Geographic and Sociodemographic Disparities in Cardiovascular Risk in Burkina Faso: Findings from a Nationwide Cross-Sectional Survey.

BACKGROUND: Cardiovascular disease (CVD) risk assessment is a critical step in the current approach to the primary prevention of CVD, particularly in low-income countries such as Burkina Faso. In this study, we aimed to assess the geographic and sociodemographic disparities of the ten-year cardiovascular risk in Burkina Faso. METHODS: We conducted a secondary analysis of the data from the first nationwide survey using the World Health Organization (WHO) STEPwise approach. Ten-year cardiovascular risk was determined using the WHO 2019 updated risk chart (WHO risk) as main outcome, and the Framingham risk score (FRS) and the Globorisk chart for secondary outcomes. We performed a modified Poisson regression model using a generalized estimating equation to examine the association between CVD risk and sociodemographic characteristics. RESULTS: A total of 3081 participants aged 30 to 64 years were included in this analysis. The overall age and sex-standardized mean of absolute ten-year cardiovascular risk assessed using the WHO risk chart was 2.5% (95% CI: 2.4-2.6), ranging from 2.3% (95% CI: 2.2-2.4) in Centre Est to 3.0% (95% CI: 2.8-3.2) in the Centre region. It was 4.6% (95% CI: 4.4-4.8) for FRS and 4.0% (95% CI: 3.8-4.1) for Globorisk. Regarding categorized CVD risk (absolute risk ≥10%), we found out that the age and sex-standardized prevalence of elevated risk was 1.7% (95% CI: 1.3-2.1) for WHO risk, 10.4% (95% CI: 9.6-11.2) for FRS, and 5.9% (95% CI: 5.1-6.6) for Globorisk. For all of the three risk scores, elevated CVD risk was associated with increasing age, men, higher education, urban residence, and health region (Centre). CONCLUSION: We found sociodemographic and geographic inequalities in the ten-year CVD risk in Burkina Faso regardless of risk score used. Therefore, population-wide interventions are needed to improve detection and management of adult in the higher CVD risk groups in Burkina Faso

Assessing field performance of ultrasensitive rapid diagnostic tests for malaria: a systematic review and meta-analysis

BACKGROUND: To overcome the limitations of conventional malaria rapid diagnostic tests (cRDTs) in diagnosing malaria in patients with low parasitaemia, ultrasensitive malaria rapid diagnostic tests (uRDTs) have recently been developed, with promising results under laboratory conditions. The current study is the first meta-analysis comparing the overall sensitivity, and specificity of newly developed ultrasensitive Plasmodium falciparum malaria RDT (Alere™ Ultra-sensitive Malaria Ag P. falciparum RDT) with the cRDT conducted in the same field conditions. METHODS: PubMed, EMBASE, Cochrane infectious diseases group specialized register, and African Journals Online (AJOL) were searched up to 20th April 2021. Studies with enough data to compute sensitivity and specificity of uRDT and cRDT were retrieved. A random-effect model for meta-analysis was used to obtain the pooled sensitivity and specificity. RESULTS: Overall, 15 data sets from 14 studies were included in the meta-analysis. The overall sensitivity of the Alere™ ultra-sensitive Malaria Ag P. falciparum RDT regardless of the reference test and the clinical presentation of participants, was 55.5% (95% confidence interval [CI]: 45.5; 65.0), while the sensitivity regardless of the reference test and the clinical presentation of participants, was 42.9% (95% CI: 31.5; 55.2) for the cRDT performed in the same field conditions. When PCR was used as reference test, the sensitivity of uRDT was 60.4% (95% CI: 50.8; 69.2), while the sensitivity was 49.4% (95% CI: 38.2; 60.6) for the cRDT. The pooled specificity of uRDT regardless of the reference test and the clinical presentation of participants was 98.6% (95% CI: 97.1; 99.4), and the pooled specificity of cRDT regardless of the reference test and the clinical presentation of participants was 99.3% (95% CI: 98.1; 99.7). When PCR was used as reference test the specificity of uRDT and cRDT was 97.5% (95% CI: 94.1; 98.9) and 98.2% (95% CI: 95.5; 99.3). Regardless of the reference test used, the sensitivity of Alere™ Ultra-sensitive Malaria Ag P. falciparum RDT in symptomatic patients was 72.1% (95%CI: 67.4; 76.4), while sensitivity of cRDT was 67.4% (95%CI: 57.6; 75.9). CONCLUSION: Findings of the meta-analysis show that Alere™ Ultra-sensitive Malaria Ag P. falciparum RDT compared to cRDT performed in the same field conditions has higher sensitivity but lower specificity although the difference is not statistically significant

Sex-specific-evaluation of metabolic syndrome prevalence in Algeria: insights from the 2016–2017 non-communicable diseases risk factors survey

Abstract Metabolic syndrome (MetS) is a core driver of cardiovascular diseases (CVD); however, to date, gender differences in MetS prevalence and its components have not been assessed in the Algerian adult general population. This study aimed to determine the gender differences in MetS prevalence and its components, in the general population of Algeria. Secondary analysis was performed on data from the Algerian 2016–2017 non-communicable disease risk factor survey. MetS was determined according to the harmonized Joint Interim Statement criteria. A Poisson regression model based on Generalised Estimating Equations was used to estimate the adjusted prevalence ratios (aPR) for the sex-specific factors associated with MetS. Overall, the prevalence of MetS was 34.0% (95% CI 32.4–35.6). MetS prevalence in women and men was 39.1% (95% CI 37.0–41.3) and 29.1% (95% CI 27.2–31.2), respectively. The most frequent triad was the clustering of abdominal obesity with low HDL-cholesterol and high blood pressure among women (8.9%; 95% CI [8.0–10.0]) and low HDL-cholesterol with high blood pressure and hyperglycaemia among men (5.2%; 95% CI [4.3–6.3]). Increasing age (aPR 3.21 [2.35–4.39] in men and aPR 3.47 [2.86–4.22] in women), cohabitation (aPR 1.14 [1.05–1.24]), women residing in urban areas (aPR 1.13 [1.01–1.26]), men with higher educational levels (aPR 1.39 [1.14–1.70]), and men with insufficient physical activity (aPR 1.16 [1.05–1.30]) were associated with higher risk of MetS. In this population-based study, one in three Algerian adults had MetS, and key components including abdominal obesity, low HDL-cholesterol, and high blood pressure, are very common, especially in women. Reinforcing interventions for weight management targeting married women living in urban areas and improving sufficient physical activity in men with higher socioeconomic status could provide maximal health gains and stem the CVD epidemic in Algeria

Addressing challenges in routine health data reporting in Burkina Faso through Bayesian spatiotemporal prediction of weekly clinical malaria incidence

Abstract Sub-Saharan African (SSA) countries’ health systems are often vulnerable to unplanned situations that can hinder their effectiveness in terms of data completeness and disease control. For instance, in Burkina Faso following a workers' strike, comprehensive data on several diseases were unavailable for a long period in 2019. Weather, seasonal-malaria-chemoprevention (SMC), free healthcare, and other contextual data, which are purported to influence malarial disease, provide opportunities to fit models to describe the clinical malaria data and predict the disease spread. Bayesian spatiotemporal modeling was applied to weekly malaria surveillance data from Burkina Faso (2011–2018) while considering the effects of weather, health programs and contextual factors. Then, a prediction was used to deal with weekly missing data for the entire year of 2019, and SMC and free healthcare effects were quantified. Our proposed model accurately predicted weekly clinical malaria incidence (correlation coefficient, r = 0.90). The distribution of clinical malaria incidence was heterogeneous across the country. Overall, national predicted clinical malaria incidence in 2019 (605 per 1000 [95% CrI: 360–990]) increased by 24.7% compared with the year 2015. SMC and the interaction between free healthcare and health facility attendance were associated with a reduction in clinical malaria incidence. Our modeling approach could be a useful tool for strengthening health systems’ resilience by addressing data completeness and could support SSA countries in developing appropriate targets and indicators to facilitate the subnational control effort.info:eu-repo/semantics/publishe

How to Estimate Optimal Malaria Readiness Indicators at Health-District Level: Findings from the Burkina Faso Service Availability and Readiness Assessment (SARA) Data

International audienceOne of the major contributors of malaria-related deaths in Sub-Saharan African countries is the limited accessibility to quality care. In these countries, malaria control activities are implemented at the health-district level (operational entity of the national health system), while malaria readiness indicators are regionally representative. This study provides an approach for estimating health district-level malaria readiness indicators from survey data designed to provide regionally representative estimates. A binomial-hierarchical Bayesian spatial prediction method was applied to Burkina Faso Service Availability and Readiness Assessment (SARA) survey data to provide estimates of essential equipment availability and readiness for malaria care. Predicted values of each indicator were adjusted by the type of health facility, location, and population density. Then, a health district composite readiness profile was built via hierarchical ascendant classification. All surveyed health-facilities were mandated by the Ministry of Health to manage malaria cases. The spatial distribution of essential equipment and malaria readiness was heterogeneous. Around 62.9% of health districts had a high level of readiness to provide malaria care and prevention during pregnancy. Low-performance scores for managing malaria cases were found in big cities. Health districts with low coverage for both first-line antimalarial drugs and rapid diagnostic tests were Baskuy, Bogodogo, Boulmiougou, Nongr-Massoum, Sig-Nonghin, Dafra, and Do. We provide health district estimates and reveal gaps in basic equipment and malaria management resources in some districts that need to be filled. By providing local-scale estimates, this approach could be replicated for other types of indicators to inform decision makers and health program managers and to identify priority areas

Bayesian spatiotemporal modeling of routinely collected data to assess the effect of health programs in malaria incidence during pregnancy in Burkina Faso

Control of malaria in pregnancy (MiP) remains a major challenge in Burkina Faso. Surveillance of the burden due to MiP based on routinely collected data at a fine-scale level, followed by an appropriate analysis and interpretation, may be crucial for evaluating and improving the effectiveness of existing control measures. We described the spatio-temporal dynamics of MiP at the community-level and assessed health program effects, mainly community-based health promotion, results-based financing, and intermittent-preventive-treatment with sulphadoxine-pyrimethamine (IPTp-SP). Community-aggregated monthly MiP cases were downloaded from Health Management Information System and combined with covariates from other sources. The MiP spatio-temporal pattern was decomposed into three components: overall spatial and temporal trends and space-time interaction. Bayesian hierarchical spatio-temporal Poisson models were used to fit the MiP incidence rate and assess health program effects. The overall annual incidence increased between 2015 and 2017. The findings reveal spatio-temporal heterogenicity throughout the year, which peaked during rainy season. From the model without covariates, 96 communities located mainly in the Cascades, South-West, Center-West, Center-East, and Eastern regions, exhibited significant relative-risk levels. The combined effect (significant reducing effect) of RBF, health promotion and IPTp-SP strategies was greatest in 17.7% (17/96) of high burden malaria communities. Despite intensification of control efforts, MiP remains high at the community-scale. The provided risk maps are useful tools for highlighting areas where interventions should be optimized, particularly in high-risk communities

Progress in coverage of bed net ownership and use in Burkina Faso 2003-2014: Evidence from population-based surveys

Background: Use of insecticide-treated bed nets (ITNs) is the cornerstone of malaria prevention. In 2010 and 2013, the Burkina Faso Government launched mass distribution campaigns of ITNs to increase coverage of ownership and use in the country. This study assessed the progress towards universal bed net coverage in Burkina Faso. Methods: The authors used data from the Burkina Faso 2003 and 2010 Demographic and Health Surveys (DHS), the 2006 Multiple Indicator Cluster Surveys (MICS) and the 2014 Malaria Indicator Survey (MIS). For each survey, the authors computed key malaria prevention indicators in line with recommendations from the Survey and Indicator Task Force of the Roll Back Malaria Monitoring and Evaluation Reference Group. The trends over a decade was assessed by calculating percentage point change between 2003 and 2014. Results: At national level, the proportion of households owning at least one ITN increased substantially from 5.6, 95% CI (4.7, 6.5%) in 2003 to 89.9% (88.5, 91.2%) in 2014, with low heterogeneity between regions. The proportion of households owning at least one ITN per two people increased significantly from 1.8% (1.4, 2.3%) in 2003 to 49.2% (47.3, 51.0%) in 2014. ITN use in the general population increased from 2.0% (1.6, 2.3%) in 2003, to 67.0% (65.3, 68.7%) in 2014. A similar trend was observed among children under the age of five years, increasing from 1.9% (1.5, 2.4%) in 2003 to 75.2% (73.2, 77.3%) in 2014, and among pregnant women, increasing from 3.0% (1.9, 4.2%) in 2003 to 77.1% (72.9, 81.3%) in 2014. The intra-household ownership gap was 67.0% (61.5, 72.4%) in 2003, but decreased significantly to 45.3% (43.6, 47.1%) in 2014. The behavioural gap, which was relatively low in 2013 with only 20.0% of people who had access to an ITN but were not using it, further decreased to 5.9% in 2014. Conclusion: Burkina Faso made considerable progress in coverage of ITN ownership, access and use between 2003 and 2014, as a result of the two free mass distribution campaigns in 2010 and 2013. However, ITN coverage remains below the national targets of 100% for ownership and 80% for use. The results of 90% of ownership and 67% of use confirm that free mass distribution campaigns of ITNs are effective; however, there is room for improvement to reach and maintain optimal coverage of ITN ownership and use.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Sex-specific-evaluation of metabolic syndrome prevalence in Algeria: insights from the 2016–2017 non-communicable diseases risk factors survey

Abstract Metabolic syndrome (MetS) is a core driver of cardiovascular diseases (CVD); however, to date, gender differences in MetS prevalence and its components have not been assessed in the Algerian adult general population. This study aimed to determine the gender differences in MetS prevalence and its components, in the general population of Algeria. Secondary analysis was performed on data from the Algerian 2016–2017 non-communicable disease risk factor survey. MetS was determined according to the harmonized Joint Interim Statement criteria. A Poisson regression model based on Generalised Estimating Equations was used to estimate the adjusted prevalence ratios (aPR) for the sex-specific factors associated with MetS. Overall, the prevalence of MetS was 34.0% (95% CI 32.4–35.6). MetS prevalence in women and men was 39.1% (95% CI 37.0–41.3) and 29.1% (95% CI 27.2–31.2), respectively. The most frequent triad was the clustering of abdominal obesity with low HDL-cholesterol and high blood pressure among women (8.9%; 95% CI [8.0–10.0]) and low HDL-cholesterol with high blood pressure and hyperglycaemia among men (5.2%; 95% CI [4.3–6.3]). Increasing age (aPR 3.21 [2.35–4.39] in men and aPR 3.47 [2.86–4.22] in women), cohabitation (aPR 1.14 [1.05–1.24]), women residing in urban areas (aPR 1.13 [1.01–1.26]), men with higher educational levels (aPR 1.39 [1.14–1.70]), and men with insufficient physical activity (aPR 1.16 [1.05–1.30]) were associated with higher risk of MetS. In this population-based study, one in three Algerian adults had MetS, and key components including abdominal obesity, low HDL-cholesterol, and high blood pressure, are very common, especially in women. Reinforcing interventions for weight management targeting married women living in urban areas and improving sufficient physical activity in men with higher socioeconomic status could provide maximal health gains and stem the CVD epidemic in Algeria.info:eu-repo/semantics/publishe

Effect of Free Healthcare Policy for Children under Five Years Old on the Incidence of Reported Malaria Cases in Burkina Faso by Bayesian Modelling: "Not only the Ears but also the Head of the Hippopotamus".

Burkina Faso has recently implemented an additional strategy, the free healthcare policy, to further improve maternal and child health. This policy targets children under five who bear the brunt of the malaria scourge. The effects of the free-of-charge healthcare were previously assessed in women but not in children. The present study aims at filling this gap by assessing the effect of this policy in children under five with a focus on the induced spatial and temporal changes in malaria morbidity. We used a Bayesian spatiotemporal negative binomial model to investigate the space-time variation in malaria incidence in relation to the implementation of the policy. The analysis relied on malaria routine surveillance data extracted from the national health data repository and spanning the period from January 2013 to December 2018. The model was adjusted for meteorological and contextual confounders. We found that the number of presumed and confirmed malaria cases per 1000 children per month increased between 2013 and 2018. We further found that the implementation of the free healthcare policy was significantly associated with a two-fold increase in the number of tested and confirmed malaria cases compared with the period before the policy rollout. This effect was, however, heterogeneous across the health districts. We attributed the rise in malaria incidence following the policy rollout to an increased use of health services combined with an increased availability of rapid tests and a higher compliance to the "test and treat" policy. The observed heterogeneity in the policy effect was attributed to parallel control interventions, some of which were rolled out at different paces and scales. Our findings call for a sustained and reinforced effort to test all suspected cases so that, alongside an improved case treatment, the true picture of the malaria scourge in children under five emerges clearly (see the hippopotamus almost entirely).info:eu-repo/semantics/publishe

Adequacy of Phenomenological Models in Forecasting Trajectory of the Early Phase of COVID-19 Outbreak: Application to Burkina Faso Data

info:eu-repo/semantics/publishe