Economic and psychological burden of scheduled surgery cancellation in a sub-Saharan country (Burkina Faso)

Background: Cancellation of scheduled surgery creates a financial burden for hospitals, caregivers and patients. Cancellation causes emotional stress, which impacts on outcomes. In poor countries where the adequacy of healthcare is limited, the ethical dilemma created by scheduled surgery cancellation is particularly important.Objective: To identify the incidence, cost and emotional impact of elective surgical cancellation in a teaching hospital in BurkinoFaso.Methods: A four month, prospective, observational study was undertaken in a teaching hospital (Yalgado Ouedraogo). All surgical patients were eligible. The causes of cancellation, financial cost and patients’ emotional response were assessed. The cost was estimated using a tool adapted for the economic cost of African job types.Results: During the study period, 1 088 cases were scheduled to undergo inpatient surgery. Of these, 239 cases (21.9%) were cancelled. Among the cancelled cases, 237 were cancelled during preparation in the surgical ward and two cases were cancelled in the operation room. A large number of the patients were housewives (n = 87). The highest cancellation rate (35.9%) was found in general surgery. Cancellation was judged avoidable in 214 cases (89.5%). The total cost of surgery cancellation to the hospital was US$19 147 (mean value US$ 80 per patient). Patients lost a mean of US$62.70, which represented 117.6$ 4 989 ). Cancellation caused a negative emotional reaction in 205 patients (85.7%) and ‘sadness’ was the most frequent (54.8%; n = 131). Cancellation resulted in 163 days of work lost.Conclusion: Based on income, the cost of day of surgery cancellation was high in Burkina Faso.Keywords: cost, emotional reaction, psychology, surgery cancellatio

Etiology and risk factors for meningitis during an outbreak in Batié Health District, Burkina Faso, January-March 2016

Introduction: On 16 March 2016, Batié Health District notified the Burkina Faso Ministry of Health Surveillance unit of 12 suspected cases of meningitis. During the same period, Batié´s neighboring districts in Côte d'Ivoire and Ghana were experiencing a meningitis epidemic. We investigated to establish the etiology and risk factors for the disease and to recommend prevention and control measures. Methods: We conducted unmatched case control study. A case was any person living in Batié with fever (temp. ≥ 38.5°C) and any of the following: neck stiffness, neurological disorder, bulging fontanelle, convulsion during January to April 2016 with cerebrospinal fluid (CSF) positive to PCR. Controls were non sick household members, neighbors or friends to the cases. We analyzed the investigation and laboratory records. We included all confirmed cases and two neighborhood controls per case. We used a standard questionnaire to collect data. We analyzed data by Epi info 7 and calculated odds ratio (ORs),adjusted odds ratios (AOR) and 95% confidence interval. We proceeded to univariate, bivariate, multivariate and logistic regression analysis. Results: We interviewed 93 participants including 31 meningitis cases and 62 controls. The median age of cases was 8 years old [2 months-55 years] and 6.5 years old [5 months-51 years] for controls. Streptococcus pneumoniae 16(51.61%), Neisseria meningitidis W 14(45.16%) and Haemophilus influenzae b 1(3.23%) were the identified germs. The independent risk factors identified were travel to meningitis affected areas (Adjusted odd ratio(AOR)=12[2.3-60],p=0.0029); >5 persons sharing bedroom (AOR=5.7[1.5-22],p=0.012) and rhinopharyngitis (AOR=26[1.8-380],p=0.017). Conclusion: Streptococcus pneumoniae and Neisseria meningitidis W caused the outbreak in Batié. The risk factors were overcrowding, travel to affected areas, and rhinopharyngitis. We recommended reactive vaccination against Neisseria meningitidis W, limited travel to affected areas and ventilation of rooms

Ampleur de la dengue dans la ville de Ouagadougou, Burkina-Faso, 2016: Magnitude of dengue fever in the city of Ouagadougou, Burkina-Faso, 2016

Introduction: En Octobre 2016, le Burkina Faso a connu une flambée de cas de dengue dont l’ampleur est peu connue. Aussi aucune étude n’a été réalisée durant les dix dernières années, donnant lieu à un manque d’information actualisée sur sa prévalence et son incidence. Cette étude avait pour objectif de déterminer l’ampleur de la dengue à Ouagadougou et le type de virus circulant. Méthodes: Nous avons mené une étude transversale sur les cas de dengue enregistrés dans les formations sanitaires (FS) de la ville de Ouagadougou du 1er août au 31 décembre 2016. Un cas de dengue était défini comme toute personne résident dans la ville de Ouagadougou présentant une maladie fébrile aiguë (2-7 jours), avec au moins deux des symptômes suivants : céphalées, douleur rétro-orbitale, myalgie, arthralgie, éruption cutanée, manifestations hémorragiques, syndrome de choc et un test biologique positif à la PCR ou avec TDR-Dengue positif ayant un lien épidémiologique avec un cas confirmé. Nous avons réalisé une recherche active des cas à travers une revue documentaire des registres de laboratoire, consultation et/ou d’hospitalisation des FS, Une fiche de collecte a été utilisée pour recueillir les caractéristiques sociodémographiques, cliniques, biologiques des cas. Résultats: Au total, 5094 cas de dengue ont été enregistrés dans les FS. L’âge médian était de 27 ans avec un intervalle interquartile de 16 à 37 ans. Quinze cas (51,72%) ont été testés positifs à la PCR dont 10 (66,67%) au DENV2 et 5 (33,33%) au DENV3. Parmi les cas, 2569 (50,76%) étaient de sexe féminin et 1494 (28,16%) cas avaient été hospitalisés. Sur les cas recensés, 73% avaient été notifiés par les structures privées et 3174 (88,88%) étaient des éleves/étudiants ou fonctionnaires ou commerçants. Le taux d’attaque global était de 201 cas (5094/2532311) pour 100000 habitants. Le taux de létalité était de 35/5094 (0,69%). Conclusion: Le taux d’attaque global de la dengue en 2016 était de 201 cas pour 100000 habitants. La dengue touchait plus les adultes jeunes surtout les élèves/étudiants et les fonctionnaires et était causée par les types 2 et 3. Les cas étaient plus notifiés par les structures privées. Une surveillance hebdomadaire associée à une surveil-lance sentinelle et la sensibilisation de la population sur la dengue contribueraient à endiguer ce fléau au Burki-na Faso. Background: In October 2016, Burkina Faso experienced an outbreak of dengue fever that the magnitude is little known. Also, no studies have been performed in the past ten years, giving rise to a lack of updated information on its prevalence and incidence. We conducted an investigation to determine the magnitude of dengue fever in Ouagadougou’s city and the type of virus circulating. Methods: We conducted a cross-sectional study on the cases of dengue recorded in health facilities (HF) in Ouagadougou’s city from August 1st to December 31st, 2016. We defined a case of dengue as any person resident in the city of Ouagadougou with acute febrile illness (2-7days), with at least two of the following symptoms (headache, retro-orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestations, shock syndrome) and a positive PCR test or with dengue-RDT positive, having an epidemiological link with a confirmed case. We carried out an active search for cases through a documentary review of laboratory, consultation and/or hospitalization registers of HF, used a file to collect the socio-demographic, clinical and biological characteristics of the cases. Results: A total of 5094 cases of dengue fever were recorded in the HF. The median age was 27 years with an interquartile range of 16 to 37 years old. Fifteen (51.72%) cases tested positive with PCR including 10(66.67%) for DENV2 and 5(33.33%) for DENV3. Among the cases, 2,569(50.76%) were female and 1,494(28.16%) cases were hospitalized. Of the cases listed, 73% were notified by private’s hospitals and 3,174 (88.88%) were pupils/students or civil servants or traders. The overall attack rate was 201 cases (5094/2532311) per 100,000 populations. The case fatality rate was 35/5094 (0.69%). Conclusion: The overall dengue attack rate in 2016 was 201 cases per 100,000 populations. Dengue more affected young adults especially the pupils/students or civil servants and was caused by types 2 and 3. The cases were more notified by the private hospitals. We recommend weekly surveillance, sentinel surveillance and public awareness of dengue fever

Community protection of the environment within the framework of UEMOA : challenges, scope and prospects

L’Union économique et monétaire ouest-africaine (UEMOA), instituée en 1994, est l’une des plus jeunes organisations d’intégration économique en Afrique de l’Ouest. Mise en place à un moment où tous les voyants sur la gestion durable des ressources naturelles sont déjà allumés, elle n’a pourtant pas explicitement consacré la préservation de l’environnement dans son Traité constitutif.Le droit dérivé de l’UEMOA, qui tend à combler les lacunes de son droit primaire, est malheureusement pris en otage par des procédures complexes et longues, maintenant au stade de projets inachevés la plupart des cadres juridiques initiés. Pour se hisser au rang des institutions modernes déterminées à allier économie et écologie, entreprise certes ardue mais indispensable, l’UEMOA devrait réviser son droit primaire pour y inscrire la préservation de l’environnement et le développement durable comme l’un de ses objectifs essentiels. Elle devrait également accélérer l’adoption finale de ses nombreux projets de textes juridiques relatifs à la protection de l’environnement au sein de l’Union.The West African Economic and Monetary Union (UEMOA), established in 1994, is one of the youngest economic integration organizations in West Africa. Set up at a time when all the lights on the sustainable management of natural resources were already on, it has however not explicitly enshrined the preservation of the environment in its Constitutive Treaty.UEMOA’s secondary law, which tends to fill in the gaps in its primary law, is unfortunately held hostage by complex and lengthy procedures. Thus, most of the legal instruments being developed remain at the stage of unfinished drafts. To rise to the rank of modern institutions committed to reconciling economy and ecology, a difficult but necessary undertaking, UEMOA should revise its primary law to include the preservation of the environment and sustainable development as one of its essential objectives. It should also speed up the final adoption of its many draft legal texts on the protection of the environment within the Union

La protection communautaire de l'environnement dans le cadre de l'UEMOA : enjeux, portée et perspectives

The West African Economic and Monetary Union (UEMOA), established in 1994, is one of the youngest economic integration organizations in West Africa. Set up at a time when all the lights on the sustainable management of natural resources were already on, it has however not explicitly enshrined the preservation of the environment in its Constitutive Treaty.UEMOA’s secondary law, which tends to fill in the gaps in its primary law, is unfortunately held hostage by complex and lengthy procedures. Thus, most of the legal instruments being developed remain at the stage of unfinished drafts. To rise to the rank of modern institutions committed to reconciling economy and ecology, a difficult but necessary undertaking, UEMOA should revise its primary law to include the preservation of the environment and sustainable development as one of its essential objectives. It should also speed up the final adoption of its many draft legal texts on the protection of the environment within the Union.L’Union économique et monétaire ouest-africaine (UEMOA), instituée en 1994, est l’une des plus jeunes organisations d’intégration économique en Afrique de l’Ouest. Mise en place à un moment où tous les voyants sur la gestion durable des ressources naturelles sont déjà allumés, elle n’a pourtant pas explicitement consacré la préservation de l’environnement dans son Traité constitutif.Le droit dérivé de l’UEMOA, qui tend à combler les lacunes de son droit primaire, est malheureusement pris en otage par des procédures complexes et longues, maintenant au stade de projets inachevés la plupart des cadres juridiques initiés. Pour se hisser au rang des institutions modernes déterminées à allier économie et écologie, entreprise certes ardue mais indispensable, l’UEMOA devrait réviser son droit primaire pour y inscrire la préservation de l’environnement et le développement durable comme l’un de ses objectifs essentiels. Elle devrait également accélérer l’adoption finale de ses nombreux projets de textes juridiques relatifs à la protection de l’environnement au sein de l’Union

Comparaison de l’effet de deux champignons mycorhiziens arbusculaires sur la croissance et la productivité du sésame (Sesamum indicum L.) au Burkina Faso

L’agriculture conventionnelle caractérisée par une forte utilisation de pesticides et d’engrais chimiques entraine de nombreuses répercussions délétères sur la santé humaine et sur l’environnement notamment la dégradation de la fertilité des sols. Pour atténuer ces effets, l’agriculture biologique basée sur l’utilisation des champignons mycorhiziens arbusculaires pourrait être un modèle alternatif. L’effet de l’inoculation mycorhizienne avec Glomus aggregatum et Rhizophagus irregularis sur la productivité du sésame a été étudié. Les résultats de l’inoculation du sésame avec ces deux souches ont été comparés au témoin non inoculé et au traitement fertilisé au compost dans un dispositif en bloc de Fisher. Les résultats ont montré que l’intensité de mycorhization des plantes de sésame est très faible tout au long du cycle végétatif (de 8,65% à 22,72%). L’inoculation du sésame avec Glomus aggregatum a également eu un effet significatif sur le nombre de capsules (plus de 54 capsules/plante), la biomasse totale et le rendement graine (362,27 Kg ha-1) comparativement au témoin (315,51 Kg ha-1). L’effet de Rhizophagus irregularis en provenance du Sénégal n’a pas été significatif sur tous les paramètres morphologiques du sésame contrairement au témoin naturellement mycorhizé. Les champignons mycorhiziens arbusculaires indigènes présents dans les agroécosystèmes du Burkina Faso induisent donc plus d’effet sur le sésame que la souche de Rhizophagus irregularis provenant du Sénégal

Protocol for a quasi-experimental study to assess the feasibility, acceptability and costs of multiple first-lines artemisinin-based combination therapies for uncomplicated malaria in the Kaya health district, Burkina Faso

Introduction As demonstrated in mathematical models, the simultaneous deployment of multiple first-line therapies (MFT) for uncomplicated malaria, using artemisinin-based combination therapies (ACTs), may extend the useful therapeutic life of the current ACTs. This is possible by reducing drug pressure and slowing the spread of resistance without putting patients’ life at risk. We hypothesised that a simultaneous deployment of three different ACTs is feasible, acceptable and can achieve high coverage rate if potential barriers are properly identified and addressed.Methods and analysis We plan to conduct a quasi-experimental study in the Kaya health district in Burkina Faso. We will investigate a simultaneous deployment of three ACTs, artemether–lumefantrine, pyronaridine–artesunate, dihydroartesinin–piperaquine, targeting three segments of the population: pregnant women, children under five and individuals aged five years and above. The study will include four overlapping phases: the formative phase, the MFT deployment phase, the monitoring and evaluation phase and the post-evaluation phase. The formative phase will help generate baseline information and develop MFT deployment tools. It will be followed by the MFT deployment phase in the study area. The monitoring and evaluation phase will be conducted as the deployment of MFT progresses. Cross-sectional surveys including desk reviews as well as qualitative and quantitative research methods will be used to assess the study outcomes. Quantitatives study outcomes will be measured using univariate, bivariate and multivariate analysis, including logistic regression and interrupted time series analysis approach. Content analysis will be performed on the qualitative data.Ethics and dissemination The Health Research Ethics Committee in Burkina Faso approved the study (Clearance no. 2018-8-113). Study findings will be disseminated through feedback meetings with local communities, national workshops, oral presentations at congresses, seminars and publications in peer-reviewed scientific journals.Trial registration number NCT04265573

Income-based inequalities in self-reported moderate-to-vigorous physical activity among adolescents in England and the USA: a cross-sectional study

Objective Quantify income-based inequalities in self-reported moderate-to-vigorous physical activity (MVPA) in England and the USA by sex.Design Population-based cross-sectional study.Participants 4019 adolescents aged 11–15 years in England (Health Survey for England 2008, 2012, 2015) and 4312 aged 12–17 years in the US (National Health and Nutrition Examination Survey 2007–2016).Main outcome measures Three aspects of MVPA: (1) doing any, (2) average min/day (MVPA: including those who did none) and (3) average min/day conditional on participation (MVPA active). Using hurdle models, inequalities were quantified using the absolute difference in marginal means (average marginal effects).Results In England, adolescents in high-income households were more likely than those in low-income households to have done any formal sports/exercise in the last 7 days (boys: 11%; 95% CI 4% to 17%; girls: 13%; 95% CI 6% to 20%); girls in high-income households did more than their low-income counterparts (MVPA: 6 min/day, 95% CI 2 to 9). Girls in low-income households spent more time in informal activities than girls in high-income households (MVPA: 21 min/day; 95% CI 10 to 33), while boys in low-income versus high-income households spent longer in active travel (MVPA: 21 min/week; 95% CI 8 to 34). In the USA, in a typical week, recreational activity was greater among high-income versus low-income households (boys: 15 min/day; 95% CI 6 to 24; girls: 19 min/day; 95% CI 12 to 27). In contrast, adolescents in low-income versus high-income households were more likely to travel actively (boys: 11%; 95% CI 3% to 19%; girls: 10%; 95% CI 3% to 17%) and do more.Conclusions Policy actions and interventions are required to increase MVPA across all income groups in England and the USA. Differences in formal sports/exercise (England) and recreational (USA) activities suggest that additional efforts are required to reduce inequalities