Geographic and Sociodemographic Disparities in Cardiovascular Risk in Burkina Faso: Findings from a Nationwide Cross-Sectional Survey.

BACKGROUND: Cardiovascular disease (CVD) risk assessment is a critical step in the current approach to the primary prevention of CVD, particularly in low-income countries such as Burkina Faso. In this study, we aimed to assess the geographic and sociodemographic disparities of the ten-year cardiovascular risk in Burkina Faso. METHODS: We conducted a secondary analysis of the data from the first nationwide survey using the World Health Organization (WHO) STEPwise approach. Ten-year cardiovascular risk was determined using the WHO 2019 updated risk chart (WHO risk) as main outcome, and the Framingham risk score (FRS) and the Globorisk chart for secondary outcomes. We performed a modified Poisson regression model using a generalized estimating equation to examine the association between CVD risk and sociodemographic characteristics. RESULTS: A total of 3081 participants aged 30 to 64 years were included in this analysis. The overall age and sex-standardized mean of absolute ten-year cardiovascular risk assessed using the WHO risk chart was 2.5% (95% CI: 2.4-2.6), ranging from 2.3% (95% CI: 2.2-2.4) in Centre Est to 3.0% (95% CI: 2.8-3.2) in the Centre region. It was 4.6% (95% CI: 4.4-4.8) for FRS and 4.0% (95% CI: 3.8-4.1) for Globorisk. Regarding categorized CVD risk (absolute risk ≥10%), we found out that the age and sex-standardized prevalence of elevated risk was 1.7% (95% CI: 1.3-2.1) for WHO risk, 10.4% (95% CI: 9.6-11.2) for FRS, and 5.9% (95% CI: 5.1-6.6) for Globorisk. For all of the three risk scores, elevated CVD risk was associated with increasing age, men, higher education, urban residence, and health region (Centre). CONCLUSION: We found sociodemographic and geographic inequalities in the ten-year CVD risk in Burkina Faso regardless of risk score used. Therefore, population-wide interventions are needed to improve detection and management of adult in the higher CVD risk groups in Burkina Faso

Prevalence of symptoms of vaginal fi stula in 19 sub-Saharan Africa countries: a meta-analysis of national household survey data

Background Vaginal fi stula is a serious medical disorder characterised by an abnormal opening between the vagina and the bladder or rectum, which results in continuous leakage of urine or stool. The burden of this disorder in sub- Saharan Africa is uncertain. We estimated the lifetime and point prevalence of symptoms of vaginal fi stula in this region using national household surveys based on self-report of symptoms. Methods We considered all Demographic and Health Surveys (DHS) and Multiple Indicators Cluster Surveys (MICS) from sub-Saharan Africa and included data for women of reproductive age (15–49 years). We estimated lifetime prevalence and point prevalence of vaginal fi stula with use of Bayesian hierarchical meta-analysis. Findings We included 19 surveys in our analysis, including 262 100 respondents. Lifetime prevalence was 3·0 cases (95% credible interval 1·3–5·5) per 1000 women of reproductive age. After imputation of missing data, point prevalence was 1·0 case (0·3–2·4) per 1000 women of reproductive age. Ethiopia had the largest number of women who presently have symptoms of vaginal fi stula. Interpretation This study is the fi rst to estimate the burden of vaginal fi stula in 19 sub-Saharan Africa countries using nationally representative survey data. Point prevalence was slightly lower than previously estimated but these earlier estimates are within the prevalence’s credible intervals. Although vaginal fi stula is relatively rare, it is still too common in sub-Saharan Africa

Fistula in sub-Saharan Africa – Authors' reply

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Assessing field performance of ultrasensitive rapid diagnostic tests for malaria: a systematic review and meta-analysis

BACKGROUND: To overcome the limitations of conventional malaria rapid diagnostic tests (cRDTs) in diagnosing malaria in patients with low parasitaemia, ultrasensitive malaria rapid diagnostic tests (uRDTs) have recently been developed, with promising results under laboratory conditions. The current study is the first meta-analysis comparing the overall sensitivity, and specificity of newly developed ultrasensitive Plasmodium falciparum malaria RDT (Alere™ Ultra-sensitive Malaria Ag P. falciparum RDT) with the cRDT conducted in the same field conditions. METHODS: PubMed, EMBASE, Cochrane infectious diseases group specialized register, and African Journals Online (AJOL) were searched up to 20th April 2021. Studies with enough data to compute sensitivity and specificity of uRDT and cRDT were retrieved. A random-effect model for meta-analysis was used to obtain the pooled sensitivity and specificity. RESULTS: Overall, 15 data sets from 14 studies were included in the meta-analysis. The overall sensitivity of the Alere™ ultra-sensitive Malaria Ag P. falciparum RDT regardless of the reference test and the clinical presentation of participants, was 55.5% (95% confidence interval [CI]: 45.5; 65.0), while the sensitivity regardless of the reference test and the clinical presentation of participants, was 42.9% (95% CI: 31.5; 55.2) for the cRDT performed in the same field conditions. When PCR was used as reference test, the sensitivity of uRDT was 60.4% (95% CI: 50.8; 69.2), while the sensitivity was 49.4% (95% CI: 38.2; 60.6) for the cRDT. The pooled specificity of uRDT regardless of the reference test and the clinical presentation of participants was 98.6% (95% CI: 97.1; 99.4), and the pooled specificity of cRDT regardless of the reference test and the clinical presentation of participants was 99.3% (95% CI: 98.1; 99.7). When PCR was used as reference test the specificity of uRDT and cRDT was 97.5% (95% CI: 94.1; 98.9) and 98.2% (95% CI: 95.5; 99.3). Regardless of the reference test used, the sensitivity of Alere™ Ultra-sensitive Malaria Ag P. falciparum RDT in symptomatic patients was 72.1% (95%CI: 67.4; 76.4), while sensitivity of cRDT was 67.4% (95%CI: 57.6; 75.9). CONCLUSION: Findings of the meta-analysis show that Alere™ Ultra-sensitive Malaria Ag P. falciparum RDT compared to cRDT performed in the same field conditions has higher sensitivity but lower specificity although the difference is not statistically significant

A Latent Class Analysis of Health Lifestyles in Relation to Suicidality among Adolescents in Mauritius

Suicidality, which includes suicidal thoughts, planning, and suicide attempts, resultsmainly from a combination of psychological, sociological, and environmental factors. Despite a highprevalence of suicidality among adolescents in Africa, only a few studies have considered thesefactors simultaneously. The objective of the study was to identify the prevalence of suicidality, todraw up profiles of concomitant risks, and to examine the associations between these profiles andsuicidality in Mauritius. This study used data from the 2017 Mauritian Global School-based StudentHealth Survey including 3012 adolescents with a mean age of 14.9±1.4 years. Factors related tolifestyle such as consumptions of alcohol and tobacco, physical activity, violence, parental support,anxiety, and loneliness were considered. A latent class analysis was performed to identify the profiles.Finally, a modified Poisson regression analysis with generalized estimating equations, adjusted withsociodemographic characteristics, was used to assess the association between these profiles andsuicidality. Overall, more than one in ten adolescents had at least one of the suicidality behaviors.Three profiles were identified: 1 = “low risk group” (63.9%); 2 = “problems with violence” (15.2%);3 = “problems with violence, alcohol, tobacco and psychological distress” (20.9%). Profiles 2 and3 were mainly made up of males. Adolescents under 15 represented the majority of individualsin profile 2. Finally, the risk of suicidality was higher in adolescents belonging to profiles 2 and 3compared to profile 1 for the three suicidality behaviors (profile 3: Prevalence ratio (PR) for suicidalthoughts = 1.26, 95% CI = 1.19–1.34; PR for planning = 1.23, 95% CI = 1.17–1.30; PR for attempt = 1.23,95% CI = 1.17–1.29). This study highlights the high prevalence of suicidality and a list of concomitantrisks, emphasizing this suicidality in Mauritian adolescents. Therefore, these results recommendfocusing preventive efforts toward a simultaneous consideration of these factors

Utilisation des données hebdomadaire de surveillance du paludisme et des facteurs météorologiques et des programmes de santé pour la prévision des cas en fonction du faciès épidémiologique du Burkina Faso

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Addressing challenges in routine health data reporting in Burkina Faso through Bayesian spatiotemporal prediction of weekly clinical malaria incidence

Abstract Sub-Saharan African (SSA) countries’ health systems are often vulnerable to unplanned situations that can hinder their effectiveness in terms of data completeness and disease control. For instance, in Burkina Faso following a workers' strike, comprehensive data on several diseases were unavailable for a long period in 2019. Weather, seasonal-malaria-chemoprevention (SMC), free healthcare, and other contextual data, which are purported to influence malarial disease, provide opportunities to fit models to describe the clinical malaria data and predict the disease spread. Bayesian spatiotemporal modeling was applied to weekly malaria surveillance data from Burkina Faso (2011–2018) while considering the effects of weather, health programs and contextual factors. Then, a prediction was used to deal with weekly missing data for the entire year of 2019, and SMC and free healthcare effects were quantified. Our proposed model accurately predicted weekly clinical malaria incidence (correlation coefficient, r = 0.90). The distribution of clinical malaria incidence was heterogeneous across the country. Overall, national predicted clinical malaria incidence in 2019 (605 per 1000 [95% CrI: 360–990]) increased by 24.7% compared with the year 2015. SMC and the interaction between free healthcare and health facility attendance were associated with a reduction in clinical malaria incidence. Our modeling approach could be a useful tool for strengthening health systems’ resilience by addressing data completeness and could support SSA countries in developing appropriate targets and indicators to facilitate the subnational control effort.info:eu-repo/semantics/publishe

Sex-specific-evaluation of metabolic syndrome prevalence in Algeria: insights from the 2016–2017 non-communicable diseases risk factors survey

Abstract Metabolic syndrome (MetS) is a core driver of cardiovascular diseases (CVD); however, to date, gender differences in MetS prevalence and its components have not been assessed in the Algerian adult general population. This study aimed to determine the gender differences in MetS prevalence and its components, in the general population of Algeria. Secondary analysis was performed on data from the Algerian 2016–2017 non-communicable disease risk factor survey. MetS was determined according to the harmonized Joint Interim Statement criteria. A Poisson regression model based on Generalised Estimating Equations was used to estimate the adjusted prevalence ratios (aPR) for the sex-specific factors associated with MetS. Overall, the prevalence of MetS was 34.0% (95% CI 32.4–35.6). MetS prevalence in women and men was 39.1% (95% CI 37.0–41.3) and 29.1% (95% CI 27.2–31.2), respectively. The most frequent triad was the clustering of abdominal obesity with low HDL-cholesterol and high blood pressure among women (8.9%; 95% CI [8.0–10.0]) and low HDL-cholesterol with high blood pressure and hyperglycaemia among men (5.2%; 95% CI [4.3–6.3]). Increasing age (aPR 3.21 [2.35–4.39] in men and aPR 3.47 [2.86–4.22] in women), cohabitation (aPR 1.14 [1.05–1.24]), women residing in urban areas (aPR 1.13 [1.01–1.26]), men with higher educational levels (aPR 1.39 [1.14–1.70]), and men with insufficient physical activity (aPR 1.16 [1.05–1.30]) were associated with higher risk of MetS. In this population-based study, one in three Algerian adults had MetS, and key components including abdominal obesity, low HDL-cholesterol, and high blood pressure, are very common, especially in women. Reinforcing interventions for weight management targeting married women living in urban areas and improving sufficient physical activity in men with higher socioeconomic status could provide maximal health gains and stem the CVD epidemic in Algeria