Mortalite des accidents vasculaires cerebraux a la phase aigüe au centre Hospitalier Universitaire Souro Sanou Bobo-Dioulasso; Burkina Faso

Introduction: Les accidents vasculaires cérébraux (AVC) sont des urgences médicales fréquentes dans le monde, en particulier en Afrique, où ils sont grevés d‘une lourde mortalité.Objectif : Notre objectif était d‘analyser la mortalité et les facteurs liés au pronostic vital des patients  hospitalisés pour AVC au centre hospitalier Sourô SANOU de Bobo-Dioulasso.Méthodologie: Il s‘agit d‘une étude rétrospective portant sur les dossiers de 331 malades hospitalisés pour AVC du 1er janvier 2009 au 31 décembre 2013.Résultats: L‘âge moyen était de 61,01 ±13 ans avec un sex-ratio de 1,58 en faveur des hommes. Les principaux facteurs de risque cérébro-vasculaires retrouvés étaient l‘HTA chronique (68,23 %), le tabagisme (18,85 %), l‘antécédent d‘AVC (17,69 %), le diabète (7,35 %). Le délai moyen de consultation des cas d‘AVC était de 24 heures (42,54%). Les troubles de la conscience étaient notés chez 38,20% des AVC. La mortalité intra hospitalière était de 28,21% avec des décès survenant principalement dans les 24 premières heures (86,67%). Les facteurs associés à la mortalité étaient l‘âge (p=0,001; OR 2,4 ; IC95%1,4-4,1), le coma (p<0,001; OR= 3,8 ; IC95% :1,8-8,1), le type d‘AVC (p=0,007; OR= 2,0 ; IC95%:1,2-3,3), la prescription de mesures de réanimation (p <0,001; OR= 3,5 ; IC95%:1,6-7,8) ainsi que l‘hospitalisation en unité de réanimation (p <0,001; OR= 9,9 ; IC95%: 4,8-20,6).Conclusion: La mortalité intra hospitalière des AVC à Bobo Dioulasso reste élevée et survient surtout à la phase aigüe.   English title: Mortality among patients admitted for acute stroke in Sourô Sanou Teaching Hospital of Bobo-Dioulasso; Burkina Faso Introduction: Strokes are frequent medical emergencies in the world, especially in Africa, where they are burdened by a heavy mortality.Objective: Our objective was to analyze mortality and factors linked to the prognosis for survival of the patients hospitalized for stroke in Sourô SANOU teaching hospital of Bobo-Dioulasso.Methodology: It was a retrospective study concerning the cases of 331 patients admitted to hospital for stroke from January 1st, 2009 to December 31st, 2013.Results: The mean age was 61.01 (±13 years). The sex-ratio was 1.58. Chronic high blood pressure (68.23 %), smoking (18.85 %), history of stroke (17.69 %), diabetes (7.35 %) were the most frequent cerebro-vascular risk factors in past medical history. The average time for consultation was 24 hours (42.54 %). Loss of consciousness was noted in 38.20 % of the stroke patients. The fatality rate was 28.21 % occurring mostly during the first 24 hours. The factors associated with mortality were age (p=0.001; OR 2.4 ; IC95% :1.4-4.1), coma (p<0.001; OR= 3.8 ; IC95% :1.8-8.1), type of stroke (p=0.007; OR= 2.0 ; IC95%:1.2-3.3), prescription of resuscitation‘s measures (p <0.001; OR= 3.5 ; IC95%:1.6-7.8) and hospitalization in resuscitation unit (p <0,001; OR= 9.9 ; IC95%: 4.8-20.6).Conclusion: The in hospital m rtality remains high and occurs mainly in acute stage in stroke patients in Bobo Dioulasso

Prevalence of and factors associated with human cysticercosis in 60 villages in three provinces of Burkina Faso

Background : Taenia solium, a zoonotic infection transmitted between humans and pigs, is considered an emerging infection in Sub-Saharan Africa, yet individual and community-level factors associated with the human infection with the larval stages (cysticercosis) are not well understood. This study aims to estimate the magnitude of association of individual-level and village-level factors with current human cysticercosis in 60 villages located in three Provinces of Burkina Faso. Methodology/Principal Findings : Baseline cross-sectional data collected between February 2011 and January 2012 from a large community randomized-control trial were used. A total of 3609 individuals provided serum samples to assess current infection with cysticercosis. The association between individual and village-level factors and the prevalence of current infection with cysticercosis was estimated using Bayesian hierarchical logistic models. Diffuse priors were used for all regression coefficients. The prevalence of current cysticercosis varied across provinces and villages ranging from 0% to 11.5%. The results obtained suggest that increased age, being male and consuming pork as well as a larger proportion of roaming pigs and percentage of sand in the soil measured at the village level were associated with higher prevalences of infection. Furthermore, consuming pork at another village market had the highest increased prevalence odds of current infection. Having access to a latrine, living in a household with higher wealth quintiles and a higher soil pH measured at the village level decreased the prevalence odds of cysticercosis. Conclusions/Significance : This is the first large-scale study to examine the association between variables measured at the individual-, household-, and village-level and the prevalence odds of cysticercosis in humans. Factors linked to people, pigs, and the environment were of importance, which further supports the need for a One Health approach to control cysticercosis infection

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

Development of a health education intervention strategy using an implementation research method to control taeniasis and cysticercosis in Burkina Faso

Background: Taeniasis and cysticercosis are two diseases caused by Taenia solium, a parasite transmitted between humans and pigs, leading to considerable economic loss and disabilities. Transmission of the parasite is linked to environmental and behavioural factors such as inadequate sanitation and hygiene, poor pig management, and consumption of infected pork. This study used implementation research method to design a health education intervention strategy for reducing T. solium infections in Burkina Faso, a country endemic for the parasite. Methods: Eighteen group discussions were conducted with 8-18 participants each in three villages. In addition, structured interviews were conducted among 4 777 participants and 2 244 pig owners, who were selected through cluster random sampling in 60 villages of three provinces of Burkina Faso. Both approaches assessed knowledge and practices related to T. solium. The information obtained was used to develop a community-adapted health education intervention strategy to control taeniasis and cysticercosis in Burkina Faso. Results: The group discussions revealed that participants had a poor quality of life due to the diseases as well as inadequate access to latrines, safe water, and healthcare services. In addition, it was found that pig production was an important economic activity, especially for women. Furthermore, financial and knowledge constraints were important limitations to improved pig management and latrine construction. The survey data also showed that open defecation and drinking unboiled water were common behaviours, enhanced by a lack of knowledge regarding the transmission of the parasite, perceived financial barriers to the implementation of control measures, lack of public sensitization, as well as a lack of self-efficacy towards control of the parasite. Nevertheless, the perceived financial benefits of controlling porcine cysticercosis could be emphasized by an education program that discourages open defecation and encourages drinking safe water. The final intervention strategy included a Participatory Hygiene and Sanitation Transformation (PHAST) approach, as well as a 52-min film and an accompanying comic booklet. Conclusions: The main problem in the study communities regarding the transmission of T. solium cysticercosis is the random disposal of human faeces, which can be contaminated with parasite eggs. Prevention of open defecation requires the building of latrines, which can be quite problematic in economically challenged settings. Providing the community with the skills to construct durable latrines using low-cost locally available materials would likely help to resolve this problem. Further studies are required to implement and evaluate the T. solium control strategy developed in this study

Factors Associated with the Prevalence of Circulating Antigens to Porcine Cysticercosis in Three Villages of Burkina Faso

Taenia solium cysticercosis is a neglected tropical infection transmitted between humans and pigs. This infection is particularly common in areas where sanitation, hygiene and pig management practices are poor, and can sometimes lead to epilepsy in humans. There is very little information about the importance of this infection in Burkina Faso, even though pork meat is widely consumed in many villages. We conducted a pilot study in three villages: two villages where pig rearing and pork consumption are common (Batondo and Pabré) but with different pig management practices, and one village with limited pig farming and pork consumption (Nyonyogo). Blood tests were done on pigs and information on pig raising was collected from farmers. Our study demonstrated that at least one third of pigs are infected with cysticercosis in villages where they are raised, and, particularly when pigs are left to roam some or all of the time. It also demonstrated that farmers may not be aware of this disease until one of their animals is found to be infected. Thus, the study concluded that there is an urgent need for improving education in order to control this tropical disease

Efficacy and immunogenicity of R21/Matrix-M vaccine against clinical malaria after 2 years' follow-up in children in Burkina Faso: a phase 1/2b randomised controlled trial

BACKGROUND: Malaria is a leading cause of morbidity and mortality worldwide. We previously reported the efficacy of the R21/Matrix-M malaria vaccine, which reached the WHO-specified goal of 75% or greater efficacy over 12 months in the target population of African children. Here, we report the safety, immunogenicity, and efficacy results at 12 months following administration of a booster vaccination. METHODS: This double-blind phase 1/2b randomised controlled trial was done in children aged 5-17 months in Nanoro, Burkina Faso. Eligible children were enrolled and randomly assigned (1:1:1) to receive three vaccinations of either 5 μg R21/25 μg Matrix-M, 5 μg R21/50 μg Matrix-M, or a control vaccine (the Rabivax-S rabies vaccine) before the malaria season, with a booster dose 12 months later. Children were eligible for inclusion if written informed consent could be provided by a parent or guardian. Exclusion criteria included any existing clinically significant comorbidity or receipt of other investigational products. A random allocation list was generated by an independent statistician by use of block randomisation with variable block sizes. A research assistant from the University of Oxford, independent of the trial team, prepared sealed envelopes using this list, which was then provided to the study pharmacists to assign participants. All vaccines were prepared by the study pharmacists by use of the same type of syringe, and the contents were covered with an opaque label. Vaccine safety, efficacy, and a potential correlate of efficacy with immunogenicity, measured as anti-NANP antibody titres, were evaluated over 1 year following the first booster vaccination. The population in which the efficacy analyses were done comprised all participants who received the primary series of vaccinations and a booster vaccination. Participants were excluded from the efficacy analysis if they withdrew from the trial within the first 2 weeks of receiving the booster vaccine. This trial is registered with ClinicalTrials.gov (NCT03896724), and is continuing for a further 2 years to assess both the potential value of additional booster vaccine doses and longer-term safety. FINDINGS: Between June 2, and July 2, 2020, 409 children returned to receive a booster vaccine. Each child received the same vaccination for the booster as they received in the primary series of vaccinations; 132 participants received 5 μg R21 adjuvanted with 25 μg Matrix-M, 137 received 5 μg R21 adjuvanted with 50 μg Matrix-M, and 140 received the control vaccine. R21/Matrix-M had a favourable safety profile and was well tolerated. Vaccine efficacy remained high in the high adjuvant dose (50 μg) group, similar to previous findings at 1 year after the primary series of vaccinations. Following the booster vaccination, 67 (51%) of 132 children who received R21/Matrix-M with low-dose adjuvant, 54 (39%) of 137 children who received R21/Matrix-M with high-dose adjuvant, and 121 (86%) of 140 children who received the rabies vaccine developed clinical malaria by 12 months. Vaccine efficacy was 71% (95% CI 60 to 78) in the low-dose adjuvant group and 80% (72 to 85) in the high-dose adjuvant group. In the high-dose adjuvant group, vaccine efficacy against multiple episodes of malaria was 78% (95% CI 71 to 83), and 2285 (95% CI 1911 to 2568) cases of malaria were averted per 1000 child-years at risk among vaccinated children in the second year of follow-up. Among these participants, at 28 days following their last R21/Matrix-M vaccination, titres of malaria-specific anti-NANP antibodies correlated positively with protection against malaria in both the first year of follow-up (Spearman's ρ -0·32 [95% CI -0·45 to -0·19]; p=0·0001) and second year of follow-up (-0·20 [-0·34 to -0·06]; p=0·02). INTERPRETATION: A booster dose of R21/Matrix-M at 1 year following the primary three-dose regimen maintained high efficacy against first and multiple episodes of clinical malaria. Furthermore, the booster vaccine induced antibody concentrations that correlated with vaccine efficacy. The trial is ongoing to assess long-term follow-up of these participants and the value of further booster vaccinations. FUNDING: European and Developing Countries Clinical Trials Partnership 2 (EDCTP2), Wellcome Trust, and NIHR Oxford Biomedical Research Centre. TRANSLATION: For the French translation of the abstract see Supplementary Materials section

Médicaments antiépileptiques en zone tropicale

International audienceEn zone tropicale, l’épilepsie constitue un problème de santé publique en raison de sa fréquence plus élevée que dans le reste du monde, des difficultés d’accès aux antiépileptiques et à la stigmatisation associée. Par ailleurs, le personnel qualifié pour sa prise en charge adéquate est insuffisant. Une fois le diagnostic établi, le problème demeure, celui de la prise en charge médicale pour laquelle au moins 3 des 4 antiépileptiques classiques, qui font partie de la liste des médicaments essentiels de l’Organisation mondiale de la santé, sont généralement disponibles.Le phénobarbital, qui demeure peu cher, efficace et d’utilisation aisée a été reconnu comme antiépileptique de première ligne dans le traitement de l’épilepsie dans les pays en développement. Malgré son prix modeste, le phénobarbital reste inaccessible à certains patients. Les résultats des études comparant l’efficacité et la tolérance du phénobarbital à la phénytoïne et la carbamazépine n’ont pas montré de différence significative. L’accessibilité de ces médicaments antiépileptiques (MAE) est limitée dans une part non négligeable des pays en Afrique sub-saharienne avec de fréquentes ruptures de stocks, malgré l’existence des formes génériques de ces MAE dans certains pays. La faible disponibilité des MAE reste un problème récurrent dans les pays en développement, tant pour les MAE classiques, que ceux de dernière génération difficilement disponibles sous les tropiques, en raison de leur coût élevé – ce qui peut aussi expliquer les difficultés dans la prise en charge de l’épilepsie dans ce contexte.La qualité des MAE dans les zones tropicales est un des défis à relever. En effet, les conditions climatiques associant chaleur et humidité ainsi que l’entreposage parfois défavorables peuvent avoir un impact négatif et altérer durablement le produit. En raison de la rentabilité des produits pharmaceutiques y compris les MAE, la contrefaçon peut constituer une menace dans la qualité de la prise en charge efficace et favoriser l’échec du traitement antiépileptique en zone tropicale en l’absence de contrôle.Une meilleure qualité des MAE pourrait améliorer la prise en charge des personnes souffrant d’épilepsie en zone tropicale et réduire la stigmatisation résultant de cette maladie

Neurocysticercosis: a preventable cause of epilepsy in sub-Saharan Africa.

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