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

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

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

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

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

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

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

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

Background 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: In spite of considerable progress, malaria remains a public health problem in many areas, particularly in sub-Saharan Africa. One major complexity of malaria disease is caused by the development and the spread of vector and parasite resistance to insecticides and antimalarial drugs respectively. The Pfcrt76T gene mutation has been validated as a marker conferring resistance to chloroquine and other antimalarial drugs. The extension of Plasmodium falciparum resistance to commonly used antimalarial drugs (chloroquine, sulfadoxine-pyrimethamine) led to the adoption and the use of artemisinin-based combinations in Burkina Faso since 2005. Aims: The present study was initiated to assess the prevalence of the Pfcrt76T mutation in two different malaria epidemiological setting after a decade of introduction of artemisinin-based combination therapies (ACTs) in Burkina Faso. Methodology: The study population consisted of 181 uncomplicated malaria patients recruited in Banfora and Saponé health districts in 2012 and 2013. Blood samples were collected from finger prick on filter paper, dried and sent to the Molecular Biology Laboratory at Centre National de Recherche et de Formation sur le Paludisme (CNRFP) for molecular analyzes. DNA of Plasmodium falciparum was extracted with DNA extraction kit (Qiagen®) and the Pfcrt76T mutation was determined based on Polymerase Chain Reaction / Restriction Fragment Length Polymorphism technique (RFLP). Results: The results of this study showed that the frequency of the pfcrt76T mutant allele (33.7%) was statistically lower than the Pfcrt76K wild-type allele (57.4%) in the study area. Moreover, the prevalence of Pfcrt76T mutation was neither associated with the patient age nor with the parasite density while a significant difference was observed between the two epidemiological setting, Banfora and Saponé. Conclusion: The findings of this study has shown a drop in the prevalence of mutant parasites Pfcrt76T in both the study area eight years after the introduction of ACTs compared to previous studies.

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

Introduction : L’anemie de grossesse, ou gravidique, demeure un probleme majeur de sante publique dans les pays a faible revenu. La qualite de la ressource humaine est primordiale pour garantir l’efficacite des interventions. Cette etude avait pour objectif d’evaluer les connaissances et les pratiques des professionnels de sante et des agents de sante communautaires en matiere de prevention de l’anemie de grossesse au Burkina Faso.Methode : Il s’agit d’une etude transversale descriptive. Les donnees ont ete collectees a l’aide d’un questionnaire aupres des agents professionnels de sante et des agents de sante communautaires dans la region des Cascades.Resultats : Au total, 124 agents professionnels de sante et 77 agents de sante communautaires ont participe a l’enquete. Les connaissances des agents professionnels de sante sur la prevention de l’anemie de grossesse etaient « suffisantes » dans 25 % des cas et celles des agents de sante communautaires etaient « acceptables » dans 33,8 % des cas. Ni le nombre ni la diversite des themes de formation continue et des informations recues n’etaient associes au niveau de connaissances des agents sur la prevention de l’anemie. Les agents professionnels de sante des hopitaux (ORa = 6,7 ; IC 95 % : 1,3-34,5) et ceux ayant ete formes sur la prevention de la transmission mere-enfant du virus de l’immunodeficience humaine (VIH) (ORa = 3,0 ; IC 95 % : 1,0-8,0) ainsi que les agents de sante communautaires ayant ete scolarises (OR = 2,2 ; IC 95 % : 1,3-4,0) avaient les meilleurs niveaux de connaissances. Mais les agents professionnels de sante les plus qualifies etaient plutot concentres dans les hopitaux et non dans les centres de sante peripheriques censes promouvoir les mesures essentielles de prevention de l’anemie de grossesse.Conclusion : La prevention de l’anemie de grossesse reste un defi au Burkina Faso au regard du faible niveau de connaissances et des pratiques dans les centres de sante peripheriques et dans la communaute. Une amelioration des connaissances et des pratiques des acteurs peripheriques de soins a travers de meilleurs curricula de formation continue pourraient contribuer a lutte contre l’anemie de la femme enceinte.

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.

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

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

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

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

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

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

Background 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.

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

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

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

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

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

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.

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.

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

Background 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.

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

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

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

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

>Objective: To investigate the compliance of computed tomography (CT) scan requests in the X-ray units of Sub-Saharan Africa. Methods: Multi-centric, exhaustive, descriptive and cross-sectional study (Burkina Faso and Benin) focused on CT scan requests implemented and interpreted from May 1 to July 31, 2014. Request compliance was assessed according to the criteria of the French High Authority for Health to which was added a criterion for fulfillment of description of patient clinical information. An exam was deemed compliant when all criteria were met. Ratios were compared by means of Chi2 test at 0.05% significance level. Results: Among the 426 colligated computed tomography prescriptions, the least filled fields were allergy concept (0%), creatinine-mia (0.3%), examination purpose (50.2%). The overall compliance rate was 35%. The requests made by medical specialists were more compliant than those made by general practitioners and students (p = 0.003). Fulfillment of clinical information description was also better among medical specialists compared to the other prescribers (p = 0.002). Conclusion: It is important to improve the quality of computed tomography (CT) scan requests in the hospitals of Bobo-Dioulasso (Bur-kina Faso) and Parakou (Benin).

Few studies have been conducted on the epidemiology in pregnancy in sub-Saharan Africa. This study aimed to improve the care of pregnant women infected with hepatitis B virus (VHB) and their newborns in the urban district health. Method: This study was conducted from 01/09/2014 to 01/09/2015. Study involved three types of data collection: a collection of data from health facilities involved in the project; repeated cross-sectional survey among health personnel; a pros- pective study of pregnant women identified positive for HBsAg and followed at the University Hospital Yalgado Ouedraogo (CHU-YO). Knowledge assessment was made among health staff and pregnant women using a knowledge score. Construction of the score came after a factorial analysis of multiple correspondences on population health workers surveyed in the first round (N = 119) on one hand and all pregnant women (N = 266) on the other hand. This had identified among the 79/19 questions, those that discriminated best knowledge of paramedics and pregnant women. For pregnant women, this score was then dichotomized from the center and logistic regression was performed to determine the sociodemographic, medical and obstetric characteristics that influenced it (p value < 005). Results: Health staff had been surveyed twice (N = 119/100). In general, the level of knowledge was good on targeted knowledge, both before and after training. No health worker routinely offered screening for hepatitis B among pregnant women attending antenatal clinics. Altogether 266 pregnant women HBsAg-positive were referred and followed CHU-YO. Half of the patients had a score lower than 2/17. Univariate analysis showed that variables such as education level influenced significantly the level of knowledge. Women with higher levels of education had a higher level of knowledge about the disease, compared to those of primary level [OR = 1.63; [1.34 to 1.99], p value < 0,001]. Newborns during the study period numbered 128 and the vaccine was made in the first 24 hours of life for 83.6% of them. Conclusion: routine screening for infection with VHB during pregnancy and improved knowledge of mothers is strongly reco- mmended in Burkina Faso.

La maladie de Von Hippel-Lindau (VHL) est une maladie rare, multisystemique autosomale dominante, predisposant au developpement de tumeurs benignes et malignes richement vascularisees. Elle est due a des mutations germinales du gene suppresseur de tumeur VHL. Au cours de cette maladie, l’atteinte pancreatique est frequente mais les manifestations cliniques sont rares. Cette atteinte consiste habituellement en des kystes multiples, plus rarement en des cystadenomes sereux ou des kystes isoles. Nous rapportons le cas d’une patiente qui a presente une pancreatite aigue au cours d’une maladie de Von Hippel-Lindeau de novo avec une atteinte pancreatique par plusieurs types de lesions. L’interet de notre observation reside dans ce mode d’atteinte pancreatique et d’expression clinique, rarement decrits et dans la necessite de rappeler que cette affection existe aussi en Afrique subsaharienne. Nous devrions y penser meme en l’absence d’histoire familiale de maladie de VHL.

Evaluer la tolerance et l’acceptabilite de l’endoscopie digestive haute. Il s’agissait d’une etude prospective realisee de janvier a avril 2009. Les gastroscopies ont ete realisees par deux operateurs dans 3 unites d’endoscopies. La premedication etait faite au diazepam 5 mg en IVD ou au clonazepam 2,5 mg en per os et a la lidocaine visqueuse en gel oral. Auparavant, les informations essentielles sur la procedure de l’examen etaient donnees aux patients apres avoir obtenu leur consentement. L’opinion des patients sur la tolerance et l’acceptabilite etait recueillie sur une fiche de collecte de donnees a la fin de l’examen ou 24 heures apres. Trois cent cinquante patients ont ete inclus, dont 204 femmes (58,3%) avec un sex-ratio de 1,4. L’âge moyen etait de 37,2 ans (extremes de 18 et 79 ans). Selon le niveau d’instruction, les patients scolarises representaient 55%. Plus de la moitie (51,1%) des patients beneficiant de l’endoscopie digestive haute pour la premiere fois n’avaient eu aucune information prealable de leur prescripteur. L’information medicale recue des prescripteurs n’etait pas de bonne qualite dans pres de trois quarts des cas (72,2%). Une sedation a ete faite chez 98% des patients et l’examen a dure moins de 5 minutes dans 96,3% des cas. La tolerance etait bonne dans la majorite des cas (84,6%). Les manifestations desagreables etaient : l’anxiete (79,4%), la douleur de la gorge (40%), les nausees (79,4%) et la sensation d’etouffement (18,8%). L’acceptabilite d’une endoscopie digestive haute ulterieure etait de 96% (83,7% des patients souhaiteraient refaire l’examen dans les memes conditions contre 12,3% qui souhaiteraient une anesthesie).

The impact of a Computerized Immunization Register (CIR) on Expanded Program on Immunization (EPI), with sending SMS to parents before immunization sessions, has never been studied in sub-Saharan Africa. The objective of this study is to measure EPI quickness and completeness of vaccinations after sending call-back SMS to parents through CIR put in place in a health center. In a health center, chosen at random (Colma 1) in the city of Bobo Dioulasso, Burkina Faso, West Africa, mothers, at first EPI session, if they had a mobile phone available at hand or in her surrounding, were randomized for receiving, or not, a call-back SMS before following EPI sessions, after child registration on a Francophone CIR (Siloxane's Intervax ©). Mothers, which were sent SMS and did not correctly followed sessions were asked through mobile phone why their child was late for EPI. 523 newborns were included in the study, with 253 whose parents were sent SMS, and 268 being informed of sessions only by ordinary methods. At second EPI session at 2 months of age, there was a statistical significant increase of coverage for children whose parents received SMS (p

Etablir le profil general des hemorragies digestives hautes colligees au centre hospitalier universitaire Yalgado Ouedraogo a Ouagadougou, Burkina Faso. Nous rapportons les resultats de notre centre dans le cadre de l’etude prospective multicentrique « Observatoire des hemorragies digestives hautes en Afrique francophone » realisee par l’Association Africaine Francophone de Formation Continue en Hepato-gastro-enterologie (www.aaffchge.org), menee du 1/01/2010 au 30/12/2010. Ont ete inclus de facon consecutive les malades ayant presente au moins un des trois symptomes suivants: anemie, hematemese, melena. Deux cent soixante-cinq malades (âge moyen de 46,8±17,1 ans) ont ete inclus avec un sex-ratio de 2,4. Une hematemese et un melena concomitant etaient le motif de consultation le plus frequent (50,9%). La prise de medicaments gastro-toxiques etait le principal facteur de risque hemorragique (37,2%). L’endoscopie a permis de porter un diagnostic lesionnel (94,8%) avec l’ulcere gastroduodenal (52,3%) et les varices oesophagiennes (17,6%) comme principales principales etiologies. Le score de Rockall (SR) clinique moyen etait de 2,0±0,1 et celui complet de 3,2±0,1. Aucune hemostase endoscopique ou chirurgicale n’a ete realisee. L’evolution a ete essentiellement marquee par une recidive hemorragique (11,7%) ou par un deces (17%). Les facteurs predictifs de recidive etaient le sexe masculin (odds ratio [OR]: 3,1; intervalle de confiance a 95% [95%IC] 1,1-9,2), une hemoglobinemie inferieure a 10 g/dl a l’admission (OR: 6,2; 95%IC 1,4-26,9) et un SR complet superieur a 2 (OR: 2,8; 95%IC 1,1-7,2). La mortalite etait associee a une cirrhose (OR: 10,8; 95%IC 4,9-24,1), un etat de choc hemodynamique (OR: 4,7; 95%IC 1,9-11,7) et un SR clinique superieur a 0 (OR: 4,9; 95%IC 1,5-16,4).

Introduction : Evaluer la conformite avec les directives nationales, du diagnostic et du traitement du paludisme au CHU Souro Sanou de Bobo-Dioulasso.Methodes : Il s’est agi d’une etude descriptive transversale a partir des dossiers des cas hospitalises en 2012 dans les departements de Medecine et de Pediatrie. Tous les cas etiquetes « paludisme » a l’admission et a la sortie et dont le dossier etait complet ont ete inclus.Resultats : 1 722 dossiers ont ete colliges dont 1 674 cas etiquetes « paludisme complique » (97,22 %). L’âge moyen des cas etait de 2,65 ans [95 % IC : 2,41 – 2,90 ans] ; 87,63 % des cas avaient moins de 5 ans. Le sex-ratio etait de 1,22. Le diagnostic etait conforme aux directives dans 13,82 % des cas. Le taux de conformite du diagnostic ne differait pas avec la gravite du paludisme (p = 0,78) mais avec le groupe d’âge : 13,12 % chez les moins de 5 ans contre 18,78 % chez les 5 ans et plus (p = 0,02). Parmi les cas etiquetes « paludisme complique » (PC), on denombrait 1,47 % de cas de paludisme non complique (PNC) ; inversement, il y avait 4,17 % de cas de PC parmi les cas etiquetes PNC. Au total, 242 cas (14,05 %) etaient des cas confirmes de paludisme contre 1480 cas (85,95 %) presomptifs. Sur le plan therapeutique, le traitement etait conforme aux directives dans 57,49 %. Le taux d’adequation du traitement etait plus important chez les cas de PC (58,90 % versus 8,33 %, p < 0,01) et dans le groupe d’âge des moins de 5 ans (58,71 % versus 48,30 %, p = 0,02).Conclusion : Cette etude a montre que les pratiques en matiere de prise en charge des cas de paludisme au CHU de Bobo concordaient peu avec les directives. L’identification des facteurs de leur non-respect permettrait de trouver des mesures idoines afin d’ameliorer leur application et contribuer au recul du paludisme dans le pays.

Ce travail avait pour but d’etudier l’efficacite et l’observance du traitement de l’hepatite B chronique par la lamivudine et le tenofovir. Il s’agit d’une etude observationnelle avec recrutement consecutif de patients âges de plus de 15 ans, porteurs chroniques du virus B (AgHBs positif audela de 6 mois et ADN-VHB positif) et traites pendant au moins un an. La quantification de l’ADN-VHB a ete realisee par PCR en temps reel (Roche Cobas Taq Man, seuil de sensibilite 20 UI/mL). L’activite et la fibrose hepatique etaient evaluees par une ponction biopsie du foie ou un test sanguin de fibrose hepatique (FibroMetre®). Un traitement antiviral etait indique chez les malades ayant une activite et/ou une fibrose = 2. La reponse virologique complete a ete definie par un ADN-VHB indetectable datant au plus d’un an. A l’aide d’un questionnaire, l’observance au traitement a ete evaluee sur les trois derniers mois. Au total 97 patients ont ete inclus, dont 80 hommes (82,5%). L’âge moyen etait de 40 ans. Soixante dix-sept patients ont ete traites par du tenofovir et 20 par de la lamivudine avec une virosuppression globale de 83,5%. L’ADNVHB etait indetectable chez 69/77 patients (89,6%) dans le groupe tenofovir et chez 15/20 patients (75%) du groupe lamivudine. Une seroconversion HBe a ete observee chez 18 sur 25 patients sous tenofovir et chez 4 sur 5 patients traites par lamivudine. Quatre patients ont negative l’AgHBs: tenofovir (1/77) et lamivudine (3/20). Aucune resistance n’a ete observee avec le tenofovir. Avec la lamivudine, le taux de resistance a ete a 1 an (13%), 2 ans (24%), 3 ans 34,8%), 4 ans (46,3%) et 5 ans (59,8%). L’observance a ete totale chez 66 patients (68%), moderee chez 14 patients (14,4%), et 17 patients (17,5%) ont ete non observants.

Background & Aims To eliminate hepatitis B virus (HBV) infection, it is essential to scale up antiviral treatment through decentralized services. However, access to the conventional tools to assess treatment eligibility (liver biopsy/Fibroscan®/HBV DNA) is limited and not affordable in resource-limited countries. We developed and validated a simple score to easily identify patients in need of HBV treatment in Africa. Methods As a reference, we used treatment eligibility determined by the European Association for the Study of the Liver based on alanine aminotransferase (ALT), liver histology and/or Fibroscan and HBV DNA. We derived a score indicating treatment eligibility by a stepwise logistic regression using a cohort of chronic HBV infection in The Gambia (n = 804). We subsequently validated the score in an external cohort of HBV-infected Africans from Senegal, Burkina Faso, and Europe (n = 327). Results Out of several parameters, two remained in the final model, namely HBV e antigen (HBeAg) and ALT level, constituting a simple score (treatment eligibility in Africa for the hepatitis B virus: TREAT-B). The score demonstrated a high area under the receiver operating characteristic curve (0.85, 95% CI 0.79–0.91) in the validation set. The score of 2 and above (HBeAg-positive and ALT ≥20 U/L or HBeAg-negative and ALT ≥40 U/L) had a sensitivity and specificity for treatment eligibility of 85% and 77%, respectively. The sensitivity and specificity of the World Health Organization criteria based on the aspartate aminotransferase-to-platelet ratio index (APRI) and ALT were 90% and 40%, respectively. Conclusions A simple score based on HBeAg and ALT had a high diagnostic accuracy for the selection of patients for HBV treatment. This score could be useful in African settings. Lay summary Limited access to the diagnostic tools used to assess treatment eligibility (liver biopsy/Fibroscan/hepatitis B virus DNA) has been an obstacle to the scale up of hepatitis B treatment programs in low- and middle-income countries. Using the data from African patients with chronic HBV infection, we developed and validated a new simple diagnostic score for treatment eligibility, which only consists of hepatitis B virus e antigen and alanine aminotransferase level. The diagnostic accuracy of the score for selecting patients for HBV treatment was high and could be useful in African settings.

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.

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.