What prevent women for a sustainable use of maternal care in two medical districts of Burkina Faso? A qualitative study

Introduction: Skilled attendance is one of the major strategies to curtail maternal mortality,  specifically in developing countries. Despite the low level of equipment, it is only in health facilities that skilled care are provided during pregnancy and childbirth; but there are some barriers which prevent women to use health facilities for good care.Methods: This study was carried out in Ouargaye where a skilled care initiative was implemented by Family care International with the aim to increase the skilled attendance at delivery and Diapaga, the control district. Thirty (30) In-depth interviews, 8 Focus group discussions and 6 non participant observations were carried out. Participants were women from 15-49 years. All the interviews were tape-recorded, transcribed and analysed line by line. NVIVO was used to manage the interviews.Results: Four types of barriers have been described by women; 1) the cultural barriers concern the low status of women in the two districts and some traditional beliefs which mean that women can not always decide to use health facility by themselves. 2) The geographical barrier is about the distance to reach health facility and the lack of transport means. 3) The financial barrier to pay care and drugs. 4) Bad organization of care and poor quality of care provided to womenConclusion: To minimize the risk of complications during pregnancy and childbirth, it is important that women use health facilities. The barriers described by women are not insurmountable but needed to be integrated in a global comprehensive health policy.Key words: Maternal care, skilled care, rural, medical district, Burkina Fas

Behavior Change After 20 Months of a Radio Campaign Addressing Key Lifesaving Family Behaviors for Child Survival: Midline Results From a Cluster Randomized Trial in Rural Burkina Faso.

BACKGROUND: In Burkina Faso, a comprehensive 35-month radio campaign addressed key, multiple family behaviors for improving under-5 child survival and was evaluated using a repeated cross-sectional, cluster randomized design. The primary outcome of the trial was postneonatal under-5 child mortality. This paper reports on behavior change achieved at midline. METHOD: Fourteen community radio stations in 14 geographic areas were selected based on their high listenership. Seven areas were randomly allocated to receive the intervention while the other 7 areas served as controls. The campaign was launched in March 2012. Cross-sectional surveys of about 5,000 mothers of under-5 children, living in villages close to the radio stations, were conducted at baseline (from December 2011 to February 2012) and at midline (in November 2013), after 20 months of campaigning. Statistical analyses were based on cluster-level summaries using a difference-in-difference (DiD) approach and adjusted for imbalances between arms at baseline. In addition, routine health facility data were analyzed for evidence of changes in health facility utilization. RESULTS: At midline, 75% of women in the intervention arm reported recognizing radio spots from the campaign. There was some evidence of the campaign having positive effects on care seeking for diarrhea (adjusted DiD, 17.5 percentage points; 95% confidence interval [CI], 2.5 to 32.5; P= .03), antibiotic treatment for fast/difficult breathing (adjusted DiD, 29.6 percentage points; 95% CI, 3.5 to 55.7; P= .03), and saving money during pregnancy (adjusted DiD, 12.8 percentage points; 95% CI, 1.4 to 24.2; P= .03). For other target behaviors, there was little or no evidence of an impact of the campaign after adjustment for baseline imbalances and confounding factors. There was weak evidence of a positive correlation between the intensity of broadcasting of messages and reported changes in target behaviors. Routine health facility data were consistent with a greater increase in the intervention arm than in the control arm in all-cause under-5 consultations (33% versus 17%, respectively), but the difference was not statistically significant (P= .40). CONCLUSION: The radio campaign reached a high proportion of the primary target population, but the evidence for an impact on key child survival-related behaviors at midline was mixed

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

Herpes Simplex Virus Type-2 Cervicovaginal Shedding Among Women Living With HIV-1 and Receiving Antiretroviral Therapy in Burkina Faso: An 8-Year Longitudinal Study.

BACKGROUND: The impact of antiretroviral therapy (ART) on herpes simplex virus type-2 (HSV-2) replication is unclear. The aim of this study was to assess factors associated with cervicovaginal HSV-2 DNA shedding and genital ulcer disease (GUD) in a cohort of women living with human immunodeficiency virus type-1 (HIV-1) in Burkina Faso. METHODS: Participants were screened for cervicovaginal HSV-2 DNA, GUD, cervicovaginal and systemic HIV-1 RNA, and reproductive tract infections every 3-6 months over 8 years. Associations with HSV-2 shedding and quantity were examined using random-effects logistic and linear regression, respectively. RESULTS: Of the 236 women with data on HSV-2 shedding, 151 took ART during the study period. Cervicovaginal HSV-2 DNA was detected in 42% of women (99 of 236) in 8.2% of visits (151 of 1848). ART was associated with a reduction in the odds of HSV-2 shedding, which declined for each year of ART use (odds ratio [OR], 0.74; 95% confidence interval [CI], .59-.92). In the multivariable model, the impact of ART was primarily associated with suppression of systemic HIV-1 RNA (adjusted OR, 0.32; 95% CI, .15-.67). A reduction in the odds of GUD was also observed during ART, mainly in those with HIV-1 suppression (adjusted OR, 0.53; 95% CI, .25-1.11). CONCLUSIONS: ART is strongly associated with a decrease in cervicovaginal HSV-2 shedding, and the impact was sustained over several years

CD4+ T cells spontaneously producing human immunodeficiency virus type I in breast milk from women with or without antiretroviral drugs

<p>Abstract</p> <p>Background</p> <p>Transmission of human immunodeficiency virus type 1 (HIV-1) through breast-feeding may involve both cell-free and cell-associated virus. This latter viral reservoir remains, however, to be fully explored. CD4⁺T cell-associated virus production in breast milk was therefore investigated.</p> <p>Methods</p> <p>The <it>ex vivo </it>spontaneous production of HIV-1 antigen and HIV-1 RNA by CD4⁺T cells was measured in paired blood and breast milk samples from 15 HIV-1 infected women treated or not with antiretroviral drugs. Spontaneous antigen secreting cells (HIV-1-AgSCs) from breast milk and blood were enumerated by an ELISpot assay, and cell-associated HIV-1 RNA was quantified by real-time PCR in supernatants of CD4⁺T cells cultured for 18 hours without addition of polyclonal activators.</p> <p>Results</p> <p>Among the CD4⁺T cells present in breast milk, memory cells expressing high levels of cell-surface activation markers were predominant. Spontaneous HIV-1-AgSCs were detected and enumerated in the breast milk of all 15 women, with a median number of 13.0 and 9.5 HIV-1- AgSCs/106 CD4⁺T cells in aviremic (n = 7) and viremic (n = 8) women, respectively. Cell- associated HIV-1 RNA was detected in cell-free supernatants from 4/7 aviremic and 5/8 viremic individuals at median levels of 190 and 245 copies/ml, respectively.</p> <p>Conclusions</p> <p>Activated CD4⁺T cells producing HIV-1 are detected in the breast milk of untreated individuals as well as those receiving highly active antiretroviral therapy. This finding strongly suggests that HIV-1 replication occurs in latently infected CD4⁺T cells that, upon spontaneous activation, revert to productively infected cells. These cells might be responsible for a residual breast milk transmission despite maternal highly active antiretroviral therapy.</p

Health of women after severe obstetric complications in Burkina Faso: a longitudinal study.

BACKGROUND: Little is known about the health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect a range of health, social, and economic indicators in the first year post partum. METHODS: We did a prospective cohort study of women with severe obstetric complications recruited in hospitals when their pregnancy ended with a livebirth (n=199), perinatal death (74), or a lost pregnancy (64). For every woman with severe obstetric complications, two unmatched control women with uncomplicated delivery were sampled in the same hospital (677). All women were followed up for 1 year. FINDINGS: Women with severe obstetric complications were poorer and less educated at baseline than were women with uncomplicated delivery. Women with severe obstetric complications, and their babies, were significantly more likely to die after discharge: six (2%) of the 337 women with severe obstetric complications died within 1 year, compared with none of the women with uncomplicated delivery (unadjusted p=0.001); 17 babies of women with severe obstetric complications died within 1 year, compared with 18 of those born by uncomplicated delivery (hazard ratio for mortality 4.67, 95% CI 1.68-13.04, adjusted for loss to follow-up and confounders; p=0.003). Women with severe obstetric complications were significantly more likely to have experienced depression and anxiety at 3 months (odds ratio 1.82, 95% CI 1.18-2.80), to have experienced suicidal thoughts within the past year at all time points (2.27, 1.33-3.89 at 3 months; 2.30, 1.17-4.50 at 6 months; 2.26, 1.30-3.95 at 12 months), and to report the pregnancy having had a negative effect on their lives at all time points (1.54, 1.04-2.30 at 3 months; 2.30, 1.56-3.39 at 6 months; 2.44, 1.63-3.65 at 12 months) than were women with uncomplicated delivery. INTERPRETATION: Women who give birth with severe obstetric complications are at greater risk of death and mental-health problems than are women with uncomplicated delivery. Greater resources are needed to ensure that these women receive adequate care before and after discharge from hospital

HIV-1 disease progression in immune-competent HIV-1-infected and breastfeeding mothers participating in the ANRS 12174 clinical trial in Burkina Faso, South Africa, Uganda and Zambia: a cohort study

International audienceObjective We have assessed HIV-1 disease progression among HIV-1-positive mothers in relation to duration of any or exclusive breast feeding in the context of ANRS 12174 trial.Methods The analysis was completed on 203, 212, 272 and 529 HIV-1-positive and lactating mothers with CD4 count >350 cells/µL from Burkina Faso, South Africa, Uganda and Zambia, respectively. The trial compared lamivudine and lopinavir/ritonavir as a peri-exposure prophylaxis during a 50-week follow-up time. A multiple logistic regression model was run with the mothers’ weight, CD4 count and HIV-1 viral load as separate dependent variables, then combined into a dependent composite endpoint called HIV-1 disease progression where HIV-1 viral load was replaced by the HIV-1 clinical stage. Exclusive or predominant breast feeding (EPBF) and any breastfeeding duration were the key explanatory variables.Results In the adjusted model, the associations between EPBF duration and weight change, CD4 cell count and the HIV-1 viral load were consistently insignificant. The CD4 cell count was associated with a significantly higher mothers’ body mass index (BMI; a mean increase of 4.9 (95% CI 2.1 to 7.7) CD4 cells/µL per each additional kilogram per square metre of BMI) and haemoglobin concentration (19.4 (95% CI 11.4 to 27.4) CD4 cells/µL per each additional gram per decilitre of haemoglobin concentration). There was no significant association between EPBF duration and HIV-1 disease progression. A higher education level was a factor associated with a slower HIV-1 disease progression.Conclusion Breast feeding was not a risk factor for a faster progression of HIV-1 disease in mothers of this cohort with a baseline CD4 cell count >350 cells/µL

Profil épidémiologique de la Tuberculose, Sénégal, 2009-2018: Epidemiological profile of Tuberculosis, Senegal, 2009-2018

Introduction: Le fardeau de la tuberculose (TB) pose un grave problème de santé publique au Sénégal. Nous avons analysé les données de surveillance de la tuberculose pour décrire le poids et la tendance de la tuberculose au Sénégal. Méthodes: Nous avons effectué une analyse secondaire des données de surveillance de la tuberculose du 1er janvier 2009 au 31 décembre 2018 du programme national de lutte contre la tuberculose (PNT). Résultats: Au total, 128 836 cas de tuberculose toutes formes ont été analysées dont 67,42% de nouveaux cas de TB pulmonaire confirmée par microscopie. Les personnes âgées de 25-34 ans représentaient 29,66%. Le sex-ratio H/F était de 2,33. Dakar avait rapporté la plupart des cas 44,17%. L'incidence pour 100 000 habitants était de 91, 87 et 86 en 2009, 2008 et 2011, de 93, 95 et 95 en 2012, 2013 et 2014 et de 92, 86, 87 et 84 en 2015, 2016, 2017 et 2018. La majorité des cas (77%) avaient été testés pour le VIH, dont 6,84% co-infectés. Le taux de TB multirésistante (TB-MR) était de 11%. Conclusion: Au Sénégal, l'incidence de la tuberculose a légèrement diminué en raison du faible taux de détection qui était de 62% en 2018. Le nombre de cas détecté a augmenté entre 2013 et 2014, mais elle restait inférieure à celle estimée par l'organisation mondiale de la santé. Une surveillance accrue de la tuberculose et un suivi des tuberculeux pour éviter la pharmaco-résistance sont nécessaires. Introduction: The burden of tuberculosis (TB) is a serious public health problem in Senegal. We analysed TB surveillance data to describe the burden and trend of TB in Senegal. Method: We conducted a secondary analysis of TB surveillance data from 1 January 2009 to 31 December 2018 from the national TB control programme (NTP). Results: A total of 128,836 cases of all forms of tuberculosis were analysed, of which 67.42% were new cases of microscopically confirmed pulmonary TB. Persons aged 25-34 years accounted for 29.66%. The sex ratio M/F was 2.33. Dakar reported most cases 44.17%. The incidence per 100 000 populations was 91, 87 and 86 in 2009, 2008 and 2011, 93, 95 and 95 in 2012, 2013 and 2014 and 92, 86, 87 and 84 in 2015, 2016, 2017 and 2018. The majority of cases (77%) had tested positive for HIV, with 6.84% co-infected. The rate of multidrug-resistant TB (MDR-TB) was 11%. Conclusion: In Senegal, the incidence of TB has slightly decreased due to the low detection rate which was 62% in 2018. The number of detected cases increased between 2013 and 2014, but it remained below that estimated by the World Health Organization. Increased surveillance of TB and monitoring of TB patients to avoid drug resistance is needed. &nbsp

Social Ecological Factors Affecting Substance Abuse in Ghana (West Africa) Using Photovoice

Introduction: substance abuse is an important public health issue affecting West Africa; however, there is currently a dearth of literature on the actions needed to address it. The aim of this study was to assess the risks and protective factors of substance abuse in Ghana, West Africa, using the photovoice method. Methods: this study recruited and trained 10 participants in recovery from substance abuse and undergoing treatment in the greater Accra region of Ghana on the photovoice methodology. Each participant received a disposable camera to take pictures that represented the risk and protective factors pertinent to substance abuse in their communities. They were also given the opportunity to provide narratives of the pictures using pre-identified themes and the different levels of the social-ecological model and participatory action research (PAR). Results: participants identified at the individual level: ignorance; interpersonal level: family and peer pressure; organizational level: lack of regulation; community level: media, availability of drugs, cost of drugs, urbanization, slum communities and cultural factors; and policy level: lack of regulations and their enforcement. Education and beliefs were cited at the individual level; family at the interpersonal level; religion at the organizational level; organizing youth, media and narcotics anonymous at the community level; and nothing at the policy level. Conclusion: this is an exploratory study that will add to the limited body of knowledge in the scientific literature with respect to substance abuse in the country and also help develop interventions to address the respective needs of several communities in Ghana

Plaintes des patients: une opportunité pour améliorer la qualité des soins des personnes âgées avec des multimorbidités au Burkina Faso

Introduction: peu de données existent sur les plaintes des patients pour identifier des pistes d’amélioration de la qualité de soins des personnes âgées avec des multimorbidités. L’objectif de cette étude était d’analyser les plaintes des personnes âgées qui présentent des multimorbidités dans les formations sanitaires à Bobo-Dioulasso, Burkina Faso. Méthodes: nous avons réalisé une étude transversale dans les formations sanitaires de la ville de Bobo-Dioulasso de novembre 2013 à février 2014. Les personnes âgées de 60 ans ou plus, avec au moins une pathologie chronique vues en ambulatoire ou en hospitalisation pendant la période d’étude ont été inclues. Des entretiens qualitatifs ont été réalisés à l’aide d’un questionnaire semi-structuré. Une analyse du contenu a été réalisée. Résultats: nous avons noté des plaintes liées au long temps d’attente pour les soins, des conditions inadaptées de transfert des patients en hospitalisation, un manque d’échanges d’informations sur les maladies et des conditions d’hôtellerie inadaptées pour la personnes âgée venue en consultation et en hospitalisation. Conclusion: des pistes d’amélioration pourraient passer par la rénovation et l’agrandissement des salles d’attentes des formations sanitaires, la séparation des prestations des soins chroniques des soins aigus en ambulatoire et en hospitalisation, l’appui à l’autonomisation par une meilleure communication avec le patient avec l’appui d’un groupe d’entraide communautaire et l’implication des familles