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The extraction of natural resources, such as minerals, oil, and gas, can have profound economic effects. The application of economic analysis methods in impact studies of resource extraction projects holds potential to inform decision-making in order to optimise gains and minimise negative externalities. This paper aims to identify and characterise peer-reviewed publications that report on economic studies implemented as part of impact assessments of resource extraction projects. We conducted a systematic scoping review in PubMed and Scopus of articles published between 1998 and 2020. Out of 1,579 raw hits, we identified 13 articles describing 15 economic analyses of resource extraction projects. Half of the identified papers presented economic analyses conducted in the context of mining and oil/gas projects. The majority of the identified studies dealt with the cost and/or benefits of environmental and/or social impacts. Only one study investigated economic aspects associated with potential health impacts. Given the small number of papers identified, economic analysis of impacts associated with natural resource extraction projects seems to be a small field of published research. Yet the inclusion of economic analysis in impact assessment of resource extraction projects holds promise to better harness benefits for local communities and governments while minimising negative externalities. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

BackgroundAccording to the World Health Organization the global burden of nosocomial infections is poorly characterized as surveillance systems for nosocomial infection are lacking. Nosocomial infections occur at higher rates in low- and lower-middle-income countries (LMICs) than in high-income countries (HICs). Current global RSV burden estimates are largely based on community-acquired disease. We aimed to characterize children with nosocomial RSV-related mortality and to understand the potential impact of RSV immunization strategies.MethodsRSV GOLD is a global registry of children younger than 5 years who died with laboratory-confirmed RSV infection. We compared clinical and demographic characteristics of children with nosocomial and community-acquired RSV in-hospital mortality.ResultsWe included 231 nosocomial and 931 community-acquired RSV-related in-hospital deaths from 65 countries. Median age at death was similar for both groups (5.4 vs 6 months). As expected, a higher proportion of children with nosocomial infection had comorbidities (87% vs 57%; pConclusionsThis is the first global case series of children dying with nosocomial RSV infection. Future infant-targeted immunization strategies can prevent the majority of nosocomial RSV-related deaths. Although nosocomial RSV deaths are expected to occur at highest rates in LMICs, the number of reported nosocomial RSV deaths was low in these countries. Hospital-based surveillance is needed to capture the full burden of nosocomial RSV mortality in LMICs.Key pointsThe proportion of reported nosocomial RSV-related deaths is substantially lower in lower-middle-income countries than in upper-middle-income countries and high-income countries (12% vs 18% and 26%, respectively).The majority of nosocomial RSV-related deaths can be prevented by infant-targeted immunization strategies as more than half were younger than 6 months of age.

This study evaluates the combined impact of school vegetable gardens linked to complementary nutrition education on the nutritional awareness, knowledge, perceptions, and eating behavior of 8–14-ye...

In 2011, an industrial copper mine was developed in northwestern Zambia. A health impact assessment was conducted to anticipate and address potential health impacts. To monitor these impacts, three community-based surveys were conducted in the area (2011, 2015 and 2019). We analysed these data to determine how household socioeconomic indicators – considered determinants of health – have changed in the area over time. In mine-impacted communities, between 2011 (pre-construction) and 2019, significant changes were observed for: (i) average household size (-0.6 members); (ii) proportion of mothers that have not completed primary school (+20.4%); (iii) ownership of economic assets (e.g. phones +29.3%; televisions +15.6%); (iv) access to safe drinking water (+27.4%); and (v) improved housing structures (e.g. finished roof +58.6%). When comparing changes between 2015 and 2019 in impacted communities to nearby comparison communities, there was (i) an increased proportion of mothers that had not completed primary school in comparison communities vs. no change in impacted communities; and (ii) increased ownership of economic assets in impacted vs. comparison communities in 2019. This study found generally positive changes in the socioeconomic development of impacted compared to comparison communities, with the most pronounced improvements in the early phases of mine development.

BackgroundThis study aimed to assess the pharmacokinetic profile of 150 mg rifabutin (RBT) taken every other day (every 48 h) versus 300 mg RBT taken every other day (E.O.D), both in combination with lopinavir/ritonavir (LPV/r), in adult patients with human immunodeficiency virus (HIV) and tuberculosis (TB) co-infection.MethodsThis is a two-arm, open-label, pharmacokinetic, randomised study conducted in Burkina Faso between May 2013 and December 2015. Enrolled patients were randomised to receive either 150 mg RBT EOD (arm A, 9 subjects) or 300 mg RBT EOD (arm B, 7 subjects), both associated with LPV/r taken twice daily. RBT plasma concentrations were evaluated after 2 weeks of combined HIV and TB treatment. Samples were collected just before drug ingestion and at 1, 2, 3, 4, 6, 8, and 12 h after drug ingestion to measure plasma drug concentration using an HPLC-MS/MS assay.ResultsThe Cmax and AUC0–12hmedians in arm A (Cmax = 296 ng/mL, IQR: 205–45; AUC0–12h = 2528 ng.h/mL, IQR: 1684–2735) were lower than those in arm B (Cmax = 600 ng/mL, IQR: 403–717; AUC0–12h = 4042.5 ng.h/mL, IQR: 3469–5761), with a statistically significant difference in AUC0–12h(p = 0.044) but not in Cmax (p = 0.313). No significant differences were observed in Tmax (3 h versus 4 h). Five patients had a Cmax below the plasma therapeutic limit ( 64 ng/mL) in the 300 mg RBT arm, while 4/9 patients had such values in the 150 mg RBT arm.ConclusionThis study confirmed that the 150 mg dose of rifabutin ingested EOD in combination with LPV/r is inadequate and could lead to selection of rifamycin-resistant mycobacteria.Trial registrationPACTR201310000629390, 28th October 2013.

Health is central to sustainable development, and thus a cross-cutting issue of the SustainableDevelopment Goal (SDG) 2030 agenda. Natural resource extraction projects in Africa haveconsiderable potential to impact on health-related targets of the SDGs. This paper introducesthe rationale and organization of the HIA4SD Project; a 6-year research for development (r4d)project that aims to inform and facilitate a policy dialogue at the national and internationallevel on whether current regulatory approaches to impact assessment in Africa promotesustainable development, placing emphasis on SDG3Good Health and Well-being. TheHIA4SD Project has a focus on large-scale natural resource extraction projects and is imple-mented in four African countries, namely Burkina Faso, Ghana, Mozambique and Tanzania.

Large-scale mining can alter the living conditions of surrounding communities in positive and negative ways. A health impact assessment conducted in the context of a newly developed large-scale copper mine in rural Zambia gave us the opportunity to measure changes in health determinants over time. We conducted periodic household surveys at baseline in 2011, during the construction phase in 2015 and during the operational phase in 2019. Data collected included economic indicators that were based on the standardized list of household assets used in the Zambia Demographic and Health Survey, which we subsequently converted into a wealth score using principal component analysis. We compared mean wealth scores in six communities directly impacted by the mine with comparison communities, as well as the rest of the North-Western province of Zambia. A difference-indifferences linear regression model was used to compare changes over time. Mean wealth of the communities near the mine was significantly lower at baseline than that of the North-Western province (? 0.54 points; pvalue< 0.001) in 2011, but surpassed the regional average in 2019 (+1.07 points; p-value

The potential health benefits of combined agricultural, nutrition, water, sanitation, and hygiene (WASH) interventions are poorly understood. We aimed to determine whether complementary school garden, nutrition, and WASH interventions reduce intestinal parasites and improve school children’s nutritional status in two regions of Burkina Faso. A cluster-randomized controlled trial was conducted in the Plateau Central and Center-Ouest regions of Burkina Faso. A total of 360 randomly selected children, aged 8–15 years, had complete baseline and end-line survey data. Mixed regression models were used to assess the impact of the interventions, controlling for baseline characteristics. The prevalence of intestinal parasitic infections decreased both in intervention and control schools, but the decrease was significantly higher in the intervention schools related to the control schools (odds ratio [OR] of the intervention effect = 0.2, 95% confidence interval [CI] = 0.1–0.5). Indices of undernutrition did not decrease at end-line in intervention schools. Safe handwashing practices before eating and the use of latrines at schools were significantly higher in the intervention schools than in the control schools at end-line (OR = 6.9, 95% CI = 1.4–34.4, and OR = 14.9, 95% CI = 1.4–153.9, respectively). Parameters of water quality remained unchanged. A combination of agricultural, nutritional, and WASH-related interventions embedded in the social–ecological systems and delivered through the school platform improved several child health outcomes, including intestinal parasitic infections and some WASH-related behaviors. Sustained interventions with stronger household and community-based components are, however, needed to improve school children’s health in the long-term.

We report 1,327 probable cases of dengue in Burkina Faso in 2016. Of 35 serum samples tested by a trioplex test, 19 were confirmed dengue virus (DENV)‒positive: 11 DENV-2, 6 DENV-3, 2 nontypeable, and 1 DENV-2/DENV-3 co-infection. Molecular testing should be conducted to correctly identify causative agents in this complex infectious disease landscape.

BackgroundTo evaluate the pharmacokinetic of plasma lopinavir (LPV) and ritonavir (RTV) when co-administered with three times weekly (TPW) rifabutin (RBT) at a dose of either 150 or 300 mg in African tuberculosis (TB) and HIV co-infected adult patients.MethodsThis is a pharmacokinetic study conducted in Ouagadougou among patients treated with a standard dosage of LPV/RTV 400/100 mg twice daily and RBT 150 mg TPW (arm A = 9 patients) or rifabutin 300 mg TPW (arm B = 7 patients) based regimens. Patients were recruited from the Bogodogo and Kossodo district hospitals in Ouagadougou from May 2013 to December 2015. Study inclusion criteria were that the patients were between 18 and 60 years of age, HIV-1 infected with pulmonary tuberculosis confirmed or suspected. Subsequent blood samples for pharmacokinetic monitoring were collected at 1, 2, 3, 4, 6, 8 and 12 h after combined drug ingestion for plasma drug monitoring using HPLC/MS assays.ResultsThe medians LPV Cmaxand Tmaxwere respectively, 20 μg/mL and 4 h for the RBT 150 mg group (arm A) and 7.7 μg/mL and 3 h for the RBT 300 mg group (arm B). The AUC0–12of LPV was 111.8 μg h/mL in patients belonging to arm A versus 69.9 μg/mL for those in arm B (p = 0.313). The C0of LPV was lower than 4 μg/mL in three patients receiving RBT 300 mg. Of note, the RTV plasma concentrations were nearly halved among patients on RBT 300 mg compared to those on lower RBT doses. The AUC0–12of RTV in arm A was 12.7 μg h/mL versus 6.6 μg h/ml in arm B (p = 0.313).ConclusionIn our study, the pharmacokinetic of LPV and RTV was found to be highly variable when coadministrated with RBT 150 mg or 300 mg three times per week. There is a need for specific large study to verify clinical and virological effects of this variation, especially when coadministrated with RBT of 300 mg TPW, and to prevent viral resistance in response to under-dosing of LPV.Trial registrationPACTR201310000629390. Registered 28 October 2013,http://www.pactr.org/

Background Malnutrition and intestinal parasitic infections are common among children in Burkina Faso and Nepal. However, specific health-related data in school-aged children in these two countries are scarce. In the frame of a larger multi-stakeholder project entitled “Vegetables go to School: Improving Nutrition through Agricultural Diversification” (VgtS), a study has been designed with the objectives to: (i) describe schoolchildren’s health status in Burkina Faso and Nepal; and to (ii) provide an evidence-base for programme decisions on the relevance of complementary school garden, nutrition, water, sanitation and hygiene (WASH) interventions. Methods/Design The studies will be conducted in the Centre Ouest and the Plateau Central regions of Burkina Faso and the Dolakha and Ramechhap districts of Nepal. Data will be collected and combined at the level of schools, children and their households. A range of indicators will be used to examine nutritional status, intestinal parasitic infections and WASH conditions in 24 schools among 1144 children aged 8–14 years at baseline and a 1-year follow-up. The studies are designed as cluster randomised trials and the schools will be assigned to two core study arms: (i) the ‘complementary school garden, nutrition and WASH intervention’ arm; and the (ii) ‘control’ arm with no interventions. Children will be subjected to parasitological examinations using stool and urine samples and to quality-controlled anthropometric and haemoglobin measurements. Drinking water will be assessed for contamination with coliform bacteria and faecal streptococci. A questionnaire survey on nutritional and health knowledge, attitudes and practices (KAP) will be administered to children and their caregivers, also assessing socioeconomic, food-security and WASH conditions at household level. Focus group and key-informant interviews on children’s nutrition and hygiene perceptions and behaviours will be conducted with their caregivers and school personnel. Discussion The studies will contribute to fill a data gap on school-aged children in Burkina Faso and Nepal. The data collected will also serve to inform the design of school-based interventions and will contribute to deepen the understanding of potential effects of these interventions to improve schoolchildren’s health in resource-constrained settings. Key findings will be used to provide guidance for the implementation of health policies at the school level in Burkina Faso and Nepal. Trial registration ISRCTN17968589 (date assigned: 17 July 2015)

The artisanal and small-scale gold mining (ASGM) sector in Burkina Faso increasingly employs cyanide leaching to exploit the natural resource gold. The long-term consequences of chronic cyanide exposure in humans have yet to be fully elucidated. Meanwhile, the local health and development actors are facing immediate, unfamiliar challenges. The aim of this study was to deepen the understanding of cyanide exposure pathways, potential human exposure and associated health effects in ASGM communities in order to tailor health promotion and sustainable development recommendations for local actors. In April and May 2017, a cross-sectional epidemiological study was carried out in three ASGM sites in Burkina Faso. Three exposure groups were included: (i) miners using cyanide; (ii) miners who do not use cyanide; and (iii) ASGM community members not directly involved in mining. A questionnaire was administered to all study participants, followed by a finger prick blood sample to determine blood lactate level as a proxy indicator for cyanide exposure. Overall, 279 individuals participated (99 cyanide-using miners, 90 non-cyanide using miners and 90 community members not involved in mining activities). Mean blood lactate levels were significantly higher in miners using cyanide (4.7 mmol/L, 95% confidence interval (CI) 3.8–5.6 mmol/L), compared to non-cyanide using miners (3.4 mmol/L, 95% CI 2.9–3.7 mmol/L) and other community members not involved in mining activities (2.8 mmol/L, 95% CI 2.4–3.2 mmol/L). Multiple linear regression found loss of short-term memory reported by participants associated with higher blood lactate level. In view of our findings, we conclude that the use of cyanide in Burkina Faso’s ASGM sector is associated with potential negative health effects. Hence, specific public health interventions are warranted, such as raising awareness among miners of the risks of cyanide use, promotion of protective measures and strengthening of health sector capacities to recognize and manage mining-related health issues and law enforcement.

The emergence of HIV-1 drug resistance (HIVDR) is a public health problem that affects women and children. Local data of HIVDR is critical to improving their care and treatment. So, we investigated HIVDR in mothers and infants receiving antiretroviral therapy (ART) at Saint Camille Hospital of Ouagadougou, Burkina Faso. This study included 50 mothers and 50 infants on ART. CD4 and HIV-1 viral load were determined using FACSCount and Abbott m2000rt respectively. HIVDR was determined in patients with virologic failure using ViroSeq HIV-1 Genotyping System kit on the 3130 Genetic Analyzer. The median age was 37.28 years in mothers and 1.58 year in infants. Sequencing of samples showed subtypes CRF02_AG (55.56%), CRF06_cpx (33.33%) and G (11.11%). M184V was the most frequent and was associated with highlevel resistance to 3TC, FTC, and ABC. Other mutations such as T215F/Y, D67N/E, K70R, and K219Q were associated with intermediate resistance to TDF, AZT, and 3TC. No mutation to LPV/r was detected among mothers and infants. The findings of HIVDR in some mothers and infants suggested the change of treatment for these persons.

Background Multiple factors determine children’s nutritional status, including energy and nutrient intake, recurrent infectious diseases, access (or lack thereof) to clean water and improved sanitation, and hygiene practices, among others. The “Vegetables go to School: improving nutrition through agricultural diversification” (VgtS) project implements an integrated school garden programme in five countries, including Burkina Faso. The aim of this study was to determine the prevalence of undernutrition and its risk factors among schoolchildren in Burkina Faso before the start of the project. Methods In February 2015, a cross-sectional survey was carried out among 455 randomly selected children, aged 8–14 years, in eight schools in the Plateau Central and Centre-Ouest regions of Burkina Faso. Nutritional status was determined by anthropometric assessment. Helminth and intestinal protozoa infections were assessed using the Kato-Katz and a formalin-ether concentration method. A urine filtration technique was used to identify Schistosoma haematobium eggs. Prevalence of anaemia was determined by measuring haemoglobin levels in finger-prick blood samples. Questionnaires were administered to children to determine their knowledge of nutrition and health and their related attitudes and practices (KAP). Questionnaires were also administered to the children’s caregivers to identify basic household socio-demographic and economic characteristics, and water, sanitation and hygiene (WASH) conditions. To determine the factors associated with schoolchildren’s nutritional status, mixed logistic regression models were used. Differences and associations were considered statistically significant if P-values were below 0.05. Results Complete datasets were available for 385 children. The prevalence of undernutrition, stunting and thinness were 35.1%, 29.4% and 11.2%, respectively. The multivariable analysis revealed that undernutrition was associated with older age (i.e. 12–14 years compared to

Objective: Giardiasis, a zoonotic, diarrheal disease with worldwide occurrence, is routinely diagnosed by microscopic examination of stool samples. However, implementation of this method relies on skilled and experienced personal; it is time consuming and relatively low in sensitivity. A superior diagnostic approach to detect the causative agent Giardia intestinalis would, hence, be highly desirable. The current study aimed to assess realtime polymerase chain reaction (PCR) for the detection of G. intestinalis as an alternative to microscopy. Material and methods: Stool samples from healthy schoolchildren aged 8-14 years from eight schools of the Centre-Ouest and Plateau Central regions in Burkina Faso were therefore collected within a cross-sectional study. Microscopic examination was performed on two faecal samples collected over two consecutive days from 441 schoolchildren. Each faecal specimen has been examined using Kato-Katz and formol-ether methods of concentration in addition to the direct examination. Real-time PCR was used to detect G. intestinalis in the 94 microscopy positive and the 53 microscopy negative samples. Results: Microscopic examination demonstrated an overall G.intestinalis prevalence of 27.2%. Using the microscopic examination as the ‘gold standard’, the overall sensitivity of real-time PCR was demonstrated to be 76.6% ranging from 58.3% to 94.1% and the specificity was 96.2% ranging from 96.2% to 100% across the schools assessed. Conclusion: Real-time PCR appears to be a solid detection method for G. intestinalis in this current setting. However, it needs to be further optimized to become a more sensitive tool for G. intestinalis diagnosis in low income settings.

Background: In 1996, tuberculosis detection rate was higher in Oudalan (Sahel region) than in other provinces in Burkina Faso. Cattle breeding, a major activity of the local population, may favor exposure of humans to bovine tuberculosis. Objectives: (i) to isolate and identify M. bovis among new cases of tuberculosis with positive culture in the Sahel (Gorom-Gorom and Dori); the Center (Ouagadougou) and the Western (Bobo-Dioulasso) regions of the country; (ii) to investigate susceptibility of isolated strains to anti-tuberculosis. Methods: (i) collection of sputum from newly TB patients with a positive smear during a prospective study carried out in 1998 in the North, Central and Western region of the country and transferred at the Mycobacteriology Laboratory, (ii) optimization of operational procedures: (iii) mycobacteria strains's isolation on 3 different media (Loweinstein Jensen (LJ), LJ without glycerine and LJ supplemented with pyruvate; (iv) identification of the tuberculosis complex according to criteria such as: bacillus growth time, colony appearance, biochemical test results, bacilli growth with pyrazinamide or thiophene carboxylate hydrazide, or D-cycloserine; (v) performing antibiograms. Results: Among the isolated strains, M. bovis represented 6.2% (2/30) in Gorom-Gorom, 0% (0/18) in Dori, 2.6% (3/109) in Ouagadougou and 2.9% (2/65) in Bobo-Dioulasso. Sixty nine percent (31/45) of strains were susceptible to the main anti-tuberculosis drugs, 13 strains presented single or combined resistance and one strain was multidrug-resistant. Conclusion: We showed that M. bovis disease is prevalent in all the studied regions but at a relatively low rate. The transhumance of from the north to the west practiced by the breeders could explain why it was found M. bovis in a similar rate as in Ouagdougou and Bobo-Dioulasso where livestock activity is less intense than in Gorom-Gorom.

BACKGROUND Although 90% of HIV-1-infected children live in sub-Saharan Africa, morbidity data after highly active antiretroviral therapy (HAART) initiation in these settings are limited. The objective of this study was to document the incidence of AIDS-defining events and non-AIDS-defining diseases in African children receiving HAART. METHODS Incidences rates (IRs) of AIDS-defining events and 10 other common diseases were estimated overall and by current CD4-strata (

Background: We demonstrated the feasibility of implanting the Dynabeads method for CD4+ T lymphocyte enumeration in resource-poor settings (ANRS 1226 study). However, as this technique requires a fluorescence microscope which is not usually available in these settings, WHO has encouraged to simplify the method allowing TCD4+ lymphocyte counting under a light microscope. Methods: TCD4+ lymphocytes enumeration was assessed using Dynabeads after staining cells nuclei with nonfluorescent dyes and readings under light microscope (DLM). A total of 305 triple of values of CD4 cells counts were generated by both Dynabeads method using a light microscopy (DLM), Dynabeads method using a fluorescent microscope (DFM) and the single-platform flow cytometry technique (FCM). The accuracy of DLM was analyzed using 4 fresh blood samples showing 200, 400, 500 and 1000 cells/μl in FCM respectively. Correlations have been studied between the 3 methods. The DLM was then evaluated for its ability to correctly segregate absolute TCD4+ lymphocyte values at the thresholds of 200 cells/μl and 350 cells/μl. Findings: Cells nuclei staining with Sternheimer-Malbin, Turck1, and Giemsa allows TCD4+ lymphocytes enumeration using DLM. FCM has shown the greatest standard deviations and amplitudes. The reproducibility of DLM was better than FCM. The correlation coefficient between FCM and DFM was 0.975 and it was 0.973, 0.972 and 0.969 with DLM using Sternheimer-Malbin, Turck1 and Giemsa, respectively. The ability of DLM to correctly segregate TCD4+ lymphocyte values at the threshold of 200 cells/μl and 350 cells/μl was good. Conclusion: Reliable TCD4+ enumeration can be obtained with DLM. These results will contribute in resourcelimited- settings to further reduce the cost of TCD4+ lymphocytes counting and make it more widely available in peripheral laboratories and even in central laboratories that face problems with maintenance and stock-out of reagents for flow cytometers.

Background: Klebsiella spp. are Enterobacteriaceae frequently isolated from pathological specimens during urinary tract infections, bloodstream infection, and pus. They are becoming more and more resistant to antibiotics and challenging treatment options. β-lactamases are a great variety of enzymes capable of inducing resistance to β- lactams. The objective of this study was to identify extended-spectrum-β-lactamase (ESBL) genes in Klebsiella spp. strains isolated from various specimens in Lome, Togo. Methods: Sixty-four strains of Klebsiella spp. were isolated from different pathological specimens. They were then further characterized and tested against 3rd generation cephalosporin (ceftazidime, ceftriaxone, cefotaxime) and aztreonam. The detection of blaTEM, blaSHV and blaCTX-M was performed on these strains using simplex and multiplex PCR techniques. Results: Fifty five (85.94%) Klebsiella pneumoniae and 9 (14.06%) Klebsiella oxytoca were isolated. These strains derived from urine (n=33; 51.56%), vaginal swabs (n=21; 32.81%), pus (n=8; 12.5%) and sperm samples (n=2; 3.13%). All strains were resistant to cefepime. The resistance rate to other β-lactams was 29.69% (19/64) for piperacillin-tazobactam, 23.08% (12/52) for cefoxitin and 1.56% (1/64) for imipenem. Other inactive antibiotics were trimethoprim-sulfamethoxazole 96.72% (59/61), doxycycline 92.06% (58/63), ciprofloxacin 90.63% (58/64), nalidixic acid 80.95% (51/63), chloramphenicol 77.42% (48/62) and gentamicin 76.69% (51/64). Amikacin and fosfomycin remained the most active antibiotics with 1.56% (1/64) and 4.69% (3/64) resistance rates respectively. ESBL genes were detected in 63/64 (98.44%) strains. TEM/SHV/CTX-M was predominant 61.90% (39/63) followed by TEM/SHV 20.63% (13/63), SHV/CTX-M 11.11% (7/63), TEM/SHV 4.76% (3/63) and TEM 1.59% (1/63). Conclusion: ESBL genes occur more by combination 96.88% (62/64) than singularly 1.59% (1/63). These strains were also very resistant to quinolones and trimethoprim-sulfamethoxazole. These findings are of high importance in a medical and scientific perspective and may motivate decision makers towards a better monitoring and control of antimicrobial resistance in Togo.

Adolescent females are a key target audience in the fight against sexually transmitted infections and HIV in sub-Saharan Africa. One issue is that families in Africa play a very limited role in sex education. The objective of this study was to examine parent-child communication from a qualitative perspective by exploring the characteristics and quality of parent-child communication. A cross-sectional study was conducted between April and September 2009 in Bobo-Dioulasso (Burkina Faso). The study included 40 parent-child pairs (50% of in-school children and 50% of out-of-school children). Individual interviews and focus groups were conducted. The data were analyzed using Stata version 9.1 (quantitative data) and QSR Nvivo 2.0 (qualitative data). The study found that 74% (14/19) of out-of-school children communicated with their parents, compared to just 45% of in-school children (p = 0.07). Mother-child communication was found to be the most common type of parent-child communication, with 59% (13/22) of families who communicated about sexuality and HIV preferring mother-child communication. Further research is needed to identify the factors determining better communication among out-of-school children.

Résumé Réduire de 75% les ratios de la mortalité maternelle d’ici à 2015 est l’un des défis majeurs des pays pauvres dans le cadre des Objectifs du Millénaire pour le Développement. Au Burkina Faso, on estime que 60% des femmes accouchent toujours sans assistance médicale, et que 480 d’entre elles meurent pour 100 000 naissances vivantes. Pour relever ce défi le pays a initié depuis 1992 une stratégie dite des « médecins formés à la chirurgie essentielle », pour officier dans les hôpitaux de district. Douze ans après, l’Organisation Ouest Africaine de la Santé et le Centre Muraz ont promu une évaluation de cette stratégie, avec un volet qualitatif devant analyser les perceptions qu’ont les concernés de ses facteurs limitants. Plusieurs profils d’informateurs ont été interrogés à cet effet. La stratégie s’est avérée une option adaptée au contexte. Toutefois, sa viabilité est mise à épreuve du fait que la formation ne soit pas diplômante, avec des avantages incitatifs. Les médecins formés, qui sont aussi les « Chefs de District », s’investissaient plus dans les tâches managériales que dans les activités cliniques. Ainsi, bien qu’elle soit une réponse alternative efficace au déficit des spécialistes, la stratégie pourrait aussi être efficiente si la formation était labellisée. A défaut, un nouveau profil de chef de district pourrait être envisagé, en y excluant la condition d’être formé à la chirurgie essentielle. L’augmentation des effectifs des Attachés de Santé en Chirurgie, formés en 2 ans, et qui sont actuellement les principaux acteurs des interventions chirurgicales dans les hôpitaux de district, est déjà une alternative à portée de main. Le recyclage et le suivi des médecins formés, mais aussi le suivi du matériel (approvisionnement et maintenance) seraient également des dispositions de renforcement des acquis.

Access to antiretroviral therapy (ART) and routine laboratory monitoring are limited for HIV-1-infected children from sub-Saharan Africa. This trial conducted in Bobo-Dioulasso, Burkina Faso, aimed to describe the biological efficacy, tolerance, and adherence of the combination of didanosine, lamivudine, efavirenz in once-daily administration among eligible HIV-1-infected children. From February 2006 to November 2007, 51 HIV-1-infected children aged from 30 months to 15 years and eligible for ART were enrolled in a phase II open clinical trial with follow-up visits every 3 months. HIV-1 genotype testing was performed in children with plasma viral load (PVL) > 1000 copies per milliliter after ART initiation. Children were followed for a median of 13.4 months [interquartile range (IQR) 12.8-14.2]. At enrollment, median CD4 count was 8% (IQR = 4.5-12). PVL was 341,032 (IQR = 127,838-761,539) copies per milliliter. At 12 months, median CD4 increased significantly by +15% (P < 10(-3)), and median PVL decreases significantly by 2290,500 copies per milliliter (P < 10(-4)). Hemoglobin and platelets counts increased significantly by +1.05 g/dL (P < 10(-5)) and 108,500 cells per milliliter (P < 10(-3)), respectively. Based on pill count, mean yearly adherence was 97.3%, and 48% of the children had an adherence rate >= 95% at the four quarterly visits. Adherence was better for girls than for boys independently of other sociodemographic variables or markers of HIV disease progression. Drug-resistant mutations were found in 11 children (21.6%). This once-daily drug combination is associated with excellent virological efficacy, immune reconstitution, and good adherence. However, the high prevalence of drug resistance mutations is a matter of concern.

Rapid human immunodeficiency virus (HIV) antibody tests have been adopted into national guidelines for HIV testing in many countries in sub-Saharan Africa. One goal of HIV rapid testing is to minimize the occurrence of indeterminate results. From January 2005 to December 2007, plasma (or serum) samples from pregnant women in Bobo-Dioulasso (Burkina Faso, West Africa) were screened for HIV by using two rapid tests (the Determine HIV1/2 test [Abbott] and Genie II HIV-1/HIV-2 [Bio-Rad]) through a sequential algorithm prior to enrollment of HIV-1-infected women in a prevention of mother-to-child transmission (PMTCT) trial (WHO/ANRS 1289 Kesho Bora trial). Samples exhibiting indeterminate results (Determine positive and Genie II negative) were further tested with a fourth-generation HIV enzyme immunoassay (EIA) (Murex HIV Ag/Ab combination in 2005 and 2006 and Vironostika HIV Uni-Form II Ag/Ab in 2007). If positive, they were finally assessed for HIV-1 RNA (Generic HIV-1 RNA viral load assay; Biocentric). From a total of 44,653 samples tested, 597 (1.3%) showed indeterminate results. Of these, 367 could be analyzed by EIA. Only 15 (15/367, 4.1%) samples were found EIA reactive. Of these, 11 could be tested for HIV-1 RNA. All were HIV-1 RNA negative. In our clinical practice, pregnant women with such indeterminate results are now reassured during posttest counseling that they are very unlikely to be infected with HIV-1. As a consequence, such women with indeterminate results can reliably be considered negative when urgent clinical decisions (such as providing PMTCT prophylaxis) need to be taken.

We aimed in this study to describe lamivudine concentration-time courses in treatment-naïve children after once-daily administration, to study the effects of body weight and age on lamivudine pharmacokinetics, and to simulate an optimized administration scheme. For this purpose, lamivudine concentrations were measured in 49 children after at least 2 weeks of didanosine-lamivudine-efavirenz treatment. A total of 148 plasma lamivudine concentrations were measured, and a population pharmacokinetic model was developed with NONMEM. The influence of individual characteristics was tested using a likelihood ratio test. Children were divided into two groups, according to their pharmacokinetic parameters, thanks to tree regression analysis. For each patient, the area under the curve was derived from estimated individual pharmacokinetic parameters. Different once-daily doses were simulated in each group, to obtain the same exposure in children as the mean effective exposure in adults (8.9 mg/liter·h). A two-compartment model in which the slope of distribution is assumed to be equal to the absorption rate constant adequately described the data. Parameter estimates were standardized for a mean standard body weight using an allometric model. Children were then divided into 2 groups according to body weight: CL/Fwas significantly higher in children weighing less than 17 kg (1.12 liters/h/kg) than in children over 17 kg (0.95 liters/h/kg;P= 0.01). The target mean AUC of 8.9 mg/liters·h was obtained with a 10-mg/kg once-daily lamivudine (3TC) dose for children below 17 kg; the recommended dose of 8 mg/kg seems to be sufficient in children weighing more than 17 kg. These assumptions should be prospectively confirmed.

Our objective was to study didanosine pharmacokinetics in children after the administration of tablets, the only formulation available in Burkina Faso for which data are missing, and to establish relationships between doses, plasma drug concentrations, and treatment effects (efficacy/toxicity). Didanosine concentrations were measured for 40 children after 2 weeks and for 9 children after 2 to 5 months of treatment with a didanosine-lamivudine-efavirenz combination. A population pharmacokinetic model was developed with NONMEM. The link between the maximal concentration of the drug in plasma (Cmax), the area under the concentration-time curve (AUC), and the decrease in human immunodeficiency virus (HIV) type 1 RNA levels after 12 months of treatment was evaluated. The threshold AUC that improved efficacy was determined by the use of a Wilcoxon test for HIV RNA, and an optimized dosing schedule was simulated. Didanosine pharmacokinetics was best described by a one-compartment model with first-order absorption and elimination. The apparent clearance and volume of distribution were higher for tablets, probably due to a lower bioavailability with tablets than with pediatric powder. The decrease in the viral load after 12 months of treatment was significantly correlated with the didanosine AUC andCmax(P≤ 0.02) during the first weeks of treatment. An AUC of >0.60 mg/liter·h was significantly linked to a greater decrease in the viral load (a decrease of 3 log10versus 2.4 log10copies/ml;P= 0.03) than that with a lower AUC. A didanosine dose of 360 mg/m2administered as tablets should be a more appropriate dose than 240 mg/m2to improve efficacy for these children. However, data on adverse events with this dosage are missing.

We conducted a molecular epidemiology study on 120 Mycobacterium tuberculosis isolates from patients presenting pulmonary tuberculosis (TB) in Burkina Faso. Classical antibiogram studies and genetic characterization, using mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) typing and spoligotyping, were applied after culture. Molecular analysis of specific signatures showed that all TB cases reported in this study were caused by M. tuberculosis and identified no Mycobacterium bovis or Mycobacterium africanum isolates. This result is unexpected, as M. africanum strains were reportedly the etiologic agent in 20% of TB cases 2 decades ago. The comparison of spoligotypes from Burkina Faso with an international spoligotype database (SpolDB4) showed that the majority of isolates belong to major clades of M. tuberculosis (Haarlem, 9%; Latin American-Mediterranean, 30%; and T, 20%). The predominant group of isolates (30%) corresponds to spoligotype 61, described in Cameroon as the “Cameroon family.” In Burkina Faso, as in Cameroon, this family could be associated with recent transmission of TB, suggesting a recent expansion in West Africa. Our data suggest a low level of primary drug resistance that may be a positive result of the Directly Observed Therapy Shortcourse program. Besides, based on spoligotyping plus MIRU-VNTR, data showed a high number of clusters in our sample, suggesting a high level of recent TB transmission in Burkina Faso. Nevertheless, an important genetic polymorphism was observed in this country, reflecting an endemicity situation where the control of TB would have less impact in the main towns.

Background and objective : Little information is available on the rapid diagnostic testing for syphilis in Burkina Faso. The objectives of the study were (i) to assess the sensitivity and specificity of four on site rapid tests in comparison with Treponema pallidum haemagglutination assay (TPHA) as a gold standard and (ii) to evaluate the operational characteristics of those tests among health workers in a maternity unit. Methods : Four rapid syphilis tests commercially available in Burkina Faso were evaluated using archived serum samples and Treponema pallidum hemagglutination assay (TPHA) as the gold standard. Blood samples were collected between November 2011 and June 2012 from blood donors at the Regional Blood Transfusion Center of Ouagadougou. The sensitivity and specificity of the tests were calculated. Evaluation of operational characteristics such as clarity of pamphlet, complexity of technique, duration, was conducted in a first-level healthcare center with health workers in maternity unit. Results : Alere DetermineTM Syphilis was the most sensitive of the four rapid syphilis tests evaluated. It was followed by SD Bioline Syphilis 3.0, Cypress Diagnostics Syphilis Quick test and Accu-Tell ® Rapid Anti-TP, which was the least sensitive. The four tests demonstrated a good diagnostic specificity for syphilis (95–98%), and healthcare workers found them easy to use. Conclusions : The study allowed confirming the good performance of three of four rapid syphilis tests in Burkina Faso. More research will be conducted to assess the feasibility of introducing selected rapid tests for syphilis in antenatal care services. Keywords : syphilis, rapid test, performance, Burkina Faso

Objective: To evaluate the feasibility and the relevance of the implementation of an alternative technique to flow cytometry (FC) for enumerating CD4 T cells (Dynabeads; Dynal Biotech Oslo Norway) based on quantifying CD4 T cells by epifluorescent microscopy following their isolation using anti-CD4 monoclonal antibody-coated magnetic beads. Design: International multi-center study. Five consecutive runs of dual CD4 T-lymphocyte enumeration by both techniques in six sites in five countries of West Africa. Methods: A total of 657 pairs of values of CD4 cell counts were generated by 43 technicians by both FC (TruCount; Becton Dickinson Immunocytometry Systems San Jose California USA) and Dynabeads from blood samples obtained from 301 HIVinfected patients seen in one (n = 112) two (n = 61) three (n = 75) four (n = 40) or five (n = 13) occasions. Results: The correlation coefficient between the results of the two techniques was 0.89. The overall systematic difference between Dynabeads and FC was -16 x 10(6) cells/l (P < 10(-4)). The median difference was insignificant (+7.5 cells) for CD4 cell counts below 200 x 10(6) cells/l and increased with CD4 levels. Patients were consistently classified at the threshold of 200 x 10(6) cells/l by both methods in 88.7% of cases. Among the 74 discrepant pairs of values only 31 (4.7%) exhibited a difference of more than 100 x 10(6) cells/l. Conclusions: Results from Dynabeads and FC were highly correlated. The ability of the alternative method to consistently classify results in agreement with FC at thresholds of CD4 cell counts relevant for clinical care was high. The implementation of this low-cost method was easy and successful in the West African context. (authors)

Background This study aimed to assess the pharmacokinetic profile of rifabutin (RBT) given at 150 mg or 300 mg every other day (EOD) in tuberculosis (TB)-HIV co-infected adult patients. Methods This is a pharmacokinetic prospective, pilot, open, randomised study of two doses of RBT in combination with lopinavir/ritonavir among HIV−TB patients in Burkina. Sixteen patients were randomised in two arms: TB treatment consisting HZE standard doses in association with RBT150 mg EOD (arm A, 8 patients) or RBT300 mg EOD (arm B, 8 patients) in combination with lopinavir/ritonavir. RBT plasma concentrations were evaluated after two weeks of combined HIV and TB treatment. Samples were collected at pre-dosing and at 1, 2, 3, 4, 6, 8 and12 hours after drug ingestion to measure plasma drug concentration using HPLC–MS/MS assay. Results The mean Cmax and AUC in the RBT 150 mg arm (Cmax=0.35±0,18 µg/mL, AUC(0–24)=3.94±2,1 µg.h/mL) were significantly lower (p=0.01) than those of the RBT 300 mg arm (Cmax=0.75±0.54 µg/mL AUC(0–24)=7.1±2.7 µg.h/mL). There was no significant difference in Tmax (Tmax=3.44±2.01 hours vs Tmax=3.86±2.04 hours) p=0.687. RBT follows linear kinetics and no significant differences were apparent in the mean oral clearance (CL/F) estimates (p=0.683), which were dose independent and similar for the 2 assessment doses. Five of 8 patients in RBT150 mg arm had a Cmax below plasma therapeutic limit ( 0.06 µg/mL) compared with 4 of 8 patients in the RBT150 mg arm. The means Cmax, AUC (0–24) and Tmax of 25-O-desacetyl rifabutin of the RBT 300 mg arm were increased by 100% and 50% respectively compared to the RBT150 mg arm. Conclusions This study confirmed that the dose of rifabutin 150 mg three times a week in combination with lopinavir/ ritonavir is inadequate and could lead to the selection of rifamycin-resistant mycobacteria.

International audience; Background. To better understand the high incidence of pneumococcal meningitis in the African meningitis belt, we conducted a pneumococcal seroprevalence study during a meningococcal meningitis epidemic in Western Burkina Faso, March 2006.Methods. In 3 villages experiencing epidemics, we included 624 healthy persons (1–39 years) by cluster sampling. We determined pneumococcal serum immunoglobulin G (IgG) antibody concentrations against 12 serotypes contained in 13-valent pneumococcal conjugate vaccine, and evaluated determinants for IgG ≥ 0.35 μg/mL by multivariate logistic regression.Results. The percentage of subjects with serotype-specific IgG concentrations ≥0.35 μg/mL increased with age and was similar for the different serotypes: it was 20%–43% among 1–4-year-olds and 56%–90% among 20–39-year-olds. Prevalence of IgG ≥ 0.35 μg/mL against serotype 1 was up to 71% after age 10 years. During multivariate analyses, determinants of IgG concentrations ≥0.35 μg/mL varied by serotype; for 5 and 6 serotypes, respectively, female sex (around 2-fold increased odds) and cigarette smoking (about 5-fold reduced odds) predicted elevated titers.Conclusions. Despite a substantially higher historical pneumococcal meningitis incidence in Burkina Faso, the general population has an antibody seroprevalence against 12 pneumococcal serotypes similar to that reported from the United Kingdom. The role of putatively protective antibody seroprevalence in preventing pneumococcal meningitis in the meningitis belt requires more thorough evaluation.

In the developed word, monitoring HIV-infected patients is routinely determined by CD4+ T lymphocyte absolute counts. The reference procedure, flow cytometry, is expensive, requires sophisticated instrumentation and operators with specific training. Due to these limitations, CD4 counting is often unavailable in developing countries. The Capcellia assay is an enzyme-linked immunoassay for quantitative determination of CD4 and CD8 molecules. We evaluated this method in West Africa on blood samples collected from 39 HIV-uninfected and 44 HIV-infected adult subjects. CD4 concentration ranges were determined according to the clinical stages of the disease. We then studied the relationship between the two methods in the HIV-infected patients. The Spearman's rank correlation was 0.61 (95% confidence interval: 0.38-0.76, P0.0001). Nevertheless, determination of limits of agreement revealed discrepancies between the two methods, especially for CD4 counts0.4 x 10(9)/l, which are discussed. We conclude that the Capcellia assay is a convenient means to determine the immunodepression level where flow cytometric instrumentation is unavailable, and can be complementary to CD4 T lymphocyte enumeration.