Unmet needs for modern contraceptive methods among sexually active adolescents and young women in Togo: a nationwide cross-sectional study

BackgroundThe unmet need for modern contraceptives among sexually active adolescent and young women (AYW) in Africa contributes to high morbidity and mortality. To investigate the prevalence of unmet need for modern contraceptives and its associated factors among AYW in Togo, we performed a secondary analysis of data from the MICS-62017 survey.MethodWe extracted data from sexually active AYW aged 15–24  years for the analysis and used multi-level logistic regression models to identify factors associated with unmet need for modern contraceptives.ResultsAmong the AYW, the median age was 20  years. The prevalence of unmet need for modern contraceptives was 27.02%. Factors that increased the likelihood of having unmet need for contraceptives included being in the “Poor” or “Middle” quintile of household wealth, aged 20–24  years, and completing primary or secondary education. Living in a household headed by a woman and having a household head aged 19–38, 39–58, or greater than 78  years decreased the likelihood of unmet need for modern contraceptives.ConclusionThe study highlights the high-unmet need for modern contraceptives among sexually active AYW in Togo and emphasizes the importance of addressing individual and household/community factors to improve their sexual and reproductive health. Interventions such as increasing AYW awareness, providing social marketing campaigns in schools, and targeting men-headed households could help promote modern contraceptive use and improve the sexual and reproductive health of AYW in Togo

24-Month Clinical, Immuno-Virological Outcomes, and HIV Status Disclosure in Adolescents Living With Perinatally-Acquired HIV in the IeDEA-COHADO Cohort in Togo and Côte d'Ivoire, 2015-2017

Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including HIV serostatus disclosure. We assessed their 24-month outcomes in relation to the disclosure of their own HIV serostatus. Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10-19 years, enrolled in HIV care before the age of 10 years, in Abidjan (Côte d'Ivoire) and Lomé (Togo) in 2015. We measured the HIV serostatus disclosure at baseline and after 24 months and analyzed its association with a favorable combined 24-month outcome using logistic regression. The 24-month combined clinical immuno-virological outcome was defined as unfavorable when either death, loss to follow-up, progression to WHO-AIDS stage, a decrease of CD4 count >10% compared to baseline, or a detectable viral load (VL > 50 copies/mL) occurred at 24 months. Results: Overall, 209 APHIV were included (51.6% = Abidjan, 54.5% = females). At inclusion, the median CD4 cell count was 521/mm (3) [IQR (281-757)]; 29.6% had a VL measurement, of whom, 3.2% were virologically suppressed. APHIV were younger in Lomé {median age: 12 years [interquartile range (IQR): 11-15]} compared to Abidjan [14 years (IQR: 12-15, p = 0.01)]. Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, six (2.9%) died, eight (3.8%) were lost to follow-up, and four (1.9%) were transferred out. Overall, 73.7% did not progress to the WHO-AIDS stage, and 62.7% had a CD4 count above (±10%) of the baseline value (48.6% in Abidjan vs. 69.0% in Lomé, p 2 years compared to those who had not been disclosed to [aOR = 0.21, 95% CI (0.05-0.84), p = 0.03]. Conclusions: The frequency of HIV-disclosure improved over time and differed across countries but remained low among West African APHIV. Overall, the 24-month outcomes were poor. Disclosure before the study was a marker of a poor 24-month outcome in Lomé. Context-specific responses are urgently needed to improve adolescent care and reach the UNAIDS 90% target of virological success

Mortalité néonatale au centre hospitalier universitaire de Tengandogo, Ouagadougou, Burkina Faso: une étude de cohorte retrospective: Neonatal mortality at Tengandogo University Hospital, Ouagadougou, Burkina Faso: a retrospective cohort study

Introduction: Selon l’organisation mondiale de la santé, les décès néonataux représentent 41% de la mortalité infanto-juvénile. L’Afrique subsaharienne a le taux de mortalité néonatale le plus élevé à 28‰. L’objectif de l’étude était de mesurer le taux de mortalité néonatale et d’identifier les facteurs associés au décès au Centre hospitalier universitaire de Tengandogo, Ouagadougou, Burkina Faso. Méthodes: Les nouveaux nés de 0 à 28 jours, hospitalisés entre le 1er janvier 2013 et le 31 décembre 2017 ont été inclus dans cette étude de cohorte rétrospective au service de néonatologie et de pédiatrie. Les informations ont été extraites à partir des dossiers cliniques. La survie a été estimée par la méthode de Kaplan Meier. Un modèle de Cox a permis d’identifier les facteurs associés. Résultats: Au total 641 nouveau-nés ont été inclus. Les enfants admis dès le premier jour de leur naissance représentaient 80%. La durée médiane de séjour était de 6 jours avec un intervalle interquartile de 3-12 jours. Les principaux diagnostics étaient la prématurité (36,05%), les infections néonatales (33,23%) et l’asphyxie (17,86%). Le taux de mortalité néonatale était de 22,25 pour 1000 personnes jours. Après ajustement, le poids de naissance inferieur 1500gramme (HRa = 4,13 ; IC 95% (2,58-6,67)) et la notion de réanimation à la naissance (HRa2,62 ; IC 95% [1,64-4,39)) étaient les facteurs de risque. Conclusion: Le taux de mortalité néonatale reste élevé. Le suivi prénatal, la prévention des infections, le renforcement des moyens de réanimation et la compétence des acteurs sont essentiels pour réduire ce taux. Introduction: According to the World Health Organization, neonatal deaths account for 41% of infant and child mortality. Sub-Saharan Africa has the highest neonatal mortality rate at 28‰. The objective of the study was to measure the neonatal mortality rate and identify factors associated with death at the Tengandogo University Hospital, Ouagadougou, Burkina Faso. Method: New-borns aged 0 to 28 days, hospitalised between 1 January 2013 and 31 December 2017 were included in this retrospective cohort study in the neonatology and paediatrics department. Information was extracted from clinical records. Survival was estimated by the Kaplan Meier method. A Cox model was used to identify associated factors. Results: A total of 641 new-borns were included. Children admitted on the first day of birth accounted for 80%. The median length of stay was 6 days with an interquartile range of 3-12 days. The main diagnoses were prematurity (36.05%), neonatal infections (33.23%) and asphyxia (17.86%). The neonatal mortality rate was 22.25 per 1000 person days. After adjustment, birth weight below 1500 grams (HRa = 4.13; 95% CI (2.58-6.67)) and the notion of resuscitation at birth (HRa2.62; 95% CI (1.64-4.39)) were the risk factors. Conclusion: The neonatal mortality rate remains high. Prenatal follow-up, infection prevention, strengthening of resuscitation resources and competence of actors are essential to reduce this rate

High stress related to COVID-19 among health workers in the Plateau Central healthcare region (BURKINA FASO): a cross-sectional study

BackgroundThe COVID-19 pandemic challenged the mental wellbeing of health workers. The objective of this study was to assess health workers' perceived stress during the response to COVID-19 in the Central Plateau region (Burkina Faso).MethodsWe conducted a cross-sectional study of health workers in the Central Plateau health region from September 20 to October 20, 2021. Agents' perceived stress was assessed by the Perceived Stress Scale (PSS-10). Factors associated with high stress (PSS-10 score ≥ 27) were identified by logistic regression.ResultsA total of 272 officers participated in the survey. The mean PSS-10 score was 29.3 points (standard deviation: 6.2). Three out of ten agents (68%) had a high level of stress. The main sources of stress were the risk of being exposed to contamination (70%) and being the source of contamination (78%). Working at the referral health center [adjusted odds ratio (aOR): 2.29; 95% confidence interval (95% CI): 1.19–4.41], the hospital as the main source of COVID-19 information (aOR: 1.17; 95% CI: 1.01-3.04), fear of COVID-19 patients being managed at one's center (aOR: 1.8; 95% CI: 1.06–3.07) were factors associated with high health worker stress levels during the first wave of COVID-19.ConclusionThe COVID-19 pandemic caused high stress among health care workers in Burkina Faso. Psychological support for health center workers in responding to future epidemics would improve their mental health

Efavirenz-based simplification after successful early lopinavir-boosted-ritonavir-based therapy in HIV-infected children in Burkina Faso and Côte d'Ivoire: The MONOD ANRS 12206 non-inferiority randomised trial

Background: The 2016 World Health Organization guidelines recommend all children <3 years start antiretroviral therapy (ART) on protease inhibitor-based regimens. But lopinavir/ritonavir (LPV/r) syrup has many challenges in low-income countries, including limited availability, requires refrigeration, interactions with anti-tuberculous drugs, twice-daily dosing, poor palatability in young children, and higher cost than non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs. Successfully initiating LPV/r-based ART in HIV-infected children aged <2 years raises operational challenges that could be simplified by switching to a protease inhibitor-sparing therapy based on efavirenz (EFV), although, to date, EFV is not recommended in children <3 years. Methods: The MONOD ANRS 12026 study is a phase 3 non-inferiority open-label randomised clinical trial conducted in Abidjan, CÔte d'Ivoire, and Ouagadougou, Burkina Faso (ClinicalTrial.gov registry: NCT01127204). HIV-1-infected children who were tuberculosis-free and treated before the age of 2 years with 1215 months of suppressive twice-daily LPV/r-based ART (HIV-1 RNA viral load (VL) <500 copies/mL, confirmed) were randomised to two arms: once-daily combination of abacavir (ABC) + lamivudine (3TC) + EFV (referred to as EFV) versus continuation of the twice-daily combination zidovudine (ZDV) or ABC + 3TC + LPV/r (referred to as LPV). The primary endpoint was the difference in the proportion of children with virological suppression by 12 months post-randomisation between arms (14% non-inferiority bound, Chi-squared test).0SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Delays in TB Diagnosis and Treatment Initiation in Burkina Faso during the COVID-19 Pandemic

The COVID-19 pandemic has significantly disrupted TB services, particularly in low resource settings. In Burkina Faso, a cross-sectional &lsquo;before and after&rsquo; study was conducted to assess the impact of COVID-19 on access to TB services. Data was collected in two phases (Phase 1: December 2017&ndash;March 2018, and 2: October&ndash;December 2020) to estimate and compare various patient and system delays among TB patients before and during COVID-19 and explore changes in treatment seeking behaviors and practices. 331 TB patients were recruited across the two phases. A significant increase in median time between first symptom and contact with TB service (45 days vs. 26 days; p &lt; 0.01) and decrease in median time between first contact and diagnosis, and treatment initiation, respectively, during COVID-19 compared to before. Fewer patients reported using public health centers and more patients reporting using private facilities as the point of first contact following TB symptom onset during the COVID-19 period compared to before. These findings suggest that COVID-19 has created barriers to TB service access and health seeking among symptomatic individuals, yet also led to some efficiencies in TB diagnostic and treatment services. Our findings can be help target efforts along specific points of the TB patient pathway to minimize the overall disruption of COVID-19 and future public health emergencies on TB control in Burkina Faso

Facteurs associés à la mortalité chez les enfants malnutris aigus sévères du CHU Yalgado Ouédraogo, Ouagadougou

La malnutrition aigüe sévère (MAS) est responsable de 30 % des décès infanto-juvénile dans le monde. Sa prise en charge reste une préoccupation de santé publique dans les pays en développement comme le Burkina Faso. L’objectif de cette étude était de mesurer le taux de mortalité des enfants malnutris sévères hospitalisés au département de pédiatrie du Centre Hospitalier Universitaire Yalgado Ouédraogo et d’identifier ses déterminants. Nous avons mené une étude de cohorte rétrospective des enfants âgés de 6 à 59 mois, hospitalisés pour malnutrition aiguë sévère au CHU-YO entre le 1er janvier 2010 et le 31 décembre 2013. Nous avons utilisé un modèle de risque proportionnel de Cox pour identifier les facteurs associés à la mortalité au cours de l’hospitalisation. Au total 506 enfants ont été inclus dans notre étude à un âge médian de 16 mois [Intervalle interquartile (IIQ) = 10-24], le sex-ratio était de 1,30. Le taux de mortalité était de 12,10 % soit 0,60 décès/100 personnes jour. La présence de MAS avec oedèmes (Hazard Ratio ajusté (HRa) 2,20 [1,25-3,89]) ; une sérologie VIH positive (HRa = 9,21 [4,85-17,49]), ou inconnue(HRa = 6,80 [3,44-13,46]) et le traitement systématique incomplet (HRa : 1,98 [1,11-3,54]) étaient significativement associés à la mortalité des enfants malnutris aigus sévères. Le dépistage et le traitement précoce de l’infection à VIH et la prise en charge suivant les recommandations restent une condition pour l'amélioration du pronostic de la malnutrition aiguë sévère dans notre contexte.Mots-clés : malnutrition, mortalité, traitement, enfant, Ouagadougou

Acceptabilité des tests de diagnostic rapide du paludisme administrés par les agents de santé communautaire et satisfaction des bénéficiaires au Burkina Faso

Introduction : Cette étude visait à évaluer l'acceptabilité et la satisfaction de la communauté par rapport avec l’utilisation des tests de diagnostic rapide (TDR) du paludisme pour la confirmation des cas suspects par les agents de santé à base communautaire (ASBC) dans trois districts sanitaires (Kaya, Saponé et Nouna) au Burkina Faso.Matériel et méthodes : une étude transversale mixte concomitante a été conduite dans les trois districts sanitaires sélectionnés de Janvier à Août 2017. Un questionnaire a été administré à 487 bénéficiaires, choisis suivant un échantillonnage raisonné et systématique. Les données ont été analysées à l’aide des logiciels Stata 15 et Excel 2007. Une régression logistique a été réalisée avec un degré de signification p-value inférieure à 5%. Pour le volet qualitatif neuf focus group ont été réalisés auprès des bénéficiaires ; une analyse de contenu thématique a été effectuée grâce au logiciel Nvivo.10. Une triangulation des différents résultats a ensuite été effectuée.Résultats : La quasi-totalité des enquêtés ont déclaré avoir accepté la réalisation d’un TDR pour eux ou pour un membre de leur ménage (98,7%). Les bénéficiaires étaient en général très satisfaits de l’intervention (72%), avec une différence de niveau de satisfaction entre les districts sanitaires. Le niveau de satisfaction était statistiquement associé à l’âge et au niveau d’instruction du bénéficiaire, au fait de bénéficier du TDR à domicile et à la perception de la disponibilité des ASBC.Conclusion : l’utilisation des TDR du paludisme en milieu communautaire est très bien acceptée en milieu communautaire, avec un niveau élevé de satisfaction chez les bénéficiaires. Mots clés : test de diagnostic rapide, paludisme, acceptabilité, satisfaction, agent de santé à base communautair