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BackgroundAll prevention efforts currently being implemented for COVID-19 are aimed at reducing the burden on strained health systems and human resources. There has been little research conducted to understand how SARS-CoV-2 has affected health care systems and professionals in terms of their work. Finding effective ways to share the knowledge and insight between countries, including lessons learned, is paramount to the international containment and management of the COVID-19 pandemic. The aim of this project is to compare the pandemic response to COVID-19 in Brazil, Canada, China, France, Japan, and Mali. This comparison will be used to identify strengths and weaknesses in the response, including challenges for health professionals and health systems.MethodsWe will use a multiple case study approach with multiple levels of nested analysis. We have chosen these countries as they represent different continents and different stages of the pandemic. We will focus on several major hospitals and two public health interventions (contact tracing and testing). It will employ a multidisciplinary research approach that will use qualitative data through observations, document analysis, and interviews, as well as quantitative data based on disease surveillance data and other publicly available data. Given that the methodological approaches of the project will be largely qualitative, the ethical risks are minimal. For the quantitative component, the data being used will be made publicly available.DiscussionWe will deliver lessons learned based on a rigorous process and on strong evidence to enable operational-level insight for national and international stakeholders.

International audience; The indigents have long been excluded from health policies in sub-Saharan Africa. Despite recent efforts by some countries to allow them free access to health services, they face a multitude of non-financial barriers that prevent them from accessing care. Interventions to address the multiple patient-level barriers to care, such as patient navigation interventions, could help reverse this trend. However, our scoping review showed that no navigation interventions in low-income countries targeted the indigents. The objective of this qualitative study is, therefore, to go beyond the lack of evidence and discuss relevant approaches to act in favor of health care equity. We interviewed 22 public health experts with the objective of finding out which actions related to patient navigation programs (identified in the scoping review for other target groups) could be relevant and/or adapted for the indigents. For each ability to access care described by Levesque and colleagues, we were thus able to list the potential opportunities and challenges of implementing each type of action for the indigents in sub-Saharan Africa. Overall, the experts all felt that patient navigation programs were very relevant to implement for the indigents. They emphasized the need for personalized follow-up and for holistic actions to consider the whole context of the situation of indigence. The recommendations made by the experts are valuable in guiding political decision-making, while leaving room for adaptation of the proposed guidelines according to different contexts.

In France, cervical cancer screening based on cervical smear has a participation rate of around 60%. New screening strategies are encouraged to increase the participation of under-screened women, including vaginal self-sampling with high-risk human papillomavirus (HR-HPV) testing. This study was based on the distribution of an anonymous self-administered questionnaire to assess the acceptability of vaginal self-sampling with HR-HPV testing by women aged 25 to 65 years in two French Departments of the South of France, Aude, and Hérault, showing low participation in cervical cancer screening. Factors influencing this acceptability were also analyzed. From May to July 2017, 349 completed questionnaires were collected. Women declared high acceptability for vaginal self-sampling (81%) preferably at home (82.6%). Acceptability was statistically higher in the Department of Herault (

To assess the effect of a free healthcare policy for children under five years old implemented in Burkina Faso since April 2016, on the use of health care of non-malarial febrile illnesses (NMFI).To assess the immediate and long-term effect of the free healthcare policy in place, we conducted an interrupted time series analysis of routinely collected data on febrile illnesses from three urban primary health centres of Ouagadougou between 1 January 2015 and 31 December 2016.Of the 39 046 febrile cases reported in the study period, 17 017 NMFI were included in the study. Compared to the period before the intervention, we observed an immediate, non-statistically significant increase of 7% in the number of NMFI (IRR = 1.07; 95% CI = 0.75, 1.51). Compared to the trend that would have been expected in absence of the intervention, the results showed a small but sustained increase of 6% in the trend of monthly number of NMFI during the intervention period (IRR = 1.06; 95%CI = 1.01, 1.12).Our study highlighted an increase in the uptake of healthcare services, specifically for NMFI by children under five years of age, after the implementation of a free care policy. This analysis contributes to informing decision makers on the need to strengthen the capacities of healthcare centres and to anticipate the challenges of the sustainability of this policy.Evaluer l'effet d'une politique de gratuité des soins pour les enfants de moins de cinq ans mise en œuvre au Burkina Faso depuis avril 2016, sur l'utilisation des soins de santé des maladies fébriles non paludiques (MFNP). MÉTHODES: Pour évaluer l'effet immédiat et à long terme de la politique de gratuité des soins en place, nous avons mené une analyse des données de séries chronologiques interrompues collectées en routine sur les maladies fébriles dans trois centres de santé primaires urbains de Ouagadougou entre le 1Notre étude a mis en évidence une augmentation de l'utilisation des services de santé, en particulier pour les MFNP pour les enfants de moins de cinq ans, après la mise en œuvre d'une politique de gratuité des soins. Cette analyse contribue à informer les décideurs sur la nécessité de renforcer les capacités des centres de santé et d'anticiper les enjeux de la pérennité de cette politique.

In this commentary, we present a follow-up of two articles published in 2017 and 2018 about road traffic crashes, which is an important public health issue in Africa and Burkina Faso. The first article reported on a research project, conducted in partnership with local actors involved in road safety, carried out in Ouagadougou in 2015. Its aim was to test the effectiveness, acceptability, and capacity of a surveillance system to assess the number of road traffic crashes and their consequences on the health of crash victims. Several knowledge translation activities were carried out to maximize its impact and were reported in the 2018 article published in HRPS: monthly reports presenting the research data, large-format printed maps distributed to the city’s police stations, and a deliberative workshop held at the end of the research project. The present commentary presents our efforts to deepen our understanding of the impacts of the knowledge translation strategy, based on follow-up interviews, 18 months after the workshop, with the heads of the road traffic crash units in Ouagadougou police stations (n = 5). Several benefits were reported by respondents. Their involvement in the process prompted them to broaden their knowledge of other ways of dealing with the issue of road crashes. This led them, sometimes with their colleagues, to intervene differently: more rapid response at collision sites, increased surveillance of dangerous intersections, user awareness-raising on the importance of the highway code, etc. However, sustaining these actions over the longer term has proven difficult. Several lessons were derived from this experience, regarding the importance of producing useful and locally applicable research data, of ensuring the acceptability of the technologies used for data collection, of using collaborative approaches in research and knowledge translation, of ensuring the visibility of actions undertaken by actors in the field, and of involving decision-makers in the research process to maximize its impacts.

In 2016, we conducted an entomological survey in a railway transect between Banfora and Ouagadougou, Burkina Faso. The aim was to evaluate the risk factors for arbovirus epidemics, including vector infection status, in areas representative of the country. Aedes aegypti mosquitoes were collected at larval stage from four study sites and reared until adult stage and kept in RNAlater for detection of arbovirus RNA. In the laboratory, the mosquito specimens were screened for dengue virus (DENV) and chikungunya virus (CHIKV) using one step real-time qRT-PCR. We detected one DENV-2 positive pool from Ouagadougou, giving a minimum infec-tion rate (MIR) of 16.67, and 6 CHIKV positive pools, giving a MIR of 66.67 from Ouagadougou, but also in Banfora and Boromo. The qRT-PCR is a useful tool for the surveillance of arboviruses of public health importance in Burkina Faso and may be incorporated into disease surveillance and control programs in Burkina Faso.

IntroductionThe COVID-19 pandemic was first reported in West Africa on 27 February 2020 in Nigeria. It subsequently spread to other countries in the region. The objective of this study is to analyze the epidemiological profile of COVID-19 in West Africa from the first reported case to 31 January 2021.MethodWe publicly used available data from reliable sources and from the “COVID-19R” package. We used epidemic curves to describe the trends in the daily evolution of confirmed cases and deaths of COVID-19 in West Africa and specifically in the five countries. The reproduction rate and evolution rates were calculated from these trends.ResultsAs of 31 January 2021, West Africa had 342,938 confirmed cases of COVID-19 with 4,496 deaths. Nigeria had 131,242 cases with 1,586 deaths. Senegal had 26,523 cases with 628 deaths. The case-fatality rate in Mali was 4.08% and the attack rate in Cape Verde was 2587 cases per 100,000 inhabitants. In Nigeria, Senegal, Mauritania and Mali, the epidemic curves supported by the evolution rates showed an increase in confirmed cases and deaths of COVID-19 during December 2020 and January 2021 compared to the last two months. The effective reproduction rates (Re) inferred a slowdown in virus transmission (Re < 1) in these countries except for Senegal.ConclusionThe results showed that COVID-19 was still circulating in some West African countries in late 2020 and early 2021. By improving the health system and with context-specific public health interventions and vaccination, these countries should effectively control COVID-19.

This research aims to understand the level and determinants of people’s willingness to participate in a vaccine trial for COVID-19 in Senegal. We conducted a telephone survey among a marginal quota sample of 607 people over 18 years of age. Only 44.3% of the participants wanted to participate in a vaccine trial for COVID-19, with females intending to participate more than males. Participants who intended to be vaccinated against COVID-19 (OR = 6.48, 95% CI [4.12-10.4]) and who thought that being infected with the coronavirus would have a significant impact on their health (OR = 2.34, 95% CI [1.57, 3.51]) were more likely to agree to take part in the COVID-19 vaccine research. Confidence in the vaccine, health personnel, and government in the fight against the pandemic are key factors in intending to participate in vaccine research in Senegal.

IntroductionIn mid-2020, due to the health system challenges from increased COVID-19 cases, the Ministry of Health and Social Action in Senegal opted for contact management and care of simple cases at home. The study’s objective was to determine the acceptability of contact management, home care of simple cases of COVID-19, and its associated factors.MethodThis was a sequential mixed-method study. We collected data from June 11, 2020, to July 10, 2020, for the quantitative survey (N=813) and from August 24 to September 16, 2020, for the qualitative survey (N=30). We carried out a sampling strategy using marginal quotas at the national level. We collected data using a structured questionnaire in a telephone interview for the quantitative survey and using an interview guide formulated from the quantitative survey’s initial results for the qualitative data. We assessed acceptability using binomial logistic regression combined with content analysis.ResultsThe care of simple cases of COVID-19 at home was well accepted (78.5%). This result was justified for some (saturation of the health system) but not for others (risk of contamination). The use of home contact management was less accepted (51.4%), with risk limitation as the main reason given. The acceptability of home-based care for simple cases was positively associated with knowledge of the modes of transmission of the virus (ORaj: 1.55 [95%CI: 1.04,2.28]), regular research into COVID-19 (ORaj: 2.12 [95%CI: 1.45,3.12]), belief in the existence of treatment (ORaj: 1.82 [95%CI: 1.19,2.83]), and confidence in institutional information (ORaj: 2.10 [95%CI: 1.43,3.10]). The acceptability of home-based contact management was positively associated with knowledge of the modes of transmission of the virus (ORaj: 1.77 [95%CI: 1.27,2.48]), regular research for information on COVID-19 (ORaj: 2.39 [95%CI: 1.76,3.26]), and confidence in the government in the fight against the epidemic (ORaj: 1.51 [95%CI: 1.10,2.08]).ConclusionRegular information on the disease, knowledge of its mode of transmission and trust in institutions are factors in accepting COVID-19 management at the community level. Authorities should take these factors into account for better communication to improve the acceptability of home-based care.

Because of limited data on dengue virus in Burkina Faso, we conducted 4 consecutive age-stratified longitudinal serologic surveys, ≈6 months apart, among persons 1-55 years of age, during June 2015-March 2017, which included a 2016 outbreak. The seroconversion rate before the serosurvey enrollment was estimated by binomial regression, taking age as the duration of exposure, and assuming constant force of infection (FOI) over age and calendar time. We calculated FOI between consecutive surveys and rate ratios for potentially associated characteristics based on seroconversion using the duration of intervals. Among 2,897 persons at enrollment, 66.3% were IgG-positive, and estimated annual FOI was 5.95%. Of 1,269 enrollees participating in all 4 serosurveys, 438 were IgG-negative at enrollment. The annualized FOI ranged from 10% to 20% (during the 2016 outbreak). Overall, we observed high FOI for dengue. These results could support decision-making about control and preventive measures for dengue

BackgroundMeasuring progress towards financial risk protection for the poorest is essential within the framework of Universal Health Coverage. The study assessed the level of out-of-pocket expenditure and factors associated with excessive out-of-pocket expenditure among the ultra-poor who had been targeted and exempted within the context of the performance-based financing intervention in Burkina Faso. Ultra-poor were selected based on a community-based approach and provided with an exemption card allowing them to access healthcare services free of charge.MethodsWe performed a descriptive analysis of the level of out-of-pocket expenditure on formal healthcare services using data from a cross-sectional study conducted in Diébougou district. Multivariate logistic regression was performed to investigate the factors related to excessive out-of-pocket expenditure among the ultra-poor. The analysis was restricted to individuals who reported formal health service utilisation for an illness-episode within the last six months. Excessive spending was defined as having expenditure greater than or equal to two times the median out-of-pocket expenditure.ResultsExemption card ownership was reported by 83.64% of the respondents. With an average of FCFA 23051.62 (USD 39.18), the ultra-poor had to supplement a significant amount of out-of-pocket expenditure to receive formal healthcare services at public health facilities which were supposed to be free. The probability of incurring excessive out-of-pocket expenditure was negatively associated with being female (β = − 2.072,p = 0.00, ME = − 0.324;p = 0.000) and having an exemption card (β = − 1.787,p = 0.025; ME = − 0.279,p = 0.014).ConclusionsUser fee exemptions are associated with reduced out-of-pocket expenditure for the ultra-poor. Our results demonstrate the importance of free care and better implementation of existing exemption policies. The ultra-poor’s elevated risk due to multi-morbidities and severity of illness need to be considered when allocating resources to better address existing inequalities and improve financial risk protection.

Background Dengue is increasing in its global presence with an estimated 4 billion people at-risk of infection in at least 128 countries. Despite the promising results of EcoHealth and community mobilization approaches to Aedes reduction, more evidence of their efficacy on reducing dengue risk is needed. The principal research question is to determine if interventions based upon community mobilization reduce the risk of dengue virus infection among children 3 to 9 years old compared to usual dengue control practice in Fortaleza, Brazil. Methods The present study will follow a pragmatic cluster randomized controlled trial (cRCT) design with randomization at the census tract level with equal allocation to the two arms. In each arm, there will be 34 clusters of 86 children between 3 to 9 years old for an expected total of 5848 children enrolled in the study, assuming a risk reduction of 29.5% based upon findings from a previous multi-site cRCT. The primary outcomes are rates of anti-dengue Immunoglobulin G (IgG) seroconversion and adult female Aedes density. The intervention is based upon a participatory health research approach, Socializing Evidence for Participatory Action (SEPA), where the research evidence is used to foster community engagement and ownership of the health issue and solution. Following allocation, intervention communities will develop and implement their own solutions that will likely include a wide variety of collective events and media approaches. Data collection activities over a period of 3 years include household visits for blood collection, household surveys, and entomological surveys; and qualitative activities including focus groups, in-depth interviews, and document analysis to evaluate the process, acceptability, fidelity, and sustainability of the intervention. Study participants will be aware of their assignment and all research staff will be blinded although the intervention assignment will likely be revealed to field staff through interaction with participants. Discussion The results of our study will provide evidence on community mobilization as an intervention for dengue control. We anticipate that if community mobilization is effective in Fortaleza, the results of this study will help develop evidence-based vector control programs in Brazil, and also in other countries struggling with Aedes-transmitted diseases. Trial registration ISRCTN66131315, registration date: 1 October 2018.

Pts with HM and particularly those under therapy or with secondary immune deficiency have been reported to have a low or delayed specific immune response. In addition, pts receiving rituximab for either HM or auto-immune disease presented a low specific antibody response. Daratumumab, an anti-CD38 moAb was demonstrated to lower normal plasma cells and to reduce polyclonal IgA, M and E in pts with multiple myeloma (MM). It is fundamental to evaluate the early post-vaccination tolerance and the level of seroconversion for such pts. Patients' population. 194 pts having HM and followed at the Institute (IC), received at least 2 doses of BNTCV (BioNTech Pfizer, Paris, France) by IM route with 3 weeks between the 2 doses. Currently, analysis was performed on 147 pts, including 63 pts with non-Hodgkin lymphoma (NHL), 18 with B-chronic lymphocytic leukemia (CLL), 34 with MM, 14 with monoclonal gammopathy of undetermined significance (MGUS) and 18 with myeloproliferative disorder (MPD). Mean age was 69 years-old (range 27-92). Follow-up of early tolerance in pts using a telemedicine application. 43 pts vaccinated at the IC received Thess®, a telemedicine system connecting the patient to the IC, developed by La Valeriane Inc. (Montpellier, France, www.thess-corp.fr) 24/24h, 7days. Local pain (38°C) for at least 2 days, headache, or general pain. The satisfaction survey of monitoring system was good. In addition, adherence to vaccination was excellent with only one refusal out of the 194 pts. AcAS follow-up IgG AcAS and IgG+M AcAS were analyzed in the serum 3 to 4 weeks after the 1st dose and 4-8 weeks after the 2 nd dose and every 2 months, respectively by SARS-CoV-2 IgG II Quant ® Assay with a threshold of positivity at 50 AU/mL (Abbott, Rungis, France) and Elecsys ® Anti-SARS-CoV-2 S (Roche Diagnostics, Meylan, France) with a threshold of positivity at 0.8 U/mL. 270 samples were analyzed in duplicate with the 2 assays, by 2 independent labs. Data were reported and statistically analyzed by the clinical research team. 17 results were discordant including 12 with Abbott IgG test undetectable and Roche IgG+M detectable, and 5 with Abbott test detectable and Roche undetectable. After the first dose of BNTCV, 72/147 (49%) pts were seroconverted, including 7/18 (39%) with CLL, 27/63 (43%) with NHL, 10/14 (71%) with MGUS, 17/34 (50%) with MM and 11/18 (61%) with SMD. The median levels of the AcAS response for pts were 0 (range 0-40 000 AU/mL) for the AdviseDX test as compared to 12 normal subjects (mean 257 AU/mL, range 226-283), and 0 U/mL (range 0-2500) for the Elecsys test. 49/75 (65%) of untreated pts were seroconverted after the 1 st dose as compared to 26/72 (36%) of treated patients (p After the second dose of BNTCV, 50 pts have currently been tested, with only 25 additional pts seroconverted. The median levels of the AcAS response for pts were 310 AU/mL (range 62-11760) for the AdviseDX test as compared to 12 normal subjects (mean 6725 AU/mL, range 3002-9787), and 1250 U/mL (range 0.87-2500) for the Elecsys test. The 25 patients who were not seroconverted after the 2nd dose received a 3rd dose of BNTCV, including 8 with MM, 9 with NHL, 5 with CLL, 1 with MGUS (with polyneuropathy under daratumumab) and 2 with SMD. Currently, 9 pts were tested after the 3 rd dose. AcAS levels were respectively 268 AU/mL for 1 MM treated by daratumumab, 103 and 313 AU/mL for 2 MM under carfilzomib, 1622 AU/mL for 1 untreated SMD, 29100 AU/mL for 1 untreated MGUS, 537 AU/mL for 1 CLL and 2 negative NHL. In conclusion, there is a need to follow AcAS for pts having HM including SMD after BNTCV aiming to adapt vaccine strategy including a 3 rd dose and eventual recall. As some pts are always negative after a 3 rd dose, vaccination strategy could be discussed by using different combinations of vaccine or the addition of immune adjuvant in a more personalized medicine. In addition, the usage of telemedicine connecting system may help to follow the early tolerance and to improve the pts' adherence. Disclosures Rossi: NPO Petrovax Pharm: Consultancy; LEO Pharma: Consultancy; EUSA Pharma: Consultancy; E-SANA Inc: Other: Co-founder of E-SANA Inc .

Background Community-based interventions have proven effective in several Latin American countries in controlling dengue vector Aedes aegypti and reducing the burden of the disease. However, we did not find any study reporting the assessment or implementation of such interventions in Sub-Saharan Africa. This article presents local communities’ preferences for activities as part of the implementation of a community-based intervention for dengue prevention in Ouagadougou (Burkina Faso) where dengue epidemics are recurrent during the rainy season. Methods A mixed-method study combining qualitative and quantitative data collection was conducted. Information from 983 households and their preferences for community-based activities for dengue prevention were collected in five neighborhoods of the city using a quantitative questionnaire. Then, 15 qualitative focus groups were organized in one of the neighborhoods that was randomly selected to receive a community-based intervention for dengue prevention. These groups were made up of 216 people representing the different socio-cultural categories: community leaders, men, women, young girls and boys. Results More than 95% of household respondents to the quantitative questionnaire found community-based interventions acceptable and/or useful: to raise awareness of mosquito-borne disease transmission, to identify and remove the mosquito breeding sites and areas favorable to the development of the adult vectors. Most participants in the focus groups, preferred outreach activities such as video/debate sessions, school and home education sessions, focus groups. They also preferred the implementation of community working groups, responsible for identifying and eliminating mosquito breeding sites in the neighborhood. However, many participants had reservations about sending preventive text messages to residents. They found it feasible but not useful since most people cannot read. Conclusion This study shows that it is important to get the local communities involved in the formulation of health prevention activities in sub-Saharan Africa where some interventions are often implemented using strategies from other continents.

Road accidents among children are now a major public health problem worldwide. According to a WHO report (2015), 186 300 children die on the roads worldwide, and the most at risk of death live in low- and middle-income countries (WHO 2015). The sub-Saharan African region has the highest number of road accidents among children with 32% of deaths (Li, Alonge, and Hyder 2016). They are the most vulnerable to road crash risk because of their physical and cognitive attributes still in development ...

The particular concern of HIV health care policies is with the transmission of the virus from mother to infant, from delivery until cessation of breastfeeding. PMTCT care seeks to help women reduce the risk by providing suitable services. In Burkina Faso, the authorities have chosen to bring health care facilities physically closer to HIV-positive women by increasing provision and thereby reducing the distance of access to them. Our purpose is to define the area in which these health care practices take place and the factors that determine them. 30 women were monitored for this study, from pregnancy until the infant reached six months of age, in Ouagadougou, the capital of Burkina Faso. The results show the women’s active involvement in attending PMTCT services. They travel long distances in a difficult physical environment, often using precarious means of transport. But the relationship between the distances from place of residence and health care is unexpected. The observations are at variance with research studies which show that the distance from health care facilities is not a criterion of attendance. While urban studies present distance as a neutral factor in the context of the use of care health services, our research shows distance as a criterion for attendance. Regardless the means of transport used, women travel long distances for PMTCT follow-up, as opposed to usual care. La politique de santé en matière de VIH attache un intérêt particulier à la transmission du virus entre la mère et l’enfant depuis l’accouchement jusqu’au terme de l’allaitement. Les soins de PTME (Prévention de la Transmission du VIH de la Mère à l’Enfant) ont pour vocation d’aider la femme à réduire ce risque en offrant des services adaptés. Au Burkina Faso, les autorités multiplient l’offre de soin du VIH afin de réduire les distances entre établissements de soins et femmes porteuses du VIH. Cet article vise à définir le territoire dans lequel s’inscrivent ces pratiques de soins et quels sont les facteurs qui les déterminent ? L’étude menée à Ouagadougou (Burkina Faso) repose sur le suivi de 30 femmes fréquentant un service de PTME, depuis leur grossesse jusqu’au 6e mois de leur enfant, Ces femmes s’engagent avec application dans le suivi des visites médicales. Elles parcourent de longues distances dans un contexte physique difficile et avec des moyens de transport souvent précaires. Mais la relation entre distances parcourues et soins est inattendue. Alors que les études urbaines présentent la distance comme un facteur neutre dans le cadre de l’utilisation des structures de soins, nos travaux montrent l’éloignement comme un critère de fréquentation. Peu importe le moyen de déplacement, les femmes parcourent de longues distances pour le suivi PTME, contrairement aux soins ordinaires.

Background Vector-borne diseases (VBDs) continue to represent a global threat, with “old” diseases like malaria, and “emergent” or “re-emergent” ones like Zika, because of an increase in international trade, demographic growth, and rapid urbanization. In this era of globalization, surveillance is a key element in controlling VBDs in urban settings, but surveillance alone cannot solve the problem. A review of experiences is of interest to examine other solution elements. The objectives were to assess the different means of VBD surveillance in urban environments, to evaluate their potential for supporting public health actions, and to describe the tools used for public health actions, the constraints they face, and the research and health action gaps to be filled. Main body For this scoping review we searched peer-reviewed articles and grey literature published between 2000 and 2016. Various tools were used for data coding and extraction. A quality assessment was done for each study reviewed, and descriptive characteristics and data on implementation process and transferability were analyzed in all studies. After screening 414 full-text articles, we retained a total of 79 articles for review. The main targets of the articles were arboviral diseases (65.8%) and malaria (16.5%). The positive aspects of many studies fit within the framework of integrated vector management. Public awareness is considered a key to successful vector control programs. Advocacy and legislation can reinforce both empowerment and capacity building. These can be achieved by collaboration within the health sector and with other sectors. Research is needed to develop well designed studies and new tools for surveillance and control. Conclusions The need for surveillance systems in urban settings in both developing and developed countries was highlighted. Countries face the same challenges relating to human, financial, and structural resources. These findings also constitute a wake-up call for governments, academia, funders, and World Health Organization to strengthen control programs and enhance VBD research in urban environments. Electronic supplementary material The online version of this article (10.1186/s40249-018-0473-9) contains supplementary material, which is available to authorized users.

We evaluated the effectiveness of a community-based intervention for dengue vector control in Ouagadougou, the capital city of Burkina Faso. Households in the intervention (n = 287) and control (n = 289) neighborhoods were randomly sampled and the outcomes collected before the intervention (October 2015) and after the intervention (October 2016). The intervention reduced residents' exposure to dengue vector bites (vector saliva biomarker difference -0.08 [95% CI -0.11 to -0.04]). The pupae index declined in the intervention neighborhood (from 162.14 to 99.03) and increased in the control neighborhood (from 218.72 to 255.67). Residents in the intervention neighborhood were less likely to associate dengue with malaria (risk ratio 0.70 [95% CI 0.58-0.84]) and had increased knowledge about dengue symptoms (risk ratio 1.44 [95% CI 1.22-1.69]). Our study showed that well-planned, evidence/community-based interventions that control exposure to dengue vectors are feasible and effective in urban settings in Africa that have limited resources.

Background: In the early 2000s, electronic surveillance systems began to be developed to collect and transmit data on infectious diseases in low-income countries (LICs) in real-time using mobile technologies. Such surveillance systems, however, are still very rare in Africa. Among the non-infectious epidemics to be surveilled are road traffic injuries, which constitute major health events and are the fifth leading cause of mortality in Africa. This situation also prevails in Burkina Faso, whose capital city, Ouagadougou, is much afflicted by this burden. There is no surveillance system, but there have been occasional surveys, and media reports of fatal crashes are numerous and increasing in frequency. Objective: The objective of this article is to present the methodology and implementation of, and quality of results produced by, a prototype of a road traffic crash and trauma surveillance system in the city of Ouagadougou. Methods: A surveillance system was deployed in partnership with the National Police over a six-month period, from February to July 2015, across the entire city of Ouagadougou. Data were collected by all seven units of the city’s National Police road crash intervention service. They were equipped with geotracers that geolocalized the crash sites and sent their positions by SMS (short message service) to a surveillance platform developed using the open-source tool Ushahidi. Descriptive statistical analyses and spatial analyses (kernel density) were subsequently performed on the data collected. Results: The process of data collection by police officers functioned well. Researchers were able to validate the data collection on road crashes by comparing the number of entries in the platform against the number of reports completed by the crash intervention teams. In total, 873 crash scenes were recorded over 3 months. The system was accessible on the Internet for open consultation of the map of crash sites. Crash-concentration analyses were produced that identified ‘hot spots’ in the city. Nearly 80% of crashes involved two-wheeled vehicles. Crashes were more numerous at night and during rush hours. They occurred primarily at intersections with traffic lights. With regard to health impacts, half of the injured were under the age of 29 years, and 6 persons were killed. Conclusions: This pilot study demonstrated the feasibility of developing simple surveillance systems, based on mHealth, in LICs.

A variety of health financing schemes shaped on pre-payment scheme have been implemented across Sub-Saharan Africa (SSA) to address the Millennium Development Goals (MDGs). In Mauritania, the Obstetric Risk Insurance package (ORI) focusing on maternal and perinatal health has been progressively implemented at the health district level since 2002. Here, our main objective was to assess the effectiveness of the ORI in increasing facility-based delivery rates, as well as increases in family planning, antenatal and postnatal care, caesarean delivery and neonatal health, from demographic and health survey data between 2002 and 2011. We also examined whether the effects of the ORI varied between strata of the population. The study was based on a quasi-experimental before-and-after design to assess the causal link between availability of ORI and increase in use of maternal health services and neonatal mortality. In combination with geographical information system, difference-in-differences and odd ratio approaches were used to address our objectives. Indicators of access to care for pregnant women and neonatal health and improved in both non-intervention and intervention groups during the study period. There was no global effect of the availability of ORI on facility-based delivery rates, nor on the use of antenatal and postnatal care services, except for qualified antenatal services. However, delivery rates in local health centres with ORI increased more rapidly than in those with no ORI, the contrary was shown for hospitals. Caesarean delivery and family planning decreased with ORI. Although late neonatal mortality rates remained low in the country, a significant decrease was seen in districts without ORI. Except for some strata of the population, ORI has not really met its objective of attracting more pregnant women towards facility-based health care.

Background The significant malaria burden in Africa has often eclipsed other febrile illnesses. Burkina Faso’s first dengue epidemic occurred in 1925 and the most recent in 2013. Yet there is still very little known about dengue prevalence, its vector proliferation, and its poverty and equity impacts. Methods An exploratory cross-sectional survey was performed from December 2013 to January 2014. Six primary healthcare centers in Ouagadougou were selected based on previously reported presence of Flavivirus. All patients consulting with fever or having had fever within the previous week and with a negative rapid diagnostic test (RDT) for malaria were invited to participate. Sociodemographic data, healthcare use and expenses, mobility, health-related status, and vector control practices were captured using a questionnaire. Blood samples of every eligible subject were obtained through finger pricks during the survey for dengue RDT using SD BIOLINE Dengue Duo (NS1Ag and IgG/IgM)® and to obtain blood spots for reverse transcription polymerase chain reaction (RT-PCR) analysis. In a sample of randomly selected yards and those of patients, potential Aedes breeding sites were found and described. Larvae were collected and brought to the laboratory to monitor the emergence of adults and identify the species. Results Of the 379 subjects, 8.7 % (33/379) had positive RDTs for dengue. Following the 2009 WHO classification, 38.3 % (145/379) had presumptive, probable, or confirmed dengue, based on either clinical symptoms or laboratory testing. Of 60 samples tested by RT-PCR (33 from the positive tests and 27 from the subsample of negatives), 15 were positive. The serotypes observed were DENV2, DENV3, and DENV4. Odds of dengue infection in 15-to-20-year-olds and persons over 50 years were 4.0 (CI 95 %: 1.0–15.6) and 7.7 (CI 95 %: 1.6–37.1) times higher, respectively, than in children under five. Average total spending for a dengue episode was 13 771 FCFA [1 300–67 300 FCFA] (1$US = 478 FCFA). On average, 2.6 breeding sites were found per yard. Potential Aedes breeding sites were found near 71.4 % (21/28) of patients, but no adult Aedes were found. The most frequently identified potential breeding sites were water storage containers (45.2 %). Most specimens collected in yards were Culex (97.9 %). Conclusions The scientific community, public health authorities, and health workers should consider dengue as a possible cause of febrile illness in Burkina Faso. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0120-2) contains supplementary material, which is available to authorized users.

Road traffic accidents are the major cause of mortality among people aged 15-29 years in Africa. World Health Organisation (WHO) and the World Bank launched a Decade of Action for Road Safety in 2011 with the goal of halving the number of injuries and deaths on the roads. No progress has been reported in Low and Middle Income Countries (LMICs) and the number of deaths remains very high. To reach the target set, there is a need for interventions in several areas. This scoping review proposes to produce a synthesis by identifying the kinds of interventions and outcomes which have been carried out on the African continent. Using the scoping studies method, 23 articles were selected and analysed. The study shows that interventions were developed in four fields: road safety policy, health education, safety equipment and data collection. It shows also that there were records of interventions in only twelve countries, mostly in Eastern and Southern Africa. The main conclusion of this study reveals both a lack of road safety interventions and shortcomings in the assessment of those performed and selected for our study.

emergencies near their homes. We measured how often EFARs comply with these dispatches and how many arrived on-scene prior to the ambulance. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): 41 EFARs were dispatched via text message to 10 medical emergencies (average 4.1 per incident, min 1⁄4 1, max 1⁄4 11); a total of 29 EFARs (22 from text-message, 7 from word of mouth) responded to 8 emergencies (average 2.9 per event, min 1⁄4 0, max 1⁄4 7). For every emergency that was responded to, EFARs arrived onscene prior to the ambulance. Summary/Conclusion: These early findings highlight that community members, when text messaged, will cease daily activities to assist with medical emergencies. Previous studies suggest that community-based emergency health workers can improve health outcomes in rural and urban environments. We intend to follow-up and assess if text message-based dispatch leads to improved health outcomes for emergency care situations in Western Cape townships.

Since early November 2013, dengue fever has received considerable media attention in Burkina Faso [1], [2]. Nevertheless, scientific evidence, entomological knowledge, public information, health worker training, health system preparation, and public health interventions with regard to dengue fever in this country are sorely lacking. As such, our aim in this article is to draw attention to the need for rapid deployment of research and interventions on dengue fever in Burkina Faso, because it appears to have been overlooked, with the focus being, instead, on malaria. This West African country, with a population of 15.75 million and where 100,000 children under five die each year—25,000 of them from malaria [3]—has been profoundly affected by that disease; malaria is today the primary cause of years of life lost and disability-adjusted life years [4]. However, a 2010 national survey revealed that only 54% of children under five with fever went to a health centre, and just 35% of all children received antimalarial drugs [5]. Nonetheless, long-lasting insecticide-treated mosquito nets (LLINs) were distributed nationally and at no charge in 2010 and 2013, and the sale of artemisinin-based combination therapies (ACTs) in health centres and by community health workers has been subsidized since 2010 [6], [7]. Rapid diagnostic tests (RDTs) for malaria were also introduced across the country in health centres in 2012 and by community health workers in villages in 2013, improving the detection of febrile diseases due to malaria. At the same time, the arrival of RDTs also made possible the identification of nonmalarial acute undifferentiated fever, including dengue. Given this, we believe it is becoming urgent to address this disease. Dengue fever is a viral vector-borne disease caused by infection in humans of any of the four serotypes (DENV1, DENV2, DENV3, DENV4) of the dengue virus via the bite of the Aedes mosquito [8], [9]. In Burkina Faso, dengue represents an added burden in an epidemiological landscape dominated by malaria and in which national antimalarial programs are experiencing a number of problems in implementation (such as stock shortages of ACT and malaria RDTs) [6]. Despite this, neither the 2010 General Health Forum nor the March 2013 review of the health sector mentioned the problem of dengue fever. It is because of these difficulties in the fight against malaria that the emergence of public and private debates around dengue is worrisome. The media are all focusing on this “new type” of fever, and both the general public and health workers are increasingly complaining that ACTs are ineffective against malaria [2], whereas, for instance, they may not actually be dealing with malaria, but dengue fever. In fact, it is not easy to make a differential diagnosis between dengue and other febrile diseases, such as malaria, in places where they coexist, given that they share many of the same symptoms, such as myalgia, arthralgia, and headache. The difficulties of differentiating among those diseases are compounded by the country's lack of diagnostic resources and laboratory facilities. Hence, at a press conference on another topic (LLINs) held on November 5, 2013, the Minister of Health was compelled to respond to numerous questions on dengue fever. He indicated that, between 2006 and 2008, there had been 683 confirmed cases of dengue in two locations: Ouagadougou, the capital city, and Nouna, a medium-sized city in the country's western region. In October 2013, the Ministry of Health rapidly implemented an investigation limited to four health centres in the capital. Of 111 rapid tests (SD BIOLINE Dengue Duo) performed on patients presenting acute febrile disease lasting two to seven days, 33 (29.7%) were positive, including 25 NS1 (25/33; 75.8%). The majority of these cases (90.9%) involved patients over 15 years of age. Laboratory analyses requested by the Ministry of Health are currently carried out in Dakar (Pasteur Institute) to confirm the dengue RDT results [10]. In fact, a major challenge relating to dengue is that very little is known about its presence in Burkina Faso, whether in humans or in the vector. The first epidemic of dengue appears to have occurred in 1925 [11], and other significant cases linked to serotype 2 were apparently identified in the 1980s [11], [12]. The fact remains that Burkina Faso is one of 34 African countries where cases have been reported since the 2000s [11], [13]. A study in 2003 of 191 blood donors and 492 pregnant women in a rural district and in the capital found seroprevalence ranging from 26.3% to 36.5%, but information about the serotype was not presented [14]. However, to our knowledge, no other study has been done in the ten years since then. There is thus no current estimate of the prevalence and incidence of infection in the population. Our research team recently conducted, in 2013, a population survey in two of the country's medium-sized cities [15]. Of the febrile cases, in the city of Zorgho, 2.7% (3/112), and in the city of Kaya, 9.9% (15/151) showed positive IgM/IgG RTD results, including two AgNS1 positive cases (SD BIOLINE Dengue Duo). Laboratory analyses (reverse transcription PCR) of filter paper samples are being performed by Universidad del Valle (Cali, Colombia). Additionally, although the role of the Aedes aegypti mosquito as the vector of dengue fever is well known [16], [17], and despite the fact that A. aegypti and A. albopictus are present in Burkina Faso [11], there has been no recent entomological study that would provide information about its distribution, especially in the country's large cities, where populations of this very urban mosquito have likely become widespread [2]. Given the resurgence of dengue fever in Burkina Faso and the current media attention, we believe action is urgently needed on two fronts: research and public health interventions (Box 1). Box 1. Needed Research and Actions on Dengue Fever in Burkina Faso Research: Population survey to measure prevalence and serotypes circulation Entomological studies on vector distribution and presence of infection Public health interventions: Surveillance system and laboratory improvement Health staff training on diagnosis and management of dengue Vector control intervention Information targeting the general public In terms of research, there is an urgent need for epidemiological studies, such as population surveys, to measure more precisely the burden of dengue fever, especially in large cities where the vector is very likely to be present. Information is needed not only on prevalence and incidence but also on the serotypes that are circulating, to understand the disease's behaviour and to facilitate the development of intervention strategies or training programs targeted to clinicians' needs [8]. The potential discovery of a new serotype could explain the occurrence of severe cases and previously unknown forms of the disease. This will require specific training of physicians to ensure treatment that is better adapted to the context. In addition, deaths and severe cases of the disease should be systematically investigated to uncover the determinants so that appropriate action can be taken. Entomological studies are also important to gather better information on vector distribution [18]. Up to now, very few researchers and research teams have tackled the problem of dengue fever in Burkina Faso. For example, the national yellow fever reference laboratory has no ELISA kits for performing analyses. While certain competencies are available, they have not been mobilized, because dengue fever had not been seen in a very long time and was not considered a public health problem. Until a disease is recognized as a problem, there will be no search for a solution to contain it [19]. Researchers and research funding agencies must therefore now mobilize to develop new knowledge. The health system, which is already finding it very difficult to cope with malaria [20], is not prepared to contend with dengue fever. Health workers, mainly nurses and nurse assistants in both the public and private sectors, are not sufficiently trained for syndromic case management of dengue. Training based on the current WHO guidelines could be a starting point. A needs assessment should be done for health-worker training to improve the accurate diagnosis and treatment of patients with fever who do not have malaria. In general, the laboratory and surveillance systems need to be improved and decentralized. The population is not well informed on this subject, and a lot of erroneous information has been circulating since the media began focusing on this issue in early November 2013. In public health, rumours can very soon have disastrous effects [21]. Finally, the effort to control the vector, abandoned many years ago in Burkina Faso, must absolutely be revived, because it is one of the most effective means of dealing with the problem while waiting for a vaccine or another effective dengue control strategy [18]. The State and its technical and financial partners need to mobilize now so that the health system and its public health interventions can begin working on the most effective management of dengue fever [20].

RHABDOMYOLYSIS is a clinical and biochemical syndrome resulting from skeletal muscle injury with the release of muscle contents into the plasma. It results either form a direct muscle injury or from an altered metabolic relationship between energy production and consumption in muscle. Crush syndrome, extensive burns, electric shock, and prolonged immobilization are the main causes of direct muscle injury. Strenuous physical exercise, malignant hyperthermia, muscle ischemia resulting from compression or vascular injury, infections, myopathies, toxins, and drugs, including alcohol, which accounts for 20% of the cases, can cause nontraumatic rhabdomyolysis. This syndrome has been described with fibrates and statin lipid-lowering drugs, culminating in the recent removal of cerivastatin from the market because of a number of rhabdomyolysis-related deaths. Severe cases were reported in elderly patients and in patients taking lipid-lowering drugs. We observed two consecutive cases of severe postoperative rhabdomyolysis in patients who underwent elective laparoscopic surgery for adenocarcinoma of the rectum, and for whom cumulative risk factors were identified in retrospect: long-term treatment with statins and laparoscopic surgery with prologned immobilization under general anesthesia.

Background: Periodic mass distributions contribute significantly to universal access to insecticide-treated nets (ITNs). However, due to the limited number of nets distributed, needs remain unsatisfied, particularly in large households. Methods: This study was conducted in Kaya health district following the 2010 mass distribution of ITNs in Burkina Faso. Data were collected on the socio-economic and geo-spatial characteristics and ITN possession and utilization levels of 2,004 households. The study explored: 1) ITN access, in terms of intra-household saturation with ITNs (households with at least one ITN for every two members) correctly installed and in very good physical condition; and 2) factors influencing the decision to place under-five children under a net. Particular attention was given to vector control activities undertaken by mothers. Results: Of the 2,004 households, 90% possessed at least one ITN. However, intra-household saturation with ITNs was below 60% in small households and below 20% in large ones (>6 members). Crude proportion ratios comparing possession and levels of intra-household saturation with ITNs varied between 1.5 (small households) and 7.8 (large households). The proportions of households with ITNs for every two members that were correctly hung or in very good physical condition ranged from 0% to 6.5% in large households and 27.8% to 40.7% in small ones. ITN use to protect under-five children was lower in large households; it was significantly higher when there was at least one ITN for every two members. In large households, it was significantly higher when a child had experienced an episode of any illness in the previous two weeks and when the mother had taken actions to control vector proliferation. In small households, ITN use was significantly higher in families with agricultural land and children aged 12-23 months. Conclusion: Ownership rates were high, but real access to bed nets remained limited. The allocation process disadvantages large families. Real access to bed nets implies they are available, properly installed, and in good condition. More post-campaign awareness-raising activities targeting preventive practices in households could foster more effective ITN use.