطفال النساء الحوامل المصابات بفيروس الالتهاب الكبدي ب (HBV) الذين يحضرون الرعاية السابقة للولادة. الطريقة قمنا بتحديد النساء الحوامل المصابات بالمستضد السطحي للالتهاب الكبدي ب (HBsAg) في استشارة ما قبل الولادة في واغادوغو، بوركينا فاصو. في استشارة ما بعد الفحص، تم نصح النساء بالكشف عن حالة الإصابة بالالتهاب الكبدي ب لديهن لشركائهن، وتشجيع شركائهن وأطفالهن على الخضوع لفحص المستضد السطحي للالتهاب الكبدي ب. استخدمنا التحوف اللوجيستي متعدد المتغيرات لاستكشاف العوامل المرتبطة بالخضوع للفحص، والمستضد السطحي للالتهاب الكبدي ب بين أفراد الأسرة. النتائج من بين 1000 امرأة مصابة بالمستضد السطحي للالتهاب الكبدي ب، تم فحص 436/1000 شريك، و215/1281 طفلاً. تم اكتشاف المستضد السطحي للالتهاب الكبدي ب في 55 شريكًا (12.6%)، و24 طفلاً (11.2%). بعد التكيف مع المتغيرات المحيّرة، كان معدل الخضوع للفحص أعلى لدى الشركاء المتزوجين، والذين حضروا الاستشارة بعد أول فحص للمرأة، والذين كشفت لها المرأة عن حالة إصابتها بالتهاب الكبد ب. أما في الأطفال، فقد ارتبطت الإصابة بالمستضد السطحي للالتهاب الكبدي ب بالولادة قبل طرح لقاح التهاب الكبد ب للرضع في بوركينا فاصو (ليس مهمًا في التحليل متعدد المتغيرات)، مع وجود أم مصابة بمستضد التهاب الكبد ب الإلكتروني (نسبة الاحتمالات المعدلة: 8.57؛ ‏بفاصل ثقة 95%: 2.49 إلى 29.48)، أو وجود أم مصابة بالتهاب الكبد ب المستوى DNA ≥200000 وحدة دولية/مل (نسبة الاحتمالات: 6.83؛ ‏بفاصل ثقة 95%: 1.61 إلى 29.00). الاستنتاج في الدول ذات الدخل المنخفض، توفر استشارة ما قبل الولادة فرصة فعالة من حيث التكلفة لتحديد جهات الاتصال المنزلي المصابة بفيروس التهاب الكبد ب، وربطها بالرعاية. إن الأطفال المولودين قبل طرح لقاح التهاب الكبد ب للرضع، والذين كانت أمهاتهم تحملن حمولة فيروسية أعلى أو إصابة أقوى بالعدوى، يجب أن تكون لهم أولوية للاختبار والربط بالرعاية..评估对参加产前检查的孕妇的伴侣和子女进行乙肝病毒 (HBV) 筛查的实施情况。.我们在布基纳法索瓦加杜古的产前咨询中发现了 HBV 表面抗原 (HBsAg) 呈阳性的孕妇。在检测后的咨询中，我们建议这些妇女向其伴侣告知其 HBV 状况，并鼓励其伴侣和子女进行 HBsAg 筛查。我们使用多变量逻辑回归方法来探索家庭成员接受筛查且 HBsAg 呈阳性相关的因素。.在 1000 名 HBsAg 呈阳性的女性中，436/1000 名伴侣和 215/1281 名儿童接受了筛查。有 55 名（12.6%）伴侣和 24 名（11.2%）儿童检测为 HBsAg 呈阳性。在对混杂因素进行调整后，已婚妇女的伴侣、检测后参加首次询诊的妇女的伴侣以及向其伴侣告知 HBV 状况的妇女的伴侣进行筛查的比率更高。在儿童中，布基纳法索地区 HBsAg 呈阳性与婴儿在进行乙肝疫苗接种前出生（在多变量分析中不显著），母亲 HBV e 抗原呈阳性（调整后的 OR：8.57；95% 置信区间：2.49–29.48），或者母亲 HBV DNA 水平为³200,000 IU/毫升（OR：6.83；95% 置信区间：1.61–29.00）有关。.在低收入国家，产前咨询提供了经济有效的机会以确认感染 HBV 的家庭接触者并使其接受护理。对于母亲的病毒载量或传染性较高且在接受乙肝疫苗接种前出生的婴儿，应优先进行检测并使其接受护理。.Оценить осуществление стратегии скрининга для партнеров и детей беременных женщин, положительных по вирусу гепатита В (HBV), которые посещают учреждения дородовой помощи.Авторы выявляли беременных женщин, положительных по поверхностному антигену HBV (HBsAg), в женской консультации г. Уагадугу, Буркина-Фасо. На консультации после тестирования женщинам было рекомендовано сообщить о своем HBV-статусе партнеру и привести партнера и детей на скрининг по гепатиту В. Использовалась многопеременная логистическая регрессия для изучения факторов, ассоциируемых с тем, как члены семьи были охвачены скринингом и насколько часто выявлялась положительность по HBsAg.Для 1000 положительных по HBsAg женщин скрининг прошли 436/1000 партнеров и 215/1281 ребенок. HBsAg обнаружили у 55 партнеров (12,6%) и у 24 детей (11,2%). После внесения поправки на факторы, затрудняющие оценку причинно-следственной связи, оказалось, что охват скринингом был выше у женатых мужчин, которые пришли с супругами на первую консультацию после тестирования и которым жены рассказали о своем положительном статусе. У детей положительная реакция в тесте на HBsAg была связана с фактом рождения до начала кампании вакцинирования младенцев от гепатита В в Буркина-Фасо (незначимо для многопеременного анализа), с положительностью матери по е-антигену HBV (скорректированное ОШ: 8,57; 95%-й ДИ: 2,49–29,48) или с вирусной нагрузкой у матери по HBV ≥ 200 000 МЕ/мл (ОШ: 6,83; 95%-й ДИ: 1,61–29,00).В странах с низким уровнем дохода женская дородовая консультация позволяет экономичным образом выявить бытовые контакты инфицированных HBV лиц и дать им возможность получения медицинской помощи. Дети, родившиеся до начала кампании вакцинирования младенцев от гепатита В, и те, у кого матери имели более высокую вирусную нагрузку, должны проходить тестирование и приступать к лечению в первоочередном порядке.

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.

Introduction: Stroke is a major public health concern. It is a frequent pathology, 80% of which is of ischemic origin. Approximately 86% of all stroke deaths worldwide occur in low- and middle-income countries. The objective of this study was to investigate prognostic factors for in hospital lethality of stroke cases admitted in a public university hospital in Burkina Faso. Methods: This was a retrospective cohort study with a descriptive and analytical aim on adults admitted for a stroke confirmed by a brain scan at the Sourô Sanou University Teaching Hospital (CHUSS) of Bobo-Dioulasso over the period from January 1, 2009, to December 31, 2013. Results: The proportion of cases confirmed by the brain CT scan was 32% of all patients admitted for stroke in the CHUSS. The overall case fatality was 27.6%. This lethality was more pronounced in patients with hemorrhagic stroke (35.8%) compared to patients with ischemic stroke (22.4%). Median survival was higher in patients with ischemic stroke than those with hemorrhagic one (36 and 25 days, respectively) with a statistically significant difference (p value = 0.001). In multivariate analysis and hemorrhagic stroke (hazard ratio [HR]: 2.25; CI 95%: 1.41–3.61), an altered state of consciousness (HR: 1.90; CI 95%: 1.20–2.99) and the presence of central facial paralysis (HR: 1.67; CI 95%: 1.04–2.67) are factors that increased significantly the lethality. Conclusion: The study has identified three prognostic factors of lethality that are the hemorrhagic stroke type, the altered state of consciousness, and the central facial paralysis. Given the high case fatality, it is important to develop and implement effective prevention and management strategies adapted to the resources for the optimal control of stroke in Africa.

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.

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.

The use of evidence in decision-making and practice can be improved through diverse interventions, including policy dialogue. The Department of Family Health, Federal Ministry of Health of Nigeria initiated and organized the Nigeria Research Days (NRD), to serve as a platform for exchange between researchers and policymakers for improving maternal, new-born and child health. The study reports on the conceptualization, organization and lessons learned from the first edition. A cross-sectional study was designed to assess the effectiveness of a policy dialogue during the NRDs. Data were collected from the feasibility and workshop evaluation surveys. A descriptive analysis of data was performed. As a result, the Nigeria Research Days meets all the criteria for a successful policy dialogue. The participants positively rated the content and format of the meeting and made suggestions for improvement. They were willing to implement the recommendations of the final communiqué. The lessons learned from this first edition will be used to improve future editions.

Background Between 2008 and 2013, the West African Health Organisation (WAHO) conducted a series of post-graduate capacity building in research methodology in West Africa. This work evaluated the contribution of these trainings in terms of knowledge acquisition and influence of research and policy practice. Cooke’s conceptual framework for assessing research capacity building was used with three data sources to construct the indicators (training reports, research project implementation reports and WAHO research programme evaluation report). Results There was an improvement in the knowledge of the 84 participants between the pre- and post-test. At the end of the training, the learners developed 19 protocols, 14 of which were finalised, financed and implemented, reflecting the learners’ confidence to engage in research at the end of the training. The implementation of the protocols was conducted with the partnership and collaboration between the agents of the control programmes and the research centres. Some research results have been disseminated and a small portion used to strengthen the programmes. Conclusion This evaluation showed that the training was linked to practice with little publication and use of the results to improve the programmes. This regional capacity building programme should be maintained and strengthened by adding modules in data analysis, scientific communication and knowledge transfer.

The world continues to battle the ongoing COVID-19 pandemic. Whereas many countries are currently experiencing the second wave of the outbreak; Africa, despite being the last continent to be affected by the virus, has not experienced as much devastation as other continents. For example, West Africa, with a population of 367 million people, had confirmed 412 178 cases of COVID-19 with 5363 deaths as of 14 March 2021; compared with the USA which had recorded almost 30 million cases and 530 000 deaths, despite having a slightly smaller population (328 million). Several postulations have been made in an attempt to explain this phenomenon. One hypothesis is that African countries have leveraged on experiences from past epidemics to build resilience and response strategies which may be contributing to protecting the continent’s health systems from being overwhelmed. This practice paper from the West African Health Organization presents experience and data from the field on how countries in the region mobilised support to address the pandemic in the first year, leveraging on systems, infrastructure, capacities developed and experiences from the 2014 Ebola virus disease outbreak.

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.

Background Dengue’s emergence in West Africa was typified by the Burkina Faso outbreaks in 2016 and 2017, the nation’s largest to date. In both years, we undertook three-month surveys of Aedes populations in or near the capital city Ouagadougou, where the outbreaks were centered. Methodology In 1200LG (urban), Tabtenga (peri-urban) and Goundry (rural) localities, we collected indoor and outdoor resting mosquito adults, characterized larval habitats and containers producing pupae and reared immature stages to adulthood in the laboratory for identification. All mosquito adults were identified morphologically. Host species (from which bloodmeals were taken) were identified by PCR. Generalized mixed models were used to investigate relationships between adult or larval densities and multiple explanatory variables. Results From samples in 1,780 houses, adult Ae. aegypti were significantly more abundant in the two urban localities (Tabtenga and 1200 LG) in both years than in the rural site (Goundry), where Anopheles spp. were far more common. Results from adult collections indicated a highly exophilic and anthropophilic (>90% bloodmeals of human origin) vector population, but with a relatively high proportion of bloodfed females caught inside houses. Habitats producing most pupae were waste tires (37% of total pupae), animal troughs (44%) and large water barrels (30%). While Stegomyia indices were not reliable indicators of adult mosquito abundance, shared influences on adult and immature stage densities included rainfall and container water level, collection month and container type/purpose. Spatial analysis showed autocorrelation of densities, with a partial overlap in adult and immature stage hotspots. Conclusion Results provide an evidence base for the selection of appropriate vector control methods to minimize the risk, frequency and magnitude of future outbreaks in Ouagadougou. An integrated strategy combining community-driven practices, waste disposal and insecticide-based interventions is proposed. The prospects for developing a regional approach to arbovirus control in West Africa or across Africa are discussed.

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.

Host responses to infection with the malaria parasite Plasmodium falciparum vary among individuals for reasons that are poorly understood. Here we reveal metabolic perturbations as a consequence of malaria infection in children and identify an immunosuppressive role of endogenous steroid production in the context of P. falciparum infection. We perform metabolomics on matched samples from children from two ethnic groups in West Africa, before and after infection with seasonal malaria. Analysing 306 global metabolomes, we identify 92 parasitaemia-associated metabolites with impact on the host adaptive immune response. Integrative metabolomic and transcriptomic analyses, and causal mediation and moderation analyses, reveal an infection-driven immunosuppressive role of parasitaemia-associated pregnenolone steroids on lymphocyte function and the expression of key immunoregulatory lymphocyte genes in the Gouin ethnic group. In children from the less malaria-susceptible Fulani ethnic group, we observe opposing responses following infection, consistent with the immunosuppressive role of endogenous steroids in malaria. These findings advance our understanding of P. falciparum pathogenesis in humans and identify potential new targets for antimalarial therapeutic interventions.

The COVID-19 pandemic required policy makers to make urgent decisions to limit the spread of the disease. International and regional health bodies and research institutions have a role in supporting decision makers and health actors in providing accurate and timely research evidence and guidance in decision making and practice. In ECOWAS region, the West African Health Organisation (WAHO) has experience in promoting evidence use decision making and practice as part of its role as Health Policy and Research Organisation. Promoting the use of evidence to influence policy and practice is possible through various approaches including training, the development of guides and policy briefs, the synthesis and sharing of evidence, and the organisation of meetings to share experiences. In the context of the COVID-19 pandemic, WAHO has deployed several approaches to bring the use of evidence to decision-makers and stakeholders to influence policy and practice. To improve practices, WAHO has organized regional training workshops on laboratory diagnostic, surveillance and simulation exercises of outbreak response for key actors, as well as webinars on different aspects of COVID-19 pandemic surveillance, coordination and management. In addition, a synthesis of the most recent evidence and epidemiologic models were developed to enlighten decision makers in selecting and implementation response interventions.

Background The Economic Commission of the West African States (ECOWAS), through her specialised health Institution, the West African Health Organization (WAHO) is supporting Members States to improve health outcomes in West Africa. There is a global recognition that evidence-based health policies are vital towards achieving continued improvement in health outcomes. The need to have a tool that will provide systematic guide on the use of evidence in policymaking necessitated the production of the evidence-based policy-making (EBPM) Guidance. Methods Google search was performed to identify existing guidance on EBPM. Lessons were drawn from the review of identified guidance documents. Consultation, interaction and interviews were held with policymakers from the 15 West African countries during WAHO organized regional meetings in Senegal, Nigeria, and Burkina Faso. The purpose was to elicit their views on the strategies to promote the use of evidence in policymaking to be included in the EBPM Guidance. A regional Guidance Validation Meeting for West African policymakers was thereafter convened by WAHO to review findings from review of existing guidance documents and validate the EBPM Guidance. Results Out of the 250 publications screened, six publications fulfilled the study inclusion criteria and were reviewed. Among the important issues highlighted include: what evidence informed decision-making is; different types of research methods, designs and approaches, and how to judge the quality of research. The identified main target end users of the EBPM Guidance are policy/decision makers in the West African sub-region, at local, sub-national, national and regional levels. Among the key recommendations included in the EBPM Guidance include: properly defining/refining policy problem; reviewing contextual issues; initiating policy priority setting; considering political acceptability of policy; commissioning research; use of rapid response services, use of policy advisory/technical/steering committees; and use of policy briefs and policy dialogue. Conclusion The EBPM Guidance is one of the emerging tools that can enhance the understanding of evidence to policy process. The strategies to facilitate the use of evidence in policymaking outlined in the Guidance, can be adapted to local context, and incorporated validated approaches that can be used to promote evidence-to-policy-to-practice process in West Africa.

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

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.

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.

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 Since the Commission on Health Research for Development (COHRED) published its flagship report, more attention has been focused on strengthening national health research systems (NHRS). This paper evaluates the contribution of a regional project that used a participatory approach to strengthen NHRS in four post-conflict West African countries – Guinea-Bissau, Liberia, Sierra Leone and Mali. Methods The data from the situation analysis conducted at the start of the project was compared to data from the project’s final evaluation, using a hybrid conceptual framework built around four key areas identified through the analysis of existing frameworks. The four areas are governance and management, capacities, funding, and dissemination/use of research findings. Results The project helped improve the countries’ governance and management mechanisms without strengthening the entire NHRS. In the four countries, at least one policy, plan or research agenda was developed. One country put in place a national health research ethics committee, while all four countries could adopt a research information management system. The participatory approach and support from the West African Health Organisation and COHRED were all determining factors. Conclusion The lessons learned from this project show that the fragile context of these countries requires long-term engagement and that support from a regional institution is needed to address existing challenges and successfully strengthen the entire NHRS.

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.

Patients must receive high-quality and safe health care. Peripheral venous catheterization (PVC) exposes patients to complications, mostly phlebitis. This study investigated the incidence of phlebitis and its PVC-related risk factors among patients in the medical and surgical emergency departments of the Souro Sanou University Hospital Center (CHUSS) in Bobo Dioulasso, Burkina Faso. This prospective cross-sectional study took place from July 4 to August 3, 2018. The incidence of PVC-related phlebitis was calculated and its risk factors were identified by logistic regression, with SPSS software version 20 (entry option), with significance set at 5%. The 511 patients included in the study had a mean age of 44.7 (95% CI 43.1-46.3) years. The mean duration of PVC was 3.1 days. Of these patients, 149 developed phlebitis, for an incidence of 29.2% (95% CI 25.0%-33.0%). There was no statistically significant difference between the two emergency (medical and surgical) departments. Second-degree phlebitis accounted for slightly more than half the cases (53%). Risk factors associated with the occurrence of PVC-related phlebitis were female gender, catheterization duration more than 3 days, small size of the catheter, and the healthcare worker's failure to use friction in washing with a hydroalcoholic hand solution. Preventive measures are essential.

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

Community Health Workers (CHWs) were promoted in Benin to improve maternal and child health care (MCH). To improve community health workers' performance, a Quality Improvement Team (QIT) was set up to reinforce CHW capacities. The objective of this work is to present an assessment of QIT's contribution to CHW's performance and MCH coverage in the municipality of Savè.The design of the study includes a pre- and post- analysis. Data were extracted from CHWs' activity reports and routine health information systems from 2011 to 2014 in 22 health facilities. Individual in-depth interviews were also performed with some key informants. The performance of CHW and the MCH indicators were determined according to the National Community Health Policy.The QIT improved Community Health Workers' performance and maternal and child health indicators in Savè. Educational sessions, skilled delivery care coverage, percentage of newborn seen over twice a week, percentage of children treated according national standards, percentage of children fully immunized, percentage of women using family planning methods were increased.The establishment of QIT improved CHW's performance and the use of maternal and child health services in Savè. This strategy could be useful for community-based surveillance.

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

While significant advances have been made in understanding Plasmodium falciparum gametocyte biology and its relationship with malaria parasite transmission, the gametocyte sex ratio contribution to this process still remains a relevant research question. The present review discusses the biology of sex determination in P. falciparum, the underlying host and parasite factors, the sex specific susceptibility to drugs, the effect of sex ratio dynamics on malaria parasite transmission and the development of gametocyte sex specific diagnosis tools. Despite the inherent differences across several studies and approaches, the emerging picture highlights a potentially relevant contribution of the P. falciparum gametocyte sex ratio in the modulation of malaria parasite transmission. The increasing availability of molecular methods to measure gametocyte sex ratio will enable evaluation of important parameters, such as the impact of drug treatment on gametocyte sex ratio in vitro and in vivo as well as the changes of gametocyte sex ratios in natural infections, key steps towards elucidating how these parameters affect parasite infectiousness to the mosquito vectors.

Background United Nations Children’s Fund (UNICEF) designed EQUitable Impact Sensitive Tool (EQUIST) to enable global health community address the issue of equity in maternal, newborn and child health (MNCH) and minimize health disparities between the most marginalized population and the better-off. The purpose of this study was to use EQUIST to provide reliable evidence, based on demographic health surveys (DHS) on cost–effectiveness and equitable impact of interventions that can be implemented to improve MNCH outcomes in Benin, Burkina Faso, Ghana, Mali, Nigeria and Senegal. Methods Using the latest available DHS data sets, we conducted EQUIST Situation Analysis of maternal and child health outcomes in the six countries by sub-national categorization, wealth and by residence. We then identified the poorest population class within each country with the highest maternal and child mortality and performed EQUIST Scenario Analysis of this population to identify intervention package, bottlenecks and strategies to address them, cost of the intervention and strategies as well as the number of deaths avertible. Results Under-five mortality was highest in Atlantique (Benin), Sahel (Burkina Faso), Northern (Ghana), Sikasso (Mali), North-West (Nigeria), and Diourbel (Senegal). The number of under-five deaths was considerably higher among the poorest and rural population. Neonatal causes, malaria, pneumonia and diarrhoea were responsible for most of the under-five deaths. Ante-partum, intra-partum, and post-partum haemorrhages, and hypertensive disorder, were responsible for highest maternal deaths. The national average for improved water source was highest in Ghana (82%). Insecticide treated nets ownership percentage national average was highest in Benin (73%). Delivery by skilled professional is capable of averting the highest number of under-five and maternal deaths in the six countries. Redeployment/relocation of existing staff was the strategy with highest costs in Burkina Faso, Nigeria and Senegal. Ghana recorded the least cost per capita ($0.39) while the highest cost per capita was recorded in Benin ($4.0). Conclusion EQUIST highlights the most vulnerable and deprived children and women needing urgent health interventions as a matter of priority. It will continue to serve as a tool for maximizing the number of lives saved; decreasing health disparities and improving overall cost effectiveness. Electronic supplementary material The online version of this article (10.1186/s12992-018-0422-1) contains supplementary material, which is available to authorized users.

Maternal mortality remains high in Burkina Faso despite numerous interventions designed to reduce this mortality. It therefore appeared important to analyse attempts to lower maternal mortality in Burkina Faso over the last fifteen years in order to identify the strengths and weaknesses and to improve the national programme.Analysis according to the ?three delays? model using the strengths, weaknesses, opportunities and threats method was conducted. Data sources were scientific publications as well as national gray literature.Many studies have identified factors predisposing to the first delay, but very few effective interventions covering all of the country have been conducted to reduce this delay. The development of infrastructures, a rapid transfer system and integration of the cost of transfer into the cost of delivery subsidy were interventions designed to reduce the second delay. The promotion of blood transfusion, emergency obstetric and neonatal care, an increased number of trained health professionals, delegation of tasks, subsidy and then free delivery costs were interventions designed to reduce the third delay. The analysis globally demonstrated that interventions on the first delay were insufficient and rarely implemented and weaknesses were observed in relation to the intervention designed to act on the last two delays.Due to their inadequacy and poor quality, the interventions failed to significantly reduce the three delays. Priority needs to be given to new interventions, especially community-based interventions, and reinforcement of the quality of care by health training.

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.

Background: Throughout the world, there is increasing awareness and acknowledgement of the value of research evidence in the development of effective health policy and in quality health care practice and administration. Among the major challenges associated with the lack of uptake of research evidence into policy and practice in Nigeria is the capacity constraints of policymakers to use research evidence in policy making. Objective: To assess the capacity of maternal and child health policy makers to acquire, access, adapt and apply available research evidence. Methods: This cross-sectional quantitative survey was conducted at a national maternal, newborn and child health (MNCH) stakeholders’ engagement event. An evidence to policy self-assessment questionnaire was used to assess the capacity of forty MNCH policy makers to acquire, assess, adapt and apply research evidence for policy making. Results: Low mean ratings were observed ranging from 2.68-3.53 on a scale of 5 for knowledge about initiating/conducting research and capacity to assess authenticity, validity, reliability, relevance and applicability of research evidence and for organizational capacity for promoting and using of research for policy making. Conclusion: There is need to institute policy makers’ capacity development programmes to improve evidence-informed policymaking. Keywords: Policy maker; research; evidence; capacity; Nigeria

The financing of national research ethics committees for health is a decisive factor in their proper functioning and independence. Little information is available concerning the funding of these committees in West Africa.To analyze the funding of national research ethic committees for health in the Member States of the Economic Community of West African States.A review of the documents from two regional workshops with the participation of the representatives of the national ethics committees of each ECOWAS Member State was carried out. These workshops enabled the collection and validation of data on the status of national ethics committees. These data were used to conduct a descriptive analysis of the funding sources of the committees.Three sources of funding for national ethics committees were identified. The first source was the support of the state or a national structure. The second source was the fee for reviewing the submitted protocols and the last source was the support of external donors. The collection of audit fees and the support of external donors were the main sources of funding for most of the national committees. In only one state, there were no fees for review of submitted protocols and all the ethic committee member were motivated by the government.In order to ensure the autonomy and independence of the national committees, state support for the funding of these committees should improve. The establishment of a regional network and its recognition by the Assembly of Ministers of Health of ECOWAS allowed for advocacy by WAHO, which should help achieve better results in the future.

Objective: The objective of this study was to evaluate the trends, mortality rates and places of caesarean section by level of care in Burkina Faso.Method: A retrospective study was conducted using data from Burkina Faso Ministry of Health annual health statistics and public hospital reports from 2000 to 2014. Linear regression was used to analyse caesarean section trends and mortality rates in District Hospitals (HD), Regional Hospitals (CHR) and University Hospitals (CHU).Results: From 2000 to 2014, the number of caesarean sections performed in Burkina Faso public hospitals increased almost tenfold from approximately 2,365 to 19,081, corresponding to a growth of the caesarean section rate from 0.5 to 2 per 100 deliveries. This growth was linear. Between 2000 and 2006, University Hospitals performed most of these caesarean sections. Starting from 2007, the majority of caesarean sections were performed by HD. The proportion of caesarean sections performed in Regional Hospitals remained almost constant, although the number of caesarean sections increased threefold. In 2014, HD performed 52% of caesarean sections, followed by University Hospitals (25%) and Regional Hospitals (23%). Analysis of mortality rates following caesarean section showed upward and downward trends, oscillating between 1 to 2% before 2008 and 0.15% in 2014. This same mortality trend was observed in each type of hospital.Conclusion: The results show an increase of better quality caesarean section rates, performed closer to the woman’s home in Burkina Faso. The health care services decentralization policy and quality of care approaches have helped to achieve these results.

Introduction: Condom use is recognized by the WHO as the only contraceptive that protects against both HIV / AIDS and unwanted pregnancies. But to be effective, condoms must be used consistently and correctly. The objective of this study was to assess young people’s skills in male condom used, to identify the challenges faced by them when using condoms to better guide future interventions.Methods: Based on a two-level sampling representing 94,947 households within Bobo-Dioulasso municipality, 573 youth aged between 15 and 24 were interviewed. This data collection was conducted from December 2014 to January 2015 in the three districts of the municipality. A questionnaire was used to assess the knowledge and attitudes of the youth.Results: Only 24% of surveyed know how to accurately use condoms despite their knowledge of condom effectiveness and although some of them are exposed to awareness-raising and information campaigns. Indeed, various handling errors and usage problems (breakage, slippage, leakage and loss of erection) had been identified during the oral demonstration performed by the surveyed. The older youth and with the highest level of education were the most likely to demonstrate increased skills in condom use. Moreover, girls were less competent than boys in terms of condom use.Conclusion: It is important to increase awareness-raising and information campaigns, adapting the content to the real needs of young people so as to transmit the skills required for effective prevention particularly in regard to condom use.

Background Aware of the advantages of a project steering committee (SC) in terms of influencing the development of evidence-based health policies, the West African Health Organisation (WAHO) encouraged and supported the creation of such SCs around four research projects in four countries (Burkina Faso, Nigeria, Senegal and Sierra Leone). This study was conducted to describe the process that was used to establish these committees and its findings aim to assist other stakeholders in initiating this type of process. Methods This is a cross-sectional, qualitative study of the initiative’s four projects. In addition to a literature review and a review of the project documents, an interview guide was used to collect data from 14 members of the SCs, research teams, WAHO and the International Development Research Center. The respondents were selected with a view to reaching data saturation. The technique of thematic analysis by simple categorisation was used. Results To set up the SCs, a research team in each country worked with health authorities to identify potential members, organise meetings with these members and sought the authorities’ approval to formalise the SCs. The SCs’ mission was to provide technical assistance to the researchers during the implementation phase and to facilitate the transfer and use of the findings. The ‘doing by learning’ approach used by each research team, combined with WAHO’s catalytic role with each country’s Ministry of Health, helped each SC manage its contextual difficulties and function effectively. Conclusion The involvement of technical and financial partners motivated the researchers and ministries of health, who, in turn, motivated other actors to volunteer on the SCs. The ‘doing by learning’ approach made it possible to develop strategies adapted to each context to create, facilitate and operate each SC and manage its difficulties. To reproduce such an experience, a strong understanding of the local context and the involvement of strong partners are required.

Background Despite improvements over time, West Africa lags behind global as well as sub-Saharan averages in its maternal, newborn and child health (MNCH) outcomes. This is despite the availability of an increasing body of knowledge on interventions that improve such outcomes. Beyond our knowledge of what interventions work, insights are needed on others factors that facilitate or inhibit MNCH outcome improvement. This study aimed to explore health system factors conducive or limiting to MNCH policy and programme implementation and outcomes in West Africa, and how and why they work in context. Methods We conducted a mixed methods multi-country case study focusing predominantly, but not exclusively, on the six West African countries (Burkina Faso, Benin, Mali, Senegal, Nigeria and Ghana) of the Innovating for Maternal and Child Health in Africa initiative. Data collection involved non-exhaustive review of grey and published literature, and 48 key informant interviews. We validated our findings and conclusions at two separate multi-stakeholder meetings organised by the West African Health Organization. To guide our data collection and analysis, we developed a unique theoretical framework of the link between health systems and MNCH, in which we conceptualised health systems as the foundations, pillars and roofing of a shelter for MNCH, and context as the ground on which the foundation is laid. Results A multitude of MNCH policies and interventions were being piloted, researched or implemented at scale in the sub-region, most of which faced multiple interacting conducive and limiting health system factors to effective implementation, as well as contextual challenges. Context acted through its effect on health system factors as well as on the social determinants of health. Conclusions To accelerate and sustain improvements in MNCH outcomes in West Africa, an integrated approach to research and practice of simultaneously addressing health systems and contextual factors alongside MNCH service delivery interventions is needed. This requires multi-level, multi-sectoral and multi-stakeholder engagement approaches that span current geographical, language, research and practice community boundaries in West Africa, and effectively link the efforts of actors interested in health systems strengthening with those of actors interested in MNCH outcome improvement.

International audience; As a result of the high disease burden and advent of effective preventive and therapeutic measures for viral hepatitis, the UN has included its control in its Sustainable Development Goals, and the WHO has developed a viral hepatitis elimination strategy. Only with a genuine understanding of viral hepatitis can people living with these infections fully commit to a treatment program. New WHO guidelines on HBV/HCV testing published in Februay 2017, however, make little mention of communicating with populations about chronic viral hepatitis. Our recent anthropological research investigating local understandings of hepatitis B in five sub-Saharan African countries (The Gambia, Burkina Faso, Côte d’Ivoire, Central African Republic and Madagascar) underscore the communication challenges that treatment programmes must tackle: a lack of knowledge about hepatitis B; complex local terms describing visible symptoms of liver disease; and the inappropriate use of other pathologies to explain hepatitis B.

Background In Nigeria, interest in the evidence-to-policy process is gaining momentum among policymakers involved in maternal, newborn and child health (MNCH). However, numerous gaps exist among policymakers on use of research evidence in policymaking. The objective of this study was to assess the perception of MNCH policymakers regarding their needs and the barriers and facilitators to use of research evidence in policymaking in Nigeria. Methods The study design was a cross-sectional assessment of perceptions undertaken during a national MNCH stakeholders’ engagement event convened in Abuja, Nigeria. A questionnaire designed to assess participants’ perceptions was administered in person. Group consultations were also held, which centred on policymakers’ evidence-to-policy needs to enhance the use of evidence in policymaking. Results A total of 40 participants completed the questionnaire and participated in the group consultations. According to the respondents, the main barriers to evidence use in MNCH policymaking include inadequate capacity of organisations to conduct policy-relevant research; inadequate budgetary allocation for policy-relevant research; policymakers’ indifference to research evidence; poor dissemination of research evidence to policymakers; and lack of interaction fora between researchers and policymakers. The main facilitators of use of research evidence for policymaking in MNCH, as perceived by the respondents, include capacity building for policymakers on use of research evidence in policy formulation; appropriate dissemination of research findings to relevant stakeholders; involving policymakers in research design and execution; and allowing policymakers’ needs to drive research. The main ways identified to promote policymakers’ use of evidence for policymaking included improving policymakers’ skills in information and communication technology, data use, analysis, communication and advocacy. Conclusion To improve the use of research evidence in policymaking in Nigeria, there is a need to establish mechanisms that will facilitate the movement from evidence to policy and address the needs identified by policymakers. It is also imperative to improve organisational initiatives that facilitate use of research evidence for policymaking. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0217-5) contains supplementary material, which is available to authorized users.

Introduction Pour combler la pénurie en sages-femmes (SF) dans le district sanitaire de Tougan au Burkina Faso, il a été conçu une stratégie de décentralisation de l'offre des soins obstétricaux d'urgence basée sur des interventions ponctuelles de prise en charge des complications obstétricales au niveau des centres de santé (CS) en milieu rural par des SF. La présente étude a eu pour objectif de décrire cette expérience et d'analyser ses résultats. Méthodes Il s'agit d'une étude intervention de type transversal analytique basée sur une revue des données routinières de l'ensemble des parturientes prises en charge de 2013 à 2015. La collecte des données s'est déroulée du 5 au 20 janvier 2016. Un test Chi2, des rapports de cotes (OR) et leurs intervalles de confiance à 95% ont été calculés. Résultats Au total 416 parturientes présentant des complications obstétricales ont été prises en charge par les SF de zone. L'âge moyen des parturientes était de 26.4 ans. La distance médiane parcourue pour prendre en charge les parturientes était de quinze km pour un délai moyen d'intervention de 21.1 minutes (déviation standard = 7.13 minutes). Les dystocies représentaient la moitié (50.7%, IC95% = 45.8-55.6) des complications prises en charge suivies des hémorragies (26.4%, IC95% = 22.3%-31.0%). Plus de 77% des interventions avaient abouti à la résolution locale des complications obstétricales. Enfin, le résultat de l'intervention était fonction de la pathologie prise en charge (OR = 5.88; p < 0.001). Conclusion Cette stratégie a permis d'apporter une réplique à l'absence de SF dans les CS périphériques du district sanitaire de Tougan. Dans ce contexte particulier, cette intervention pourrait apporter une solution alternative au manque de ressources humaines en santé en milieu rural.

to analyze the epidemiologic and clinical aspects of intestinal parasitosis in prisoners at the prison in Ouagadougou (MACO).cross-sectional study from November 2009 to January 2010, including a survey to determine the risk factors and clinical signs of intestinal parasitosis. It also included laboratory examination of feces samples from 403 prisoners, by direct analysis, the Willis and Ritchie methods, and a scotch test for oxyuris (Enterobios vermicularis).The global prevalence of intestinal parasitosis was 71.5%. There was a link between parasitism and the prison section. Amebae were the most frequent parasites (66.7%), with high prevalence of Entamœba coli (55.6%). They were followed by flagellata (16.6%), mainly Trichomonas intestinalis (9.2%). Helminths were less frequent (7.4%). Most subjects with parasites were symptomatic (diarrhea or constipation) (p = 10(-4)).our results highlight the need to improve sanitation at the prison and provide hygiene education for the prison population.

After widespread use and misuse of antimalarial drugs led to the emergence of resistance, new guidelines for malaria treatment with artemisinine-based combination therapy (ACT) were introduced in Burkina Faso in 2005. To describe the management (drug therapy and other practices) of patients with suspected malaria before their admission to the district hospital of Dô, seven years later. This cross-sectional study was conducted during admission to the district hospital, during the low season for malaria, from December 2010 to May 2011. It included all patients aged 6 months or older diagnosed with suspected malaria according to the criteria of the national malaria control program, excluding those with severe comorbidities. The study included 476 suspected cases, 422 (88.7%) uncomplicated and 54 (11.3%) complicated. They accounted for 7.9% of all admissions. Their mean age was 14.4 years, and 35.3% (n = 168) were younger than 5 years. Only 23 (4.8%) had first consulted in a primary health care facility; 346 (72.7%) had used initial self-medication (or, more precisely in some cases, parental administration of medication without medical consultation). Overall, 435 (91.4%) came directly to the district hospital, 331 (76.1%) of them after self-medication; 10 (2.1%) had first consulted a traditional healer. The practice of self-medication did not differ according to age, gender, or complications (p0.05). The drugs used for self-medication were mainly antipyretics (94.5%) and antimalarials (16.8%); the latter included ACT (39.6%), quinine (19.0%), and non-recommended antimalarial agents (41.4%). During the malaria low season, the treatment itinerary of suspected malaria cases is marked by equal use of ACT and non-recommended antimalarials for self-medication and minimal use of the primary level of care. A study underway of this management and these itineraries during the epidemic season may provide more data about use of ACT, the last armament against malaria in drug-resistant areas such as Burkina Faso.

Introduction: Despite health education efforts, young people are still faced with major health problems. The objective of this study was to assess the knowledge and attitude regarding HIV prevention and unwanted pregnancy among young people in Bobo-Dioulasso, Burkina Faso. Methods: Based on two-level sampling, representing 94,947 households in the Bobo-Dioulasso municipality, 573 young people between the ages of 15 and 24 years were interviewed. This data collection was conducted from September 2014 to January 2015 in the three districts of the municipality. A questionnaire was used to assess the knowledge and attitudes of young people. Results: The interviewees had a poor knowledge about HIV transmission and prevention and contraception Very few young people (9%) had complete knowledge about the modes of transmission and 5% had no knowledge. Persistent misperceptions about the effectiveness of condoms (25%) and contraception (32%) did not prevent some young people from using them (79% used condoms and 46% used contraceptives). Knowledge and attitudes of young people regarding HIV and contraception varied according to age, sex, education level and type of parental supervision. Conclusion: A significant proportion of young people still has incomplete knowledge about HIV/AIDS and contraception. Actions designed to reinforce the knowledge of young people are of paramount importance. The capacities of parents and healthcare providers also need to be reinforced to improve the quality of relationship with young people.