Changes in body mass index and hemoglobin concentration in breastfeeding women living with HIV with a CD4 count over 350: Results from 4 African countries (The ANRS 12174 trial).

INTRODUCTION: Breastfeeding is recommended for infants born to HIV-infected women in low-income settings. Both breastfeeding and HIV-infection are energy demanding. Our objective was to explore how exclusive and predominant breastfeeding changes body mass index (BMI) among breastfeeding HIV1-positive women participating in the ANRS12174 trial (clinical trial no NCT0064026). METHODS: HIV-positive women (n = 1 267) with CD4 count >350, intending to breastfeed HIV-negative infants were enrolled from Burkina Faso, South Africa, Uganda and Zambia and counselled on breastfeeding. N = 1 216 were included in the analysis. The trial compared Lamivudine and Lopinavir/Ritonavir as a peri-exposure prophylaxis. We ran a linear mixed-effect model with BMI as the dependent variable and exclusive or predominant breastfeeding duration as the key explanatory variable. RESULTS: Any breastfeeding or exclusive/predominant) breastfeeding was initiated by 99.6% and 98.6% of the mothers respectively in the first week after birth. The median (interquartile range: IQR) duration of the group that did any breastfeeding or the group that did exclusive /predominant breastfeeding were 9.5 (7.5; 10.6) and 5.8 (5.6; 5.9)) months, respectively. The median (IQR) age, BMI, CD4 count, and HIV viral load at baseline (day 7) were 27 (23.3; 31) years, 23.7 (21.3; 27.0) kg/m2, 530 (432.5; 668.5) cells/μl and 0.1 (0.8; 13.7)1000 copies/mL, respectively. No major change in mean BMI was seen in this cohort over a 50-week period during lactation. The mean change between 26 and 50 weeks after birth was 0.7 kg/m2. Baseline mean BMI (measured on day 7 postpartum) and CD4 count were positively associated with maternal BMI change, with a mean increase of 1.0 kg/m2 (0.9; 1.0) per each additional baseline-BMI kilogram and 0.3 kg/m2 (0.2; 0.5) for each additional CD4 cell/μl, respectively. CONCLUSION: Breastfeeding was not negatively correlated with the BMI of HIV-1 infected Sub-Saharan African mothers. However, a higher baseline BMI and a CD4 count >500 cells/μl were associated with maternal BMI during the exclusive/ predominant breastfeeding period. Considering the benefits of breast milk for the infants and the recurrent results from different studies that breastfeeding is not harmful to the HIV-1-infected mothers, this study also supports the WHO 2016 guidelines on infant feeding that mothers living with HIV should breastfeed where formula is not safe for at least 12 months and up to 24 months, given that the right treatment or prophylaxis for the infection is administered. These findings and conclusions cannot be extrapolated to women who are immune-compromised or have AIDS

Connaissances des leaders religieux de Dori au Burkina Faso sur la contraception moderne

According to WHO, the use of contraception has significantly more health benefits than risks. However, women's access to contraception remains a public health issue. This study aimed to assess contraceptive knowledge of religious leaders in the Dori Urban District and identify the barriers to contraceptive use among women. We implemented descriptive qualitative research, including the interview of 21 religious’ leaders in the urban community of Dori, a non-participant observation, and a literature review. All religious leaders knew at least three modern contraceptive methods and acknowledged that birth spacing but not birth limitation was a necessity. Although the majority of them had information on the concept of the capture of the demographic dividend, they were consistently opposed to the use of modern contraceptive methods. More exploratory and behaviour change studies are needed to sensitize the community leaders and specifically the religious ones to accept the use of modern contraceptive methods in order to raise the contraceptive prevalence rate in this important area of the Sahel region.Selon l’OMS, l’utilisation de la contraception a nettement plus d’avantages pour la santé que de risques. Néanmoins, l'accès à la contraception moderne des femmes reste un problème de santé publique. Cette étude visait à évaluer les connaissances des leaders religieux de la Commune urbaine de Dori et à identifier les obstacles à l’utilisation de la contraception chez les femmes. Dans le cadre d’une recherche qualitative descriptive, la collecte des données a reposé principalement sur la description des connaissances recueillies lors d’entretiens réalisés auprès de 21 leaders religieux de la commune urbaine de Dori, d’une observation non participative et d’une analyse documentaire. La quasi-totalité des leaders religieux connaissaient au moins trois méthodes contraceptives modernes et l’espacement des naissances (et non leur limitation) s’imposait comme une nécessité. Bien que la majorité d’entre eux aient des informations sur la capture du dividende démographique, il y avait une unanimité de tous les enquêtés sur le fait que la religion n’admettait pas l’utilisation des méthodes contraceptives modernes. D’autres études exploratoires, éventuellement suivies d’études de promotion du changement du comportement pourraient aider à relever le niveau d’utilisation des contraceptifs modernes dans cette importante commune du Sahel

Cirrhose du foie : aspects épidémiologiques et diagnostiques au centre hospitalier universitaire Yalgado Ouédraogo

Introduction Liver cirrhosis represent 27.63% of the hepatobiliary diseases in Burkina. We aimed at studying the epidemiological characteristics and diagnostic 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 diagnostic of cirrhosis was based on i) clinical criteria (an edema-ascitic syndrome with a heterogeneous hepatomegaly with a sharp inferior border or atrophic liver and a portal hypertension); ii) biological criteria (a hepatocellular insufficiency syndrome); and iii) ultrasound imaging suggesting cirrhosis. Qualitative variables were presented as frequencies and percentages while qualitative ones were presented as means. Results The data of 273 patients representing 33,9% of all hospitalizations were analyzed. The hepato-biliary diseases represented 74.7% of all diagnostics. The participants’ mean age was 46.9 years and the sex ratio, 2.7. The complaints at entry were dominated by abdominal pains (69.2% of the cases), weight loss (42.8%), asthenia (32.2%) and anorexia (28.2%). Hepatomegaly (68.03%), oesophageal varices (54.21%), conjunctival jaundice (54.2%), edema of the lower limbs (53.8%), poor general condition (32, 2%), gastrointestinal hemorrhage (8.4%) hepatic encephalopathy (8%) were the clinical manifestations at entry. The mean alpha-foeto-protein, HBV-DNA and HCV-RNA levels were 2843.6 IU / ml, 23295569.7IU / ml and 2749IU / ml, respectively, while the antigen HBs and anti-HCV antibody were positive in 76.5% and 14.6% of cases, respectively. Conclusion Cirrhosis of the liver still mostly affects the young and active male population. The main etiological factors are hepatitis B and C viruses. Prevention through vaccination (anti-hepatitis B) and early systematic screening are very efficient weapons at our disposal.  La cirrhose domine les pathologies hépatobiliaires avec 27,63% des cas au Burkina. Le but de notre travail était d’étudier les aspects épidémiologiques et diagnostiques de la cirrhose. Il s’est agi d’une étude transversale descriptive avec collecte rétrospective des données, du 1er janvier 2012 au 31 mars 2014. Le diagnostic de cirrhose a été retenu sur la base des i) arguments cliniques (un syndrome œdémato-ascitique, une hépatomégalie hétérogène à bord inférieur tranchant ou un foie atrophique, une hypertension portale) ; ii) biologiques (un syndrome d’insuffisance hépatocellulaire); et iii) d’imagerie évoquant une cirrhose. Les variables qualitatives ont été présentées sous forme de fréquences et de pourcentage tandis que les variables quantitatives on fait l’objet de calcul de moyennes. L’analyse a concerné 273 patients soit 33,9% des hospitalisations. La pathologie hépatobiliaire a représenté 74,7% des affections rencontrées. La moyenne d’âge était de 46,9, et le sex-ratio, de 2,7. La cirrhose du foie touche encore en majorité la population masculine, jeune et active. Les plaintes à l’entrée étaient dominées par la douleur abdominale (69,2% des cas), l’amaigrissement (42,8%), l’asthénie (32,2%) et l’anorexie (28,2%). L’hépatomégalie (68,03%), les varices œsophagiennes (54,21%), l’ictère conjonctival (54,2%), les œdèmes des membres inférieurs (53,8%), le mauvais état général (32,2%), l’hémorragie digestive (8,4%) l’encéphalopathie hépatique (8%) constituaient les manifestations cliniques à l’entrée. Les taux moyen d’alpha foeto-protéine, de l’ADN-VHB et de l’ARN-VHC étaient de 2843,6 UI/ml, 23295569,7UI/ml et de 2749UI/ml, respectivement, alors que l’antigène HBs et l’anticorps anti-VHC étaient positifs dans 76,5% et de 14,6% des cas, respectivement. Les virus de l’hépatite B et C sont donc les principales étiologies de la cirrhose au Burkina Faso. La prévention par la vaccination (anti-hépatite B) et le dépistage systématique précoce sont des armes très efficientes à notre disposition

Knowledge, Attitude, and Practice of Health Care Workers in the Management of Peptic Ulcer at the Paul VI and the Bogodogo District Hospitals, in Burkina Faso

Background: In 2015, peptic ulcer disease (PUD) was cause of 52.3% and 17% of digestive bleeding and death in respectively among in-hospital patients at the gastro-enterology units of the main hospital in Ouagadougou. We aimed to assess the knowledge, attitudes and practices of the health care workers in the management of PUD. Subjects dan Method: It was a descriptive cross-sectional study with a prospective data collection implemented at the Paul VI and the Bogodogo District Hospitals in Ouagadougou (Burkina Faso) from December 15, 2015 to January 25, 2016. A questionnaire was administered to 134 health care workers including medical doctors, nurses and midwives. Results: The mean age was 33 years (Mean= 33.6; SD= 5.84). Females represented 61.9%. Kno

Screening for Hepatitis B in partners and children of women positive for surface antigen, Burkina Faso

International audienceObjective To evaluate the implementation of a screening strategy for the partners and children of pregnant women with hepatitis B virus(HBV) attending antenatal care.Methods We identified pregnant women positive for HBV surface antigen (HBsAg) at antenatal consultation in Ouagadougou, Burkina Faso.At post-test counselling, women were advised to disclose their HBV status to partners and to encourage their partner and children to bescreened for HBsAg. We used multivariable logistic regression to explore factors associated with uptake of screening and HBsAg positivityamong family members.Findings Of 1000 HBsAg-positive women, 436/1000 partners and 215/1281 children were screened. HBsAg was detected in 55 (12.6%)partners and 24 (11.2%) children. After adjusting for confounders, uptake of screening was higher in partners who were married, whoattended the woman’s first post-test consultation and to whom the woman had disclosed her HBV status. In children, HBsAg positivity wasassociated with being born before the introduction of infant hepatitis B vaccination in Burkina Faso (not significant in the multivariableanalysis), having a mother positive for HBV e-antigen (adjusted OR: 8.57; 95% CI: 2.49–29.48) or having a mother with HBV DNA level≥ 200 000 IU/mL (OR: 6.83; 95% CI: 1.61–29.00).Conclusion In low-income countries, the antenatal consultation provides a cost-effective opportunity to identify HBV-infected householdcontacts and link them to care. Children born before the introduction of infant hepatitis B vaccination and whose mother has higher viralload or infectivity should be a priority for testing and linkage to car

Women stratified in 3 BMI-categories: Paired t-test comparing mean BMI at different endpoints with baseline mean BMI.

<p>Women stratified in 3 BMI-categories: Paired t-test comparing mean BMI at different endpoints with baseline mean BMI.</p

Country-stratified paired t-test comparing mean BMI at different endpoints with baseline mean BMI.

<p>Country-stratified paired t-test comparing mean BMI at different endpoints with baseline mean BMI.</p

Country-stratified paired t-test comparing mean hemoglobin at week 14 and week 38 (hemoglobin at week 14 > hemoglobin at week 38).

<p>Country-stratified paired t-test comparing mean hemoglobin at week 14 and week 38 (hemoglobin at week 14 > hemoglobin at week 38).</p

Multivariate country-stratified analysis testing BMI change in breastfeeding mothers over the duration of extended EBF.

<p>Multivariate country-stratified analysis testing BMI change in breastfeeding mothers over the duration of extended EBF.</p

Baseline characteristics.

<p>Baseline characteristics.</p