Otomastoïdites aiguës dans le Service d’ORL du CHU Yalgadode Ouagadougou: à propos de 44 cas

Analyser les aspects diagnostiques et thérapeutiques des otomastoïdites dans le Service d’ORL du CHU-YO de Ouagadougou. Méthode : Il s’est agit d’une étude rétrospective de 10 ans, qui a porté sur 44 cas. Résultats: l’incidence annuelle était de 4,4 cas et l’âge moyen de 13,41 ans. Les mastoïdites étaient majoritairement fistulisées (59,09%) et les principaux germes incriminés étaient Staphylococcus aureus (35,29%), Proteus mirabilis (23,53%) et Pseudomonas aeruginosa (23,53%). Ils étaient surtout sensibles à la ciprofloxacine (82,35%) et la ceftriaxone (58,82%). Le traitement a été médico-chirurgical dans 86,36% des cas et l’évolution favorable dans 72,73%. Douze cas (27,27%) de décès par complication systémique et endocrânienne ont été enregistrés. Conclusion : Il convient de prioriser les mesures préventives et la prise en charge précoce des otites infectieuses.Mots clés: Otomastoïdite, épidémiologie, diagnostic, thérapeutique

Outpatient prescriptions practice and writing quality in a paediatric university hospital.

BACKGROUND: The writing of prescriptions is an important aspect of medical practice. This activity presents some specific problems given a danger of misinterpretation and dispensing errors in community pharmacies. The objective of this study was to determine the evolution of the prescription practice and writing quality in the outpatient clinics of our paediatric university hospital.¦METHODS: Copies of prescriptions written by physicians were collected from community pharmacies in the region of our hospital for a two-month period in 2005 and 2010. They were analysed according to standard criteria, including both formal and pharmaceutical aspects.¦RESULTS: A total of 597 handwritten prescriptions were reviewed in 2005 and 633 in 2010. They contained 1,456 drug prescriptions in 2005 and 1,348 in 2010. Fifteen drugs accounted for 80% of all prescriptions and the most common drugs were paracetamol and ibuprofen. A higher proportion of drugs were prescribed as International Nonproprietary Names (INN) or generics in 2010 (24.7%) compared with 2005 (20.9%). Of the drug prescriptions examined, 55.5% were incomplete in 2005 and 69.2% in 2010. Moreover in 2005, 3.2% were legible only with difficulty, 22.9% were ambiguous, and 3.0% contained an error. These proportions rose respectively to 5.2%, 27.8%, and 6.8% in 2010.¦CONCLUSION: This study showed that fifteen different drugs represented the majority of prescriptions, and a quarter of them were prescribed as INN or generics in 2010; and that handwritten prescriptions contained numerous omissions and preventable errors. In our hospital computerised prescribing coupled with advanced decision support is eagerly awaited

Task sharing for family planning services, Burkina Faso

© 2019, World Health Organization. All rights reserved. Problem In Burkina Faso, the coverage of services for family planning is low due to shortage of qualified health staff and limited access to services. Approach Following the launch of the Ouagadougou Partnership, an alliance to catalyse the expansion of family planning services, the health ministry created a consortium of family planning stakeholders in 2011. The consortium adopted a collaborative framework to implement a pilot project for task sharing in family planning at community and primary health-care centre levels in two rural districts. Stakeholders were responsible for their areas of expertise. These areas included advocacy; monitoring and evaluation; and capacity development of community health workers (CHWs) to offer oral and injectable contraceptives to new users and of auxiliary nurses and auxiliary midwives to provide implants and intrauterine devices. The health ministry implemented supportive supervision cascades involving relevant planning and service levels. Local setting In Burkina Faso, only 15% (2563/17 087) of married women used modern contraceptives in 2010. Relevant changes Adoption of new policies and clinical care standards expanded task sharing roles in family planning. The consortium trained a total of 79 CHWs and 124 auxiliary nurses and midwives. Between January 2017 and December 2018, CHWs provided injectables to 3698 new users, and auxiliary nurses or midwives provided 726 intrauterine devices and 2574 implants to new users. No safety issues were reported. Lessons learnt The pilot project was feasible and safe, however, financial constraints are hindering scale-up efforts. Supportive supervision cascades were critical in ensuring success

Risk factors associated with HIV prevalence in pregnant women in Burkina Faso, from 2006 to 2014

Purpose of the study: To determine the socio-demographic factors influencing the dynamics of HIV prevalence among pregnant women in Burkina Faso.Material and methods: A total of 66,597 pregnant women from the 13 health regions of Burkina Faso were included in this study conducted between 2006 and 2014. Venous blood samples were collected and analyzed for the detection of HIV antibodies according to WHO / UNAIDS strategy II, using the mixed test Vironostika HIV Uniform II Plus O (Bio-Mérieux) and the test discriminating ImmunoCombII HIV-1 & 2 BiSpot (Orgenics). Samples with discordant results between the two tests, as well as those positive to HIV-2 or HIV-1 + 2, were retested with HIV BLOT 2.2 (MP Diagnostics). Sociodemographic data collected from the participants were correlated with their HIV status to determine key risk factors influencing HIV infection prevalence in Burkina Faso.Results: Sociodemographic data showed that the study population consisted mainly of married women (91.2%) at their first pregnancy (27.1%) with a large majority of them being housewives (86.2%) who did not attend any form of schooling (69.4%). About 88.4% had stayed longer than a year in the health region where they initially participated in the study and 55.8% were between 20 and 29 years of age. Overall HIV prevalence significantly dropped from 2.7 % in 2006 to 1.3% in 2014. However HIV seroprevalence in this study has varied significantly according to socio-demographic characteristics including marital status, parity, occupation, education, age group and the length of stay in the women's health community (p <0.0001). Factors sustaining HIV transmission included the status of being unmarried (OR=1.67 [1.42-1.97]), primigest (OR=1.64 [1.41-1.89]), having other occupations except being student (OR = 1.68 [1.20-2.33]), aged between 20-49 years (OR=3.14 [2.51-3.93]) and the duration of stay less than a year in their locality (OR=5.33 [4.61-10.16]) and these factors were identified as main risk factors associated with HIV prevalence.Conclusion: Burkina Faso remains among the countries with concentrated epidemics despite a significant reduction in the prevalence observed in this study. The inclusion of identified risk factors in the national HIV program could improve the quality of the response to the epidemic.Keywords: HIV-Pregnant Women-Risk Factors-Burkina Fas

Antimicrobial susceptibility of extended-spectrum beta-lactamase producing Enterobacteriaceae causing urinary tract infections in Ouagadougou, Burkina Faso

Objective: To determine the frequency of extended-spectrum beta lactamase producing Enterobacteriaceae (ESBL) and other antibioticsresistant bacteria in urinary tract isolates.Study Design: prospective and experimental study.Methodology: Place and duration of study :YalgadoOuedraogo University Hospital Center, Charles De Gaulle Pediatric Hospital Center, Saint Camille Hospital and National Public Health Laboratory, Ouagadougou, from November 2014 to October 2015.AllEnterobacteriaceaestrains isolated from urinary samples of patients were identifiedusing API 20E chemical gallery (BioMerieux, France). All strains were subjected to an array of 14 antibiotics to study their drug susceptibility by using Kirby- Baeurdisk diffusion method. Detection of ESBL was carried out by double disk diffusion technique. Statistical analysis was performed by Microsoft Excel and Anova one-way GrapPad Prism version 5.01. Chi-square (χ2) test was used to determine significance. A p˂ 0.05was considered to be statistically significant.Results: A total of 324 isolates of Enterobacteriaceae were identified during the study period, including211(65%) E. coli, 75 (23%)Klebsiella spp., 18 (6%) Enterobacter spp., 11 (3%)Proteus spp., 5 (2%) Citrobacter spp., Serratia spp. 3 (1%).All the clinical isolates were susceptible to imipenem. Resistance to amikacinwas 14% (45/324); gentamicin 54% (175/324); tobramycin 58% (187/324); nalidixic acid 72% (234/324),ciprofloxacin 63% (204/324) and to cotrimoxazole 83% (269/324).The overall rate of the EBSL producing strains was 35% (114/324). Their susceptibility to antibiotics was (imipenem,amikacin, cefoxitin and fosfomycin) 100% (114/114), 93% (106/114), 74% (84/114) and 84% (96/114) respectively. ESBL positivity within individual organism group was highest inEscherichia coli 64% (73/324) followed byKlebsiellaspp. 28% (32/324), Enterobacterspp. 3% (4/324), Proteus spp. and Citrobacterspp. 2% (2/324).Conclusion: The results showeda high frequency of ESBL producing Enterobacteriaceae, especially Escherichia coli and Klebsiellaspp. The data points to theneed of routine detection and surveillance of ESBL producing bacteria in Burkina Faso.Keywords: Antimicrobial susceptibility, Enterobacteriaceae, Urine, Burkina Fas

Markets and climate are driving rapid change in farming practices in Savannah West Africa

Agricultural practices have constantly changed in West Africa, and understanding the factors that have driven the changes may help guide strategies to promote sustainable agriculture in the region. To contribute to such efforts, this paper analyzes drivers of change in farming practices in the region using data obtained from surveys of 700 farming households in five countries (Burkina Faso, Ghana, Mali, Niger and Senegal). The results showed that farmers have adopted various practices in response to the challenges they have faced during the last decade. A series of logit models showed that most changes farmers made to their practices are undertaken for multiple reasons. Land use and management changes including expanding farmed areas and using mineral fertilization and manure are positively related to perceived changes in the climate, such as more erratic rainfall. Planting new varieties, introducing new crops, crop rotation, expanding farmed area and using pesticides are positively associated with new market opportunities. Farm practices that require relatively high financial investment such as use of pesticides, drought-tolerant varieties and improved seeds were positively associated with the provision of technical and financial support for farmers through development projects and policies. Changes in markets and climate are both helping to promote needed changes in farming practices in West Africa. Therefore, policies that foster the development of markets for agricultural products, and improved weather- and climate-related information linked to knowledge of appropriate agricultural innovations in different environments are needed

Position Statement on Atopic Dermatitis in Sub-Saharan Africa:current status and roadmap

The first International Society of Atopic Dermatitis (ISAD) global meeting dedicated to atopic dermatitis (AD) in Sub-Saharan Africa (SSA) was held in Geneva, Switzerland in April 2019. A total of 30 participants were present at the meeting, including those from 17 SSA countries, representatives of the World Health Organization (WHO), the International Foundation for Dermatology (IFD) (a committee of the International League of Dermatological Societies, ILDS www.ilds.org), the Fondation pour la Dermatite Atopique, as well as specialists in telemedicine, artificial intelligence and therapeutic patient education (TPE)

PLoS One

The first objective of this study was to determine the GenoType NTM-DR assay performance for subspecies identification in Mycobacterium abscessus complex isolates. The second objective was to evaluate the GenoType NTM-DR assay ability to detect clarithromycin and amikacin resistance in M. abscessus complex isolates compared with drug susceptibility testing (DST) and PCR sequencing of the erm(41), rrl and rrs genes. The concordance between the GenoType NTM-DR and MLST results concerning subspecies identification was 100%. The wild type and mutated alleles of the rrl and rrs genes were detected by the GenoType NTM-DR assay and PCR sequencing with 100% (115/115) agreement. Similarly, 100% concordance between GenoType NTM-DR and DST was observed for clarithromycin and amikacin testing. Sensitivity for the detection of clarithromycin and amikacin resistance was 100%. The GenoType NTM-DR assay provides a robust and complementary tool to the gold standard methods (MLST and broth microdilution) for subspecies identification and drug resistance detection

Human papillomavirus genotype distribution and cervical squamous intraepithelial lesions among high-risk women with and without HIV-1 infection in Burkina Faso

Human papillomavirus (HPV) infection and cervical squamous intraepithelial lesions (SILs) were studied in 379 high-risk women. Human papillomavirus DNA was detected in 238 of 360 (66.1%) of the beta-globin-positive cervical samples, and 467 HPV isolates belonging to 35 types were identified. Multiple (2–7 types) HPV infections were observed in 52.9% of HPV-infected women. The most prevalent HPV types were HPV-52 (14.7%), HPV-35 (9.4%), HPV-58 (9.4%), HPV-51 (8.6%), HPV-16 (7.8%), HPV-31 (7.5%), HPV-53 (6.7%), and HPV-18 (6.4%). Human immunodeficiency virus type 1 (HIV-1) seroprevalence was 36.0%. Human papillomavirus prevalence was significantly higher in HIV-1-infected women (87 vs 54%, prevalence ratio (PR)=1.61, 95% confidence interval (CI): 1.4–1.8). High-risk HPV types (71 vs 40%, PR=1.79, 95% CI: 1.5–2.2), in particular HPV-16+18 (22 vs 9%, PR=2.35, 95% CI: 1.4–4.0), and multiple HPV infections (56 vs 23%, PR=2.45, 95% CI: 1.8–3.3) were more prevalent in HIV-1-infected women. High-grade SIL (HSIL) was identified in 3.8% of the women. Human immunodeficiency virus type 1 infection was strongly associated with presence of HSIL (adjusted odds ratio=17.0; 95% CI 2.2–134.1, P=0.007) after controlling for high-risk HPV infection and other risk factors for HSIL. Nine of 14 (63%) HSIL cases were associated with HPV-16 or HPV-18 infection, and might have been prevented by an effective HPV-16/18 vaccine

Understanding innovation platform effectiveness through experiences from west and central Africa

Innovation platforms (IPs) are a way of organizing multistakeholder interactions, marshalling ideas, people and resources to address challenges and opportunities embedded in complex settings. The approach has its roots in theories of complexity, the concept of innovation systems and practices of participatory action research. IPs have been widely adopted across Africa and beyond in recent years as a “must have” tool in a range of “for development” modes of agricultural research. Our experiences with establishing and facilitating nine IPs in local settings in west and central Africa contribute to understanding factors that impact on their effectiveness. The nine IPs were variously focused on developing dairy, crop and/or meat value chains by strengthening mixed crop-livestock production systems or seed systems. Using case study methods, we identified variables that contribute to explaining the performance of these IPs in relation to six domains of change in the agricultural system and the sustainability of changes. Thematic analysis was guided by a conceptual framework which grouped variables into four categories (context, structure, conduct, and process) that interact to influence IP performance. Stronger market connections and value chains were generated through some of these IPs but the most prevalent changes overall were in farm productivity and technical knowledge of producers. The structures evolved in some IPs, akin to those of producer collectives, suggested they were filling an institutional gap locally. The effect of the IPs on deeper level institutions that influence agricultural systems and food security was modest, constraining prospects for the IPs to generate impact at scale. Impacts from the IPs on research and development organisations were uncommon but had transformative significance. Our conceptual framework did not offer optimal guidance to understanding how the many variables that contributed to performance of these IPs combined and sequenced, but the pattern of interactions was consistent with increased social capital being the prime mediator for change. Achieving greater prospects for transformational change and impact at scale warrants at least equal attention to three other interconnected change pathways: through markets, institutions and innovation capacity. Important factors for increased impact are individuals and organisations with capacity to purposefully build and manage inter-organisational and cross-scale networks, early diagnostic studies of the institutional landscape, and adaptive processes of critical reflection and learning that continue beyond the short term