Traitement préventif intermittent à la sulfadoxine – pyriméthamine du paludisme chez les femmes enceintes: efficacité et observance dans deux hôpitaux urbains du Burkina Faso

Introduction: La présente étude prospective se propose dévaluer l’efficacité thérapeutique du traitement préventif intermittent à la sulfadoxine - pyriméthamine et son observance chez la femme enceinte dans deux hôpitaux urbains au Burkina Faso. Méthodes: Chaque femme répondant aux critères d’inclusion a été soumise à un questionnaire pour la collecte des données socio - démographiques et des renseignements sur la grossesse. A l’accouchement, une apposition placentaire a été réalisée systématiquement. La lecture a été faite au microscope à lobjectif 100 à immersion. Résultats: Au total, 542 femmes ont été incluses avec un âge moyen de 26,0 ± 6,45 ans (extrêmes 13- 43 ans). Le taux de couverture du TPI à la sulfadoxine- pyriméthamine a été de 80%. Le taux d’infestation placentaire a été de 4,7 %. Il a diminué avec le nombre de dose de traitement préventif intermittent. Il a augmenté cependant de juillet à octobre. De 42,9% en octobre, il a diminué significativement à 9,5% en novembre (p<0,05). Le taux global de bonne d'observance a été de 55%. Il a augmenté avec l'âge (p<0,05). Conclusion: Le taux de couverture de la sulfadoxine - pyriméthamine a été de 80%. Ce résultat est en conformité avec les objectifs du plan stratégique 2006-2010 de lutte contre le paludisme au Burkina Faso, qui préconisait un taux de couverture en sulfadoxine - pyriméthamine de 80% pour 2010. L’augmentation de la fréquence d’infestation de juillet à octobre, serait liée à la recrudescence de la transmission palustre pendant la saison des pluies (mai-octobre).Pan African Medical Journal 2013; 14: 10

Epidemiological profile of cutaneous leishmaniasis: Retrospective analysis of 7444 cases reported from 1999 to 2005 at Ouagadougou, Burkina Faso

This retrospective study was aimed to describe the trend of the cases and to determine the annual incidence rate of cutaneous leishmaniasis from 1999 to 2005 in the city of Ouagadougou. To achieve these objectives, a retrospective study was conducted. Data collection was conducted from January 1999 to December 2005. In total, 7444 cases of cutaneous leishmaniasis were recorded with an annual average of 1063.30 ± 270. 8 cases. The sex ratio M/F was 0.9. The average age was 22.8 ± 13.5 years. Patients more than 15 year-old accounted for 72.5%. A decrease in the cases of the disease was noted during the months of March, April, May, June, and December. The peak was recorded during the months of September and October. Over 7 years, the average incidence rate was 0.1% ± 0.04 but does not reflect the importance of this pathology. Thus, a prospective study was recommended.Pan African Medical Journal 2013: 10

Localisation vaginale de Mansonella perstans: à propos d’un cas au centre hospitalier universitaire de Bobo-Dioulasso, Burkina Faso

Mansonella perstans est une filaire dont les adultes sont à localisation péritonéale et les microfilaires à localisation sanguine, qui sévit principalement en Amérique Equatoriale et aux bords de rivières, de plages en Afrique tropicale humide. Sa transmission est assurée par la piqûre de culicoïdes. Nous rapportons le cas d’une patiente souffrant de prurit dans un contexte biologique d’hyperéosinophilie au cours d’un dépistage du cancer du col de l’utérus. Une microfilaire de Mansonella perstans a été observée sur son frottis cervico-vaginal mais aussi dans son sang. La patiente a été traitée avec succès par une prise unique combinée de 400 mg d’albendazole et d’ivermectine (150 μg/kg). La localisation cervico-vaginale de Mansonella perstans est atypique et exceptionnelle. Nous proposons une recherche systématique de microfilaires lors de frottis cervico-vaginaux des femmes souhaitant un dépistage du cancer du col de l’utérus au Centre Hospitalier de Bobo-Dioulasso pour déterminer la fréquence réelle de cette localisation atypique. Pan African Medical Journal 2012; 12:4

Personal protection of long lasting insecticide-treated nets in areas of Anopheles gambiae s.s. resistance to pyrethroids

BACKGROUND: The development of mosquito nets pre-treated with insecticide, Long Lasting Impregnated Nets (LLINs) that last the life span of the net, is a solution to the difficulty of the re-impregnation of conventional nets. Even if they showed a good efficacy in control conditions, their efficacy in the field, particularly in areas with resistance of Anopheles gambiae to pyrethroids, is not well documented. This study compares wide (Olyset(®)) and small (Permanet(®)) mesh LLINs in field conditions, using entomological parameters. METHODS: The two LLINs were tested in a rice-growing area of south-western Burkina Faso (West Africa) with year around high density of the main malaria vector An. gambiae s.s. In the study village (VK6), there is a mixed population of two molecular forms of An. gambiae, the S-form which dominates during the rainy season and the M-form which dominates the rest of the year. The two LLINs Olyset(® )and Permanet(® )were distributed in the village and 20 matched houses were selected for comparison with four houses without treated nets. RESULTS: Mosquito entrance rate was ten fold higher in control houses than in houses with LLINs and there was no difference between the two net types. Among mosquitoes found in the houses, 36 % were dead in LLIN houses compared to 0% in control houses. Blood feeding rate was 80 % in control houses compared to 43 % in LLIN houses. The type of net did not significantly impact any of these parameters. No mosquitoes were found inside Permanet(®), whereas dead or dying mosquitoes were collected inside the Olyset(®). More than 60% of mosquitoes found on top or inside the nets had had blood meals from cattle, as shown by ELISA analysis. CONCLUSION: The percentage of blood-fed mosquitoes in a bed net study does not necessarily determine net success. The efficacy of the two types of LLINs was comparable, during a period when the S-form of An. gambiae was carrying the kdr gene. Significantly higher numbers of mosquitoes were collected in control houses compared to intervention houses, indicating that the LLINs provided an additional deterrent effect, which enhanced their expected prevention capacity

Ex vivo anti-malarial drugs sensitivity profile of Plasmodium falciparum field isolates from Burkina Faso five years after the national policy change.

BACKGROUND: The recent reports on the decreasing susceptibility of Plasmodium falciparum to artemisinin derivatives along the Thailand and Myanmar border are worrying. Indeed it may spread to India and then Africa, repeating the same pattern observed for chloroquine resistance. Therefore, it is essential to start monitoring P. falciparum sensitivity to artemisinin derivatives and its partner drugs in Africa. Efficacy of AL and ASAQ were tested by carrying out an in vivo drug efficacy test, with an ex vivo study against six anti-malarial drugs nested into it. Results of the latter are reported here. METHODS: Plasmodium falciparum ex-vivo susceptibility to chloroquine (CQ), quinine (Q), lumefantrine (Lum), monodesethylamodiaquine (MDA), piperaquine (PPQ) and dihydroartemisinin (DHA) was investigated in children (6 months - 15 years) with a parasitaemia of at least ≥4,000/μl. The modified isotopic microtest technique was used. The results of cellular proliferation were analysed using ICEstimator software to determine the 50% inhibitory concentration (IC50) values. RESULTS: DHA was the most potent among the 6 drugs tested, with IC50 values ranging from 0.8 nM to 0.9 nM (Geometric mean IC50 = 0.8 nM; 95% CI [0.8 - 0.9]). High IC50 values ranged between 0.8 nM to 166.1 nM were reported for lumefantrine (Geometric mean IC50 = 25.1 nM; 95% CI [22.4 - 28.2]). MDA and Q IC50s were significantly higher in CQ-resistant than in CQ-sensitive isolates (P = 0.0001). However, the opposite occurred for Lum and DHA (P < 0.001). No difference was observed for PPQ. CONCLUSION: Artemisinin derivatives are still very efficacious in Burkina Faso and DHA-PPQ seems a valuable alternative ACT. The high lumefantrine IC50 found in this study is worrying as it may indicate a decreasing efficacy of one of the first-line treatments. This should be further investigated and monitored over time with large in vivo and ex vivo studies that will include also plasma drug measurements

Chlorproguanil−Dapsone−Artesunate versus Artemether−Lumefantrine: A Randomized, Double-Blind Phase III Trial in African Children and Adolescents with Uncomplicated Plasmodium falciparum Malaria

Chlorproguanil−dapsone−artesunate (CDA) was developed as an affordable, simple, fixed-dose artemisinin-based combination therapy for use in Africa. This trial was a randomized parallel-group, double-blind, double-dummy study to compare CDA and artemether−lumefantrine (AL) efficacy in uncomplicated Plasmodium falciparum malaria and further define the CDA safety profile, particularly its hematological safety in glucose-6-phosphate dehydrogenase (G6PD) -deficient patients

Decreased motivation in the use of insecticide-treated nets in a malaria endemic area in Burkina Faso

<p>Abstract</p> <p>Background</p> <p>The use of insecticide-treated nets (ITN) is an important tool in the Roll Back Malaria (RBM) strategy. For ITNs to be effective they need to be used correctly. Previous studies have shown that many factors, such as wealth, access to health care, education, ethnicity and gender, determine the ownership and use of ITNs. Some studies showed that free distribution and public awareness campaigns increased the rate of use. However, there have been no evaluations of the short- and long-term impact of such motivation campaigns. A study carried out in a malaria endemic area in south-western Burkina Faso indicated that this increased use declined after several months. The reasons were a combination of the community representation of malaria, the perception of the effectiveness and usefulness of ITNs and also the manner in which households are organized by day and by night.</p> <p>Methods</p> <p>PermaNet 2.0^®and Olyset^®were distributed in 455 compounds at the beginning of the rainy season. The community was educated on the effectiveness of nets in reducing malaria and on how to use them. To assess motivation, qualitative tools were used: one hundred people were interviewed, two hundred houses were observed directly and two houses were monitored monthly throughout one year.</p> <p>Results</p> <p>The motivation for the use of bednets decreased after less than a year. Inhabitants' conception of malaria and the inconvenience of using bednets in small houses were the major reasons. Acceptance that ITNs were useful in reducing malaria was moderated by the fact that mosquitoes were considered to be only one of several factors which caused malaria. The appropriate and routine use of ITNs was adversely affected by the functional organization of the houses, which changed as between day and night. Bednets were not used when the perceived benefits of reduction in mosquito nuisance and of malaria were considered not to be worth the inconvenience of daily use.</p> <p>Conclusion</p> <p>In order to bridge the gap between possession and use of bednets, concerted efforts are required to change behaviour by providing accurate information, most particularly by convincing people that mosquitoes are the only source of malaria, whilst recognising that there are other diseases with similar symptoms, caused in other ways. The medical message must underline the seriousness of malaria and the presence of the malaria vector in the dry season as well as the wet, in order to encourage the use of bednets whenever transmission can occur. Communities would benefit from impregnated bednets and other vector control measures being better adapted to their homes, thus reducing the inconvenience of their use.</p

Concordance élevée entre les génotypes Pfdhfr et Pfdhps entre de sprélèvemnets appariés périphériques et placentaires chez des parturientes à Bobo-Dioulasso, Burkina Fasso

peer reviewedWhether maternal peripheral parasites constitute a representative sample of the overall population infecting the individual, remains unknown in Burkina Faso. We therefore compared Pfdhfr and Pfdhps génotypes between matched peripheral and placental isolates. PCR-restriction fragment length polymorphism (PCR-RFLP) analysis of polymorphic codons of the Pfdhfr gene (51, 59, 108 and 164) and the Pfdhps gene (437 and 540) was performed in 18 matched peripheral and placental dried blood spots of delivered women in Bobo-Dioulasso. Both Pfdhfr and Pfdhps genes were successfully genotyped in 94.4% (17/18) of the matched samples. Only 8.8% (3/34) of génotypes were of the wild type, while 20.6% (7/34), 20.6% (7/34), 23.5% (8/34) and 26.5% (9/34) comprised one, two, three and four mutations, respectively. None of the samples carried both Pfdhfr I164L and Pfdhps K540E mutations. A concordance of 82.4% was observed in matched samples for both the Pfdhfr and Pfdhps genes. Setting placental allèles as the reference, a concordance of 100% was obtained with Pfdhfr mutation S108N, Pfdhfr mutation C59R+S108N, and Pfdhfr mutation N51I+C59R +S108N, respectively. Likewise, a concordance of 85.7% was observed with the Pfdhps mutation A437G. For epidemiological purposes, peripheral blood Pfdhfr and Pfdhps genotyping is sufficient for monitoring SP resistant molecular markers in pregnant women

La prise intermittente de sulfadoxine-pyriméthamine comme traitement préventif antipaludique durant la grossesse est associée à une augmentation de la prévalence de mutations sur le gène Pfdhfr à Bobo-Dioulasso, Burkina Faso

Background: The impact of sulfadoxine–pyrimethamine (SP) used as intermittent preventive treatment during pregnancy (IPTp-SP) on mutant parasite selection has been poorly documented in Burkina Faso. This study sought first to explore the relationship between IPTp-SP and the presence of mutant parasites. Second, to assess the Relationship between the mutant parasites and adverse pregnancy outcomes. Methods: From September to December 2010, dried blood spots (DBS) were collected during antenatal care visits and at delivery from 109 pregnant women with microscopically confirmed falciparum malaria infection. DBS were analysed by PCR–restriction fragment length polymorphism (PCR–RFLP) for the polymorphisms at codons 51, 59, 108 and 164 of the Pfdhfr gene and codons 437 and 540 in the Pfdhps gene. Results: Both the Pfdhfr and Pfdhps genes were successfully genotyped in 92.7% (101/109) of the samples. The prevalence of Pfdhfr mutations N51I, C59R and S108N was 71.3, 42.6 and 64.4%, respectively. Overall, 80.2% (81/101) of samples carried the Pfdhps A437G mutation. None of the samples had the Pfdhfr I164L and the Pfdhps K540E mutations. The prevalence of the triple mutation N51I + C59R + S108N was 25.7% (26/101). The use of IPTp-SP was associated with a threefold increased odds of Pfdhfr C59R mutation [crude OR 3.29; 95% CI (1.44–7.50)]. Pregnant women with recent uptake of IPTp-SP were at higher odds of both the Pfdhfr C59R mutation [adjusted OR 4.26; 95% CI (1.64–11.07)] and the Pfdhfr intermediate-to-high resistance, i.e., ≥ 2 Pfdhfr mutations [adjusted OR 3.45; 95% CI (1.18–10.07)]. There was no statistically significant association between the presence of the Pfdhfr intermediate-tohigh resistance and parasite densities or both maternal haemoglobin level and anaemia. Conclusion: The data indicate that despite the possibility that IPTp-SP contributes to the selection of resistant parasites, it did not potentiate pregnancy-associated malaria morbidity, suggesting the continuation of SP use as IPTp in Burkina Faso

Seroprevalence and risk factors of Toxoplasma gondii infection in pregnant women from Bobo Dioulasso, Burkina Faso

Abstract Background Toxoplasmosis is one of the common worldwide parasitic zoonosis due to Toxoplasma gondii (T. gondii). Toxoplasmosis during pregnancy can result in fetal and neonatal death or various congenital defects. The aim of this study was to assess the seroprevalence and risk factors of T. gondii infection in pregnant women following antenatal care (ANC) services at Bobo Dioulasso. Methods A cross-sectional study was conducted enrolling a sample of 316 pregnant women attending ANC at centers for maternal and child health of Bobo-Dioulasso town from March 2013 to February 2014. Data on socio-demographic and potential risk factors were collected from each study participant using structured questionnaire through face-to-face interview. Moreover, venous blood specimens were collected and tested for IgM and IgG anti-T. gondii antibodies by enzyme-linked immunosorbent assay and enzyme linked fluorescent assay, respectively. Multivariable logistic regression modeling was used to identify the potential predictor variables for T. gondii infection. Results The overall seroprevalence for T. gondii infection was 31.1% (98/316). All the pregnant women were positive for IgG anti-bodies exclusively. Multivariable logistic regression analysis showed that having at least a secondary education level (AOR = 2.23; 95% CI: [1.04–4.63]); being urban resident (AOR = 2.81; 95% CI: [1.24–6.86]) and the consumption of meat combination (pork + beef + mutton + wild meat + poultry) (AOR = 4.00; 95% CI: [1.06–15.24]) were potential risk factors of T. gondii infection. Conclusion Toxoplasmosis is frequent in pregnant women and studies that show incidence of T. gondii among the neonates have to be done to introduce routine antenatal screening program to control congenital toxoplasmosis. There is the need for preventive measures such as education of pregnant women about the transmission routes and prevention methods of toxoplasmosis at ANC clinics