Intermittent preventive treatment of malaria provides substantial protection against malaria in children already protected by an insecticide-treated bednet in Burkina Faso: a randomised, double-blind, placebo-controlled trial.

BACKGROUND: Intermittent preventive treatment of malaria in children (IPTc) is a promising new approach to the control of malaria in areas of seasonal malaria transmission but it is not known if IPTc adds to the protection provided by an insecticide-treated net (ITN). METHODS AND FINDINGS: An individually randomised, double-blind, placebo-controlled trial of seasonal IPTc was conducted in Burkina Faso in children aged 3 to 59 months who were provided with a long-lasting insecticide-treated bednet (LLIN). Three rounds of treatment with sulphadoxine pyrimethamine plus amodiaquine or placebos were given at monthly intervals during the malaria transmission season. Passive surveillance for malaria episodes was established, a cross-sectional survey was conducted at the end of the malaria transmission season, and use of ITNs was monitored during the intervention period. Incidence rates of malaria were compared using a Cox regression model and generalized linear models were fitted to examine the effect of IPTc on the prevalence of malaria infection, anaemia, and on anthropometric indicators. 3,052 children were screened and 3,014 were enrolled in the trial; 1,505 in the control arm and 1,509 in the intervention arm. Similar proportions of children in the two treatment arms were reported to sleep under an LLIN during the intervention period (93%). The incidence of malaria, defined as fever or history of fever with parasitaemia ≥ 5,000/µl, was 2.88 (95% confidence interval [CI] 2.70-3.06) per child during the intervention period in the control arm versus 0.87 (95% CI 0.78-0.97) in the intervention arm, a protective efficacy (PE) of 70% (95% CI 66%-74%) (p<0.001). There was a 69% (95% CI 6%-90%) reduction in incidence of severe malaria (p = 0.04) and a 46% (95% CI 7%-69%) (p = 0.03) reduction in the incidence of all-cause hospital admissions. IPTc reduced the prevalence of malaria infection at the end of the malaria transmission season by 73% (95% CI 68%-77%) (p<0.001) and that of moderately severe anaemia by 56% (95% CI 36%-70%) (p<0.001). IPTc reduced the risks of wasting (risk ratio [RR] = 0.79; 95% CI 0.65-1.00) (p = 0.05) and of being underweight (RR = 0.84; 95% CI 0.72-0.99) (p = 0.03). Children who received IPTc were 2.8 (95% CI 2.3-3.5) (p<0.001) times more likely to vomit than children who received placebo but no drug-related serious adverse event was recorded. CONCLUSIONS: IPT of malaria provides substantial protection against malaria in children who sleep under an ITN. There is now strong evidence to support the integration of IPTc into malaria control strategies in areas of seasonal malaria transmission. TRIAL REGISTRATION: ClinicalTrials.govNCT00738946. Please see later in the article for the Editors' Summary

Audit of the first caesarean section in a reference hospital in the African environment

Background The practice of a first caesarean section can condition the future obstetric prognosis. The aim of this work was to study the indications of the first caesarean sections at the Yalgado Ouedraogo Teaching Hospital in Ouagadougou. Methods: This was a cross-sectional study with prospective collection. The data were collected from 1 March to 30 May 2018. The women who benefited from caesarean section for the first time were the study population. The review of the documents, the interview with the patients and the expert opinion were the techniques used. The expert opinion made it possible to determine whether or not the caesarean section was preventable. Results: The first caesarean sections accounted for 62.5% (280/448) of all caesarean sections and 34.6% (280/810) of all childbirths in the period. Caesarean section was urgently performed in 95% of cases. It was mostly an obstetrical indication. Probable fetal asphyxia was the first major indication (27.5%) followed by preeclampsia/eclampsia (15.7%) and uterine pre-rupture syndrome (8.9%). Caesarean section was found to be avoidable in 53 cases (18.9%). Probable fetal asphyxia was the most common indication (22.4%) of these preventable caesarean sections. Conclusions: The good management of preeclampsia, the strengthening of the birth room in fetal and maternal monitoring equipment, the close coaching of physicians in specialization and the periodic audits of practices would reduce the preventable caesarean sections

Maternal mortality by direct obstetric causes in an urban referral hospital: case of Boulmiougou District Hospital in Ouagadougou, Burkina Faso

Background: Complications during pregnancy and childbirth are the leading causes of death and disability for women of childbearing age. Objective of this study was to study maternal mortality of direct obstetric origin at the Boulmiougou district hospital from 2010 to 2014.Methods: This was a retrospective cross-sectional descriptive and analytical study of maternal deaths by direct obstetric cause at the maternity ward of Boulmiougou District Hospital during the period from January 1st 2010 to December 31st, 2014, i.e. 5 years.Results: The maternal mortality rate by direct obstetric cause of 147.68 maternal deaths per 100,000 live births. The average age of the patients was 27.09 years old. The direct causes of maternal death were hemorrhage (47.06%), hypertensive disorders (20.59%), infections (14.71%) and unsafe abortion (11.76%). Contributing factors to maternal deaths were delay in evacuation (47.06%) and delay in care (38.23%).Conclusions: Maternal mortality remains high in the Boulmiougou District Hospital. To effectively combat maternal mortality, it is important to focus on the continuous training of staff and the strengthening of the technical platform

Satisfaction of patients received in emergencies in the department of obstetrics and gynecology at the Yalgado Ouedraogo teaching hospital: comparative study before and after the introduction of free care

Background: The quality of care perceived by the users of health care services is an important indicator of the quality of care. The aim of this study was to assess the satisfaction of patients received in obstetric and gynecological emergencies department of Yalgado Ouedraogo Teaching Hospital before and after the introduction of free care.Methods: This was a cross-sectional investigation. Data collection was carried out from February to July 2016, covering the last three months before the start of free care and the first three months of implementation of this free policy in Burkina Faso.Results: A total of 620 patients formed the sample. The reception (p=0.0001), the waiting period (p=0.0001), respect for treatment schedules (p=0.0001), respect for intimacy (p=0.0001), communication between providers and patients (p=0.007), the comfort of the delivery room (p=0.003) and the comfort of the ward room (p=0.002) were more favorably appreciated by patients before the free treatment than during that period. Overall patient satisfaction was better before the effectiveness of free care (p=0.003).Conclusions: The realization of free care process was followed by a lower patient’s satisfaction reflecting an alteration in the quality of health care services. A situational analysis of this free health care process is necessary in order to make corrective measures. Also adequate preventive measures should be adopted before any implementation to a larger scale of this free policy

Phenotypic and genotypic characterization of meningococcal carriage and disease isolates in Burkina Faso after mass vaccination with a serogroup a conjugate vaccine

BACKGROUND: The conjugate vaccine against serogroup A Neisseria meningitidis (NmA), MenAfriVac, was first introduced in mass vaccination campaigns of the 1-29-year-olds in Burkina Faso in 2010. The aim of this study was to genetically characterize meningococcal isolates circulating in Burkina Faso before and up to 13 months after MenAfriVac mass vaccination. METHODS: A total of 1,659 meningococcal carriage isolates were collected in a repeated cross-sectional carriage study of the 1-29-year-olds in three districts of Burkina Faso in 2010 and 2011, before and up to 13 months after mass vaccination. Forty-two invasive isolates were collected through the national surveillance in Burkina Faso in the same period. All the invasive isolates and 817 carriage isolates were characterized by serogroup, multilocus sequence typing and porA-fetA sequencing. RESULTS: Seven serogroup A isolates were identified, six in 2010, before vaccination (4 from carriers and 2 from patients), and one in 2011 from an unvaccinated patient; all were assigned to sequence type (ST)-2859 of the ST-5 clonal complex. No NmA carriage isolate and no ST-2859 isolate with another capsule were identified after vaccination. Serogroup X carriage and disease prevalence increased before vaccine introduction, due to the expansion of ST-181, which comprised 48.5% of all the characterized carriage isolates. The hypervirulent serogroup W ST-11 clone that was responsible for most of meningococcal disease in 2011 and 2012 was not observed in 2010; it appeared during the epidemic season of 2011, when it represented 40.6% of the serogroup W carriage isolates. CONCLUSIONS: Successive clonal waves of ST-181 and ST-11 may explain the changing epidemiology in Burkina Faso after the virtual disappearance of NmA disease and carriage. No ST-2859 strain of any serogroup was found after vaccination, suggesting that capsule switching of ST-2859 did not occur, at least not during the first 13 months after vaccination

Dynamique des populations d'azobé, Lophira alata Banks ex C. F. Gaertn., et implications pour sa gestion durable au Cameroun

L'impact de l'exploitation forestière sur le renouvellement du stock de bois d'oeuvre reste largement méconnu en Afrique centrale du fait du manque de données sur la dynamique des populations d'arbres exploités. C'est en particulier le cas pour l'azobé, Lophira alata, un bois d'oeuvre de grande valeur commerciale. L'objectif de cette étude est double : quantifier l'effet du type forestier et de l'exploitation sur la croissance de l'azobé et simuler l'évolution du stock exploitable et du taux de reconstitution après exploitation. Nous avons effectué pendant trois ans un suivi annuel de la croissance et de la mortalité dans trois types forestiers au Cameroun : en forêt sempervirente, en forêt mixte et en forêt semi-caducifoliée. Le recrute-ment a été étudié uniquement en forêt mixte, sous deux conditions : en milieu exploité et non exploité. Nous avons calibré, avec ces données, un modèle matriciel de Usher. Douze scénarios d'exploitation ont été simulés en faisant varier le diamètre minimum d'exploitation de 60, 70 et 80 cm, et l'intensité de prélèvement des arbres de 100 à 40 %. La croissance de l'azobé est influencée à la fois par le type forestier et l'exploitation. Les arbres de forêt sempervirente ont une croissance plus faible jusqu'à 50 cm de dia-mètre, alors que la croissance maximale prédite pour ce type forestier est la plus élevée. L'exploitation a par ailleurs stimulé la croissance. Enfin, l'exploitation de l'azobé ne respecte pas le principe du rendement soutenu : ses taux de croissance à long terme varient entre 0,54 et 0,83 %. Pour garantir la durabilité de son exploitation au Cameroun, une sylviculture dynamisant la croissance des futurs arbres exploitables, ainsi que leur régé-nération, s'avère indispensable

Gametocytes: insights gained during a decade of molecular monitoring

In vertebrate hosts, malaria parasites produce specialized male and female sexual stages (gametocytes). Soon after being taken up by a mosquito, gametocytes rapidly produce gametes and, once mated, they infect their vector and can be transmitted to new hosts. Despite being the parasite stages that were first identified (over a century ago), gametocytes have remained elusive, and basic questions remain concerning their biology. However, the postgenomic era has substantiated information on the specialized molecular machinery of gametocytogenesis and expedited the development of molecular tools to detect and quantify gametocytes. The application of such highly sensitive and specific tools has opened up novel approaches and provided new insights into gametocyte biology. Here, we review the discoveries made during the past decade, highlight unanswered questions and suggest new directions