Household costs associated with seeking malaria treatment during pregnancy: evidence from Burkina Faso and The Gambia

Background: Malaria in pregnancy remains a major health threat in sub-Saharan Africa to both expectant mothers and their unborn children. To date, there have been very few studies focused on the out of pocket costs associated with seeking treatment for malaria during pregnancy. Methods. A cross-sectional survey was undertaken in Burkina Faso and The Gambia to estimate the direct and indirect costs associated with outpatient consultations (OP) and inpatient admissions (IP). Direct costs were broken down into medical (admission fees, drug charges, and laboratory fees), and non-medical (transportation and food). Indirect costs reflected time lost due to illness. In total, 220 pregnant women in Burkina Faso and 263 in The Gambia were interviewed about their treatment seeking decisions, expenditure, time use and financial support associated with each malaria episode. Results: In Burkina Faso 6.7% sought treatment elsewhere before their OP visits, and 27.1% before their IP visits. This compares to 1.3% for OP and 25.92% for IP in The Gambia. Once at the facility, the average direct costs (out of pocket) were 3.91US$for an OP visit and 15.38US$ of an IP visit in Burkina Faso, and 0.80US$for an OP visit and 9.19US$ for an IP visit in The Gambia. Inpatient direct costs were driven by drug costs (9.27US$) and transportation costs (2.72US$) in Burkina Faso and drug costs (3.44 US$) and food costs (3.44 US$) in The Gambia. Indirect costs of IP visits, valued as the opportunity cost of time lost due to the illness, were estimated at 11.85US$in Burkina Faso and 4.07US$ in The Gambia. The difference across the two countries was mainly due to the longer time of hospitalization in Burkina Faso compared to The Gambia. In The Gambia, the vast majority of pregnant women reported receiving financial support from family members living abroad, most commonly siblings (65%). Conclusions: High malaria treatment costs are incurred by pregnant women in Burkina Faso and The Gambia. Beyond the medical costs of fees and drugs, costs in terms of transport, food and time are significant drivers. The role of remittances, particularly their effect on accessing health care, needs further investigation

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Design of a Gasification Reactor for Manufacturing and Operation in West Africa

This paper introduces the design of a biomass gasification reactor with specific constraints for its manufacturing and operation in the West African conditions. The foreseen applications are the valorisation into heat and electricity of agricultural biomass residues. Rice husk is chosen as the reference fuel for the design. Local manufacturing is a key feature and the main focus of the design, as it allows us to reduce the capital costs and facilitate the maintenance. The design methodology is based on the conceptual approach proposed by Cross. This approach leads in several steps to a rational design choice based on the evaluation of different solutions. In this study, nine reactor types have been compared leading to a prototype that best suits the defined objectives such as a local manufacturing, a secure installation and a sufficient gas quality. From this conception approach, the Semi-Batch, Fixed-bed reactor with air Aspiration appears the most suitable. Its specific characteristics for the foreseen application are a power of 44 kW based on the syngas lower heating value, an average fuel consumption of 20.38 kg/h and an average air flow of 28.8 kg/h for optimal gasification. The gasifier resulting from the design methodology has been built. It is presented in the paper

Evolution des paramètres biochimiques et hématologiques chez les personnes vivant avec le VIH/SIDA sous traitement antirétroviral au Centre Médical du Camp General Aboubacar Sangoule Lamizana

Introduction: l'objectif de ce travail était d'évaluer l'impact du traitement sur les paramètres biochimiques et hématologiques des patients VIH positifs suivis au Centre Médical du Camp Général Aboubacar Sangoulé Lamizana (CMCGASL) au Burkina Faso. Méthodes: il s'agissait d'une étude rétrospective réalisée sur la période de Janvier 2010 à septembre 2015. Seuls les patients VIH positifs sous TARV ayant réalisé un bilan biologique à l'une des périodes suivantes : à l'initiation du traitement(M0), au sixième mois(M6) et au douzième mois(M12), ont été pris en compte. Résultats: le sex-ratio des patients était de 0,88 et la tranche d'âge des 45-55 ans était la plus importante. Les trithérapies incluant 2INTI + 1INNTI (74,5%), 2INTI+1 IP (14,9%) étaient les plus prescrites. La charge virale était peu demandée. Le taux des patients réguliers aux bilans biologiques avait connu une régression statistiquement significative entre M0 (70%), et M6 (13%) (p<0,05). Une augmentation significative de la valeur moyenne des lymphocytes TCD4 allant de 79,22 à M0 à 227,95 cellules/mm3 à M12 (p<0,05) était noté chez les patients sévèrement immunodéprimés. Ascension significative du taux d'hémoglobine moyen passant de 10,5 g/dl à M0 à 12,53 g/dl à M12 (p<0,05) chez les patients qui étaient anémiés. L'analyse des paramètres biochimiques n'a pu être réalisée à cause d'une insuffisance de données. Conclusion: l'ascension du taux de lymphocytes TCD4 et du taux d'hémoglobine oriente sur l'efficacité du TARV et la tolérance au traitement. Il importe de rendre accessible la charge virale et d'améliorer le suivi biologique

Human Immunodeficiency Virus Seroconversion Among Men Who Have Sex With Men Who Use Event-Driven or Daily Oral Pre-Exposure Prophylaxis (CohMSM-PrEP): A Multi-Country Demonstration Study From West Africa

International audienceAbstract Background Data on human immunodeficiency virus (HIV) seroconversion among men who have sex with men (MSM) using pre-exposure prophylaxis (PrEP) in West Africa are needed. This study aimed to document HIV seroconversion and associated determinants, PrEP adherence, plasma drug concentrations, and HIV drug resistance in MSM using event-driven or daily PrEP in Burkina Faso, Côte d’Ivoire, Mali, and Togo. Methods A prospective cohort study was conducted in 2017–2021 among HIV-seronegative MSM aged 18 or over who were at high risk of HIV infection. Participants could choose between event-driven and daily PrEP, switch regimens, and discontinue or restart PrEP. The determinants of HIV incidence were investigated using a multivariate mixed-effects Poisson regression analysis. Results A total of 647 participants were followed for a total time of 1229.3 person-years. Of 5371 visits, event-driven PrEP was chosen in 3873 (72.1%), and daily PrEP in 1400 (26.1%). HIV incidence was 2.4 per 100 person-years (95% confidence interval [CI] 1.5–3.6) for event-driven PrEP, and 0.6 per 100 person-years (95% CI .1–2.3) for daily PrEP (adjusted incidence rate ratio 4.40, 95% CI 1.00–19.36, P = .050). Adequate adherence was lower with event-driven than daily PrEP (44.3% vs 74.9%, P < .001). Plasma drug concentrations were undetectable in 92 (97.9%) of the 94 measures taken for 23 participants who seroconverted. Only 1 participant had resistance to PrEP drugs. Conclusions HIV seroconversions mainly occurred in participants who chose event-driven PrEP. The study's data highlighted major difficulties with adherence to this regimen. Improving adherence to event-driven PrEP constitutes a major research and public health priority in this context

HIV pre-exposure prophylaxis for men who have sex with men in west Africa: a multicountry demonstration study

International audienceBackground HIV pre-exposure prophylaxis (PrEP) data in men who have sex with men (MSM) in west Africa are essential to guide its large-scale implementation. We assessed the uptake of event-driven and daily PrEP, HIV incidence, and changes over time in sexual behaviours and prevalence of bacterial sexually transmitted infections (STIs) in MSM in Burkina Faso, Côte d'Ivoire, Mali, and Togo. Methods We did a prospective cohort study from Nov 20, 2017, to April 14, 2020, in four community-based clinics in Abidjan (Côte d'Ivoire), Bamako (Mali), Lomé (Togo), and Ouagadougou (Burkina Faso). Participants were MSM aged 18 years or older at substantial risk of HIV infection. Participants could choose between event-driven (2+1+1 dosing) and daily oral PrEP (tenofovir disoproxil fumarate 300 mg plus emtricitabine 200 mg), switch regimen, and discontinue or restart PrEP. We compared HIV incidence in this study with that of the same cohort before the availability of PrEP (CohMSM). Statistical analysis included the Kaplan-Meier method and mixed-effects regression models. This study is registered with ClinicalTrials.gov, NCT03459157. Findings We followed up 598 participants for a total of 743•6 person-years. At enrolment, 445 (74%) of 598 participants chose event-driven PrEP and 153 (26%) of 598 chose daily PrEP. 60 (13%) of 445 and 65 (42%) of 153 partici pants switched PrEP regimen at least once (p<0•0001). 159 participants (27%) were lost to follow-up. Overall HIV incidence was 2•3 per 100 person-years (95% CI 1•3-3•7; adjusted incidence rate ratio 0•21, 95% CI 0•12-0•36 compared with CohMSM). Adherence was optimal in 802 (41%) of 1946 measures with event-driven PrEP and in 394 (71%) of 554 measures with daily PrEP (p<0•0001). Coverage of sex acts with PrEP only and PrEP and condom decreased during follow-up (p=0•039 if PrEP only; p=0•0025 if PrEP and condom). The frequency of condomless anal sex remained stable (p=0•96). The number of male sexual partners (p<0•0001) and number of sex acts with casual male partners (p=0•0014 for 1-4 sex acts in previous 4 weeks; p=0•030 for ≥5 sex acts) decreased. The prevalence of gonorrhoea, chlamydia, and syphilis remained stable. Interpretation PrEP availability helped prevent HIV infection and did not lead to an increase in risky sexual behaviours or other STIs. PrEP should be urgently implemented in west Africa. Retention in care and PrEP adherence require special attention to ensure PrEP reaches its full prevention potential. Funding ANRS and Expertise France

Community-based malaria screening and treatment for pregnant women receiving standard intermittent preventive treatment with sulfadoxine-pyrimethamine: a multicenter (the gambia, burkina faso, and benin) cluster-randomized controlled trial

Background. We investigated whether adding community scheduled malaria screening and treatment (CSST) with artemether- lumefantrine by community health workers (CHWs) to standard intermittent preventive treatment in pregnancy with sulfadoxine- pyrimethamine (IPTp-SP) would improve maternal and infant health. Methods. In this 2-arm cluster-randomized, controlled trial, villages in Burkina Faso, The Gambia, and Benin were randomized to receive CSST plus IPTp-SP or IPTp-SP alone. CHWs in the intervention arm performed monthly CSST during pregnancy. At each contact, filter paper and blood slides were collected, and at delivery, a placental biopsy was collected. Primary and secondary endpoints were the prevalence of placental malaria, maternal anemia, maternal peripheral infection, low birth weight, antenatal clinic (ANC) attendance, and IPTp-SP coverage. Results. Malaria infection was detected at least once for 3.8% women in The Gambia, 16.9% in Benin, and 31.6% in Burkina Faso. There was no difference between study arms in terms of placenta malaria after adjusting for birth season, parity, and IPTp-SP doses (adjusted odds ratio, 1.06 [95% confidence interval, .78-1.44]; P = .72). No difference between the study arms was found for peripheral maternal infection, anemia, and adverse pregnancy outcomes. ANC attendance was significantly higher in the intervention arm in Burkina Faso but not in The Gambia and Benin. Increasing number of IPTp-SP doses was associated with a significantly lower risk of placenta malaria, anemia at delivery, and low birth weight. Conclusions. Adding CSST to existing IPTp-SP strategies did not reduce malaria in pregnancy. Increasing the number of IPTp-SP doses given during pregnancy is a priority. Clinical Trials Registration. NCT01941264; ISRCTN37259296