Brucellosis in dairy herds: a public health concern in the milk supply chains of West and Central Africa

Ten herd-level cross-sectional studies were conducted in peri-urban dairy production areas of seven West and Central African countries (Burkina Faso, Burundi, Cameroon, Mali, Niger, Senegal and Togo). The objectives were to estimate herd level Brucella spp. seroprevalence and identify risk factors for seropositivity. In each of the ten study areas, herds (between 52 and 142 per area, total = 965) were selected probabilistically and a structured questionnaire was administered to gather information on their structure and management. A bulk milk sample from each herd was tested by indirect ELISA for Brucella spp. For each area, herd seroprevalence estimates were obtained after adjusting for the assumed performance of the diagnostic test. Herd level risk factors for Brucella spp. seropositivity were identified by means of stratified logistic regression, with each peri-urban zone as a stratum. Area-specific models were also explored. Estimated herd seroprevalences were: Lomé (Togo) 62.0% (95% CI:55.0-69.0), Bamako (Mali) 32.5% (95% CI:28.0-37.0), Bujumbura (Burundi) 14.7% (95%CI:9.4-20.8), Bamenda (Cameroon) 12.6% (95% CI:7.6-21.9), Ouagadougou (Burkina Faso) 3.0% (95% CI:1.0-9.1), Ngaoundere (Cameroon) 2.3% (95% CI:1.0-7.0), Thies (Senegal) 1.3% (95% CI:0.1, 5.3), Niamey (Niger) 1.2% (95% CI:0.08-5.3), Dakar (Senegal) 0.2% (95% CI:0.01-1.7) and Niakhar (Senegal) <0.04%. Logistic regression modelling revealed transhumant herds to be at lower risk of infection (adjusted OR: 0.25, 95% CI: 0.13 - 0.5) and in one of the areas (Bamenda), regular purchase of new animals was found to be strongly associated with Brucella spp. seropositivity (adjusted OR = 5.3, 95% CI: 1.4-25.9). Our findings confirm that Brucella spp. circulates among dairy cattle supplying milk to urban consumers in West and Central Africa, posing a serious public health concern. Control programs are urgently needed in areas such as Lomé or Bamako, where more than 30% of the herds show evidence of infection

LA PELLAGRE: ASPECTS EPIDEMIOLOGIQUES ET CLINIQUES DANS LA REGION OUEST DU BURKINA FASO

Introduction: La pellagre est une carence en vitamine PP qui regroupe l’acide nicotinique ou niacine et le nicotinamide. Elle est encore fréquente dans notre pays. Le but de cette étude était de décrire les aspects épidémiologiques et cliniques de la pellagre dans la région Ouest du Burkina Faso. Patients et Méthodes: Il s’est agi d’une étude rétrospective, descriptive à partir des dossiers des patients ayant consulté ou ayant été hospitalisés dans les services de dermatologie-vénéréologie et de psychiatrie à Bobo-Dioulasso, de 2005 à 2012. Résultats: Durant la période, 223 cas de pellagre ont été enregistrés. L’âge moyen des patients était de 37,7+17,2 ans avec des extrêmes de 6 et 85 ans et un sex-ratio de 1/3. Ces cas ont été observés dans les zones aussi bien rurales qu’urbaines de l’Ouest du Burkina Faso. Les femmes étaient les plus atteintes (76,7%), particulièrement les femmes au foyer (47,1%). Les formes ulcéreuses représentaient 6,3% des cas, les atteintes neurologiques 62% et la diarrhée chronique (6,5%). Trois patients sont décédés (1,3%). Conclusion: La pellagre est une affection fréquente chez les femmes dans l’Ouest du Burkina Faso où le maïs constitue la céréale de base dans l’alimentation des populations. Les formes ulcéreuses pouvaient égarer le diagnostic. Une sensibilisation de la population est indispensable pour prévenir cette affection

Performance-based financing to increase utilization of maternal health services: Evidence from Burkina Faso

Performance-based financing (PBF) programs are increasingly implemented in low and middle-income countries to improve health service quality and utilization. In April 2011, a PBF pilot program was launched in Boulsa, Leo and Titao districts in Burkina Faso with the objective of increasing the provision and quality of maternal health services. We evaluate the impact of this program using facility-level administrative data from the national health management information system (HMIS). Primary outcomes were the number of antenatal care visits, the proportion of antenatal care visits that occurred during the first trimester of pregnancy, the number of institutional deliveries and the number of postnatal care visits. To assess program impact we use a difference-in-differences approach, comparing changes in health service provision post-introduction with changes in matched comparison areas. All models were estimated using ordinary least squares (OLS) regression models with standard errors clustered at the facility level. On average, PBF facilities had 2.3 more antenatal care visits (95% CI [0.446–4.225]), 2.1 more deliveries (95% CI [0.034–4.069]) and 9.5 more postnatal care visits (95% CI [6.099, 12.903]) each month after the introduction of PBF. Compared to the service provision levels prior to the interventions, this implies a relative increase of 27.7 percent for ANC, of 9.2 percent for deliveries, and of 118.7 percent for postnatal care. Given the positive results observed during the pre-pilot period and the limited resources available in the health sector, the PBF program in Burkina Faso may be a low-cost, high impact intervention to improve maternal and child health