Epidemiology and control of lymphatic filariasis in Burkina Faso

This thesis presents the work divided in three main areas: 1) the distribution of Lymphatic Filariasis caused by Wuchereria bancrofti and the non-pathogenic filarial parasite Mansonella perstans; 2) the implementation of a public health programme to eliminate LF describing the activities and discussing the impact of the programme, and 3) the assessment of the cost of the NPELF. This study was the first to provide countrywide epidemiological data on W. bancrofti and M. perstans infections in Burkina Faso as well as in some other West African countries. All the 55 health districts were mapped using immunochromatographic card tests for filarial antigenaemia detection. All the 102 sampled villages were positive except one. The prevalence ranged from 2% to 74% and the overall prevalence was 29.2%. W. bancroft; microfilaraemia baseline in sentinel sites showed an overall prevalence of 8.2% and the average mean density was 1108mf/ml in positive subjects. Children under 5 years presented 0.6% W. bancrofti microfilaraemia prevalence. The urban distribution of W. bancrofti showed a lower prevalence for antigenaemia (2.3%) and microfilaraemia (0.7%). Hydrocoele prevalence in males 15 years and above was 7.2% while lymphoedema was found in 0.6% of the 13 492 surveyed individuals. M. perstans has also been found to be widely distributed in the country with an overall prevalence of 5.9%. The impact of the onchocerciasis control programme activities using the distribution of ivermectin alone for 6 and 14 years in two different sites in Burkina Faso was also studied. It was concluded that 6-year treatment with ivermectin alone might have significantly reduced the prevalence of W. bancrofti whilst it appears that up to 14 years annual or twice-annual treatment with ivermectin may have stopped W. bancrofti transmission. These findings have implications for many areas of Africa where onchocerciasis and LF are co-endemic and the APOC programme has created sustained ivermectin distribution programmes. This thesis documented the impact of 2 to 5 rounds of mass drug administration using albendazole and ivermectin following the implementation of the national programme to eliminate lymphatic filariasis. Although, yearly treatment coverage (69% to 77%) never reached the recommended 80% coverage of total population a significant decline in community microfilaraemia prevalence (up to 95%) and density (up to 98%) has been observed in all sentinel sites except one. In general, there were no significant changes in M. perstans prevalence and density after 2 to 5 annual treatments. Monitoring results showed that reported and checked coverage were largely consistent in the rural and semi-urban districts but not in the urban settings. In addition, there was relative low prevalence of side effects following treatments. Lymphatic filariasis transmission knowledge was poor and the main reason for not taking the drugs was absenteeism. The cost analysis of the programme demonstrated that the start-up financial cost per person treated was US$ 0.11 as the programme is using the existing health system including community volunteers. The studies carried out in this thesis suggest that the GPELF recommended strategy is effective; however, used by and within a national public health system of a "developing" country elimination may need more time than the anticipated four to six years. The required improvement of the social mobilisation component remains a challenge for the success of the programme, especially in urban settings

Frequency of recurrent stroke in Burkina Faso: an observational hospital based study of 6 months

Introduction: studies on stroke recurrence are rare in sub Sahara Africa. The aim to this study is to determine the prevalence and risk factors for recurrent stroke in two University Teaching Hospital in Burkina Faso. Methods: this prospective cross-sectional study was carried on 266 stroke patients admitted in two hospitals in the city of Ouagadougou from September 1, 2017 to February 28, 2018. Patients with stroke recurrence (ischemic or hemorrhagic) were included. Results: of 266 acute stroke patients included, 44(16.4%) had recurrent stroke. The mean age of patients was 66.5 ± 11.49 years with male predominance. Hypertension was the most vascular risk factors (81.8%). Previous stroke was ischemic in 61.4%, hemorrhagic in 22.7% and unknown in 15.9% of cases. Poor compliance (< 60%) was determined in patients taking antiagregant agents (43.6%) and statins (50%). At admission, the most neurological disorders was motor deficit (100%), aphasia (84.1%), and deglutition disorders (15.9%). CT scan showed ischemic in 82% and hemorrhagic stroke in 18% of cases. With the analysis of second stroke, recurrent stroke after intracerebral hemorrhage was hemorrhagic in 77.8% and ischemic in 22.2%. Recurrent stroke after ischemic stroke was ischemic in 100%. Conclusion: stroke recurrence is common in our context. Hypertension was the most common vascular risk factor in recurrent stroke. Poor compliance was determined in patients taking antiagregant agents and statins in previous stroke

Les péricardites tuberculeuses au centre hospitalier universitaire de Bobo-Dioulasso, Burkina Faso

Introduction: La tuberculose constitue toujours un problème de santé publique. Sa localisation péricardique reste fréquente. L’objectif de cette étude rétrospective descriptive était de décrire les caractéristiques cliniques et évolutives des cas de péricardites tuberculeuses dans le service de cardiologie du centre hospitalier universitaire de Bobo-Dioulasso. Méthodes: Nous avons mené une étude rétrospective descriptive des cas de péricardite tuberculeuse colligés en deux ans à partir des dossiers et registres dans le service de cardiologie du CHU de Bobo-Dioulasso de janvier 2009 à décembre 2010. Résultats: De janvier 2009 à décembre 2010, parmi 945 hospitalisations dans le service de cardiologie, une péricardite tuberculeuse a été diagnostiquée chez dix patients âgés de 18 à 82 ans. L’âge moyen était de 46,8±25 ans avec un sexe ratio de un. Soixante pour cent des patients avaient moins de 40 ans. Tous les patients avaient un niveau socio-économique bas. Une notion de contage tuberculeux a été retrouvée chez six patients. Trois patients présentaient une tuberculose pulmonaire à microscopie positive. L’insuffisance cardiaque était constante chez tous les patients avec deux cas de tamponnade à l’admission ayant nécessité une ponction péricardique d’urgence. Tous les patients avaient une sérologie VIH négative. L’échocardiographie a été importante pour le diagnostic positif et dans la prise en charge. L’évolution sous traitement antituberculeux et de l’IC a été bonne chez neuf patients à la fin de la première phase du traitement antituberculeux. Un cas de décès a cependant été enregistré chez un patient avec une HTA déjà compliquée d’accident vasculaire cérébrale ischémique. Conclusion: Les péricardiques tuberculeuses sont fréquentes au Burkina Faso. Elles touchent surtout les sujets jeunes et un intérêt particulier devrait être accordé au dépistage et au traitement précoce des cas. Pan African Medical Journal 2012; 12:1

Epidémie de choléra au Burkina Faso en 2005: aspects épidémiologiques et diagnostiques

INTRODUCTION: L’objectif de cette étude était de décrire les aspects épidémiologiques et diagnostiques de l’épidémie de choléra au Burkina Faso en 2005. METHODES: Etude rétrospective, d’août à octobre 2005. Elle a concerné dix districts sanitaires du Burkina Faso. A été inclus dans l’étude, tout patient présentant un syndrome cholériforme, admis dans les différentes formations sanitaires dont la coproculture s’est révélée positive à Vibrio cholerae. RESULTATS: Au cours cette épidémie, 1050 cas de diarrhées cholériformes ont été notifiés par l’ensemble des structures sanitaires du pays. Vibrio cholerae a été identifié à l’examen bactériologique des selles de 121 patients (17,2%), constituant notre population d’étude. Les hommes étaient majoritaires (57%). La moyenne d’âge était de 30 ans. Les femmes au foyer (24%) et les sujets non scolarisés (62,8%) représentaient les couches sociales les plus touchées. Les forages ont été la source de boisson de 39,7% des patients 72 heures avant le début de la maladie. Tous les patients ont présenté une diarrhée aqueuse. Vibrio cholerae, sérotype Ogawa, responsable de cette épidémie, était résistant au chloramphénicol et au cotrimoxazole dans respectivement 71,7% et 38,3% des cas. Ni le cas index, ni la source initiale de contamination n’ont pu être identifiés. La létalité de notre échantillon était de 3,5%. CONCLUSION: Cette épidémie a relancé la question de l’hygiène et mis à nu le problème de ces villes ou la croissance démographique galopante est en inadéquation avec le degré d’urbanisatio

Determinants of success in national programs to Eliminate Lymphatic Filariasis: A perspective identifying essential elements and research needs

The Global Programme to Eliminate Lymphatic Filariasis (GPELF) was launched in 2000. To understand why some national programs have been more successful than others, a panel of individuals with expertise in LF elimination efforts met to assess available data from programs in 8 countries. The goal was to identify: 1) the factors determining success for national LF elimination programs (defined as the rapid, sustained reduction in microfilaremia/antigenemia after repeated mass drug administration [MDA]): 2) the priorities for operational research to enhance LF elimination efforts. Of more than 40 factors identified, the most prominent were 1) initial level of LF endemicity: 2) effectiveness of vector mosquitoes; 3) MDA drug regimen: 4) population compliance. Research important for facilitating program success was identified as either biologic (i.e., [1] quantifying differences in vectorial capacity; [2] identifying seasonal variations affecting LF transmission) or programmatic (i.e., [1] identifying quantitative thresholds, especially the population compliance levels necessary for success, and the antigenemia or microfilaremia prevalence at which MDA programs can stop with minimal risk of resumption of transmission; [2] defining optimal drug distribution strategies and timing; [3] identifying those individuals who are "persistently noncompliant" during MDAs, the reasons for this non-compliance and approaches to overcoming it). While addressing these challenges is important, many key determinants of program success are already clearly understood; operationalizing these as soon as possible will greatly increase the potential for national program success