Les tumeurs malignes anorectales en milieu hospitalier à Ouagadougou: aspects épidémiologiques et diagnostiques

Le but de notre étude était de décrire les caractéristiques épidémiologiques et diagnostiques des tumeurs malignes anorectales en milieu hospitalier à Ouagadougou. Il s'est agi d'une étude rétrospective et  transversale qui a concerné les patients vus en endoscopie digestive basse au cours de la période allant  du 29/09/1999 au 04/10/2008. À l'aide d'une fiche de collecte, nous avons recueilli, dans 4 structures  sanitaires et 3 laboratoires d'anatomie et de cytologie pathologiques de la ville de Ouagadougou, les  données à partir des comptes-rendus d'endoscopie digestive basse et des registres d'anatomie et de  cytologie pathologiques. Durant la période de notre étude, 645 patients ont été examinés en anorectoscopie et 882 cas d'affections anorectales colligés. Les tumeurs malignes anorectales avec 61 cas (6,9%) occupaient la quatrième place après la maladie hémorroïdaire (45,6%), les anites (21,1%) et les fissures (13,9%). Elles regroupaient les cancers du rectum (4,2%) et les cancers de l'anus (2,7%). Vingt cancers anorectaux ont été histologiquement confirmés parmi lesquels l'adénocarcinome était le  type histologique le plus retrouvé avec 17 cas. Les tumeurs malignes, quatrième affection anorectale la plus fréquente au cours de notre étude, constituent une préoccupation du fait de leur fréquence  croissante, leur diagnostic souvent tardif et les difficultés liées à leur prise en charge surtout dans nos pays avec une population à faible revenu. La sensibilisation de la population et la prescription plus large de l'endoscopie digestive basse devraient permettre une meilleure prise en charge des patients.Key words: Tumeurs malignes, pathologie anorectale, épidémiologie, diagnostic, Burkina Faso

Added value of multiple IMCHA research projects on maternal, newborn and child health policy and practice in Nigeria

The Innovating for Maternal and Child Health in Africa (IMCHA) initiative was designed to generate findings that could influence policies and practices at national and subnational levels. This case study documents the added value of IMCHA projects on maternal, newborn and child health policy and practice in Nigeria. Three research teams implemented five research projects representative of different country contexts, allowing analysis of different facets of MNCH problems including barriers to service utilisation and perinatal depression, as well as impacts of the projects. Future research funding could build on the IMCHA model to ensure political involvement and ownership at national level.Global Affairs CanadaCanadian Institutes of Health Researc

Leafy amaranthus consumption patterns in Ouagadougou, Burkina Faso

There is a new attention to vegetables as vital components of daily diet. A concerted effort to raise their standing has begun to change mentalities and to fuel a rapid growth of traditional leafy vegetables marketing and consumption in African cities. However, little is known about the production and consumption patterns of these plant foods. This study examined, through a field survey the socio-economic, food consumption and conservation aspects of leafy vegetables in the region of Ouagadougou. It was found that leafy vegetables are cultivated under both rain-fed and irrigated conditions in the villages and also in the city’s gardens. The study has demonstrated that there is considerable indigenous knowledge on the leafy vegetables of the region. Amaranth species are the most cultivated and marketed and have potential for commercialization. They are used for many dishes in the local kitchen. Leafy Amaranths are consumed during all seasons even though they are more available (and cheap) during rainy season (June to end October). Ninety-four per cent of the interviewed people use vegetable Amaranth in sauce. There is a growing trend to use cultivated (introduced) species of Amaranth, which were brought to Africa by colonial powers and gained popularity because they were associated with high status. The introduced species are spreading quickly in a spontaneous manner. This can be a threat to biodiversity. There is need for a conservation initiative for the native species. In the commercialization of leafy vegetable and in particular for Amaranth, women play an important role. That could be optimized for marketing purpose to improve leafy vegetable adding-value. Because transportation is a cost increase factor, and given that cities should be targets for increased consumption, it is necessary to promote peri-urban agriculture of leafy vegetables, by policy guidelines. There is a need of documentation and dissemination of indigenous knowledge on indigenous leafy vegetables.Key words: vegetables, African greens, Amaranthus, micronutrients, biodiversity, horticulture, Ouagadougou, Burkina Fas

Importance of the confirmatory assay for the detection of the HBsAg in the epidemiological studies and in the diagnosis of the viral Hepatitis B

Several epidemiological studies have reported high prevalence of HBsAg among pregnant women in Burkina Faso. They used various algorithms, as it is also done for the routine diagnostic. Knowing this antigen carriage rate in such a population or in other clinic attendees is important for the implementation of a national immunisation programme and the monitoring of patients with hepatitis B. Often, the screening tests were not confirmed in spite of the existence of known false positive and false negative results. The aim of this study was to determine a more accurate prevalence of HBsAg, among the pregnant women in Burkina Faso. From October 2006 to January 2007, blood samples were collected from 1139 pregnant women. Each sample was analyzed for HBsAg, using two assays and according to manufacturers’ instructions vis, Hepanostika®HBsAg Uniform II B9 (Bio-Mérieux; France) and HBsAg (V2) Abbott AxSYM® system (Abbott Diagnostics). All the positive samples were tested with a confirmatory neutralization assay- Hepanostika®HBsAg Uniform II B9 Confirmatory (Bio-Merieux). The mean age of the pregnant women was 24.85years [range: 15-45years] and the age range of 20-24 (37%) and 25-29 (25.4%) years were the most represented. The overall rate of HBsAg-positive pregnant women with the two screening assays was 20.9%. The HBsAg detection rate was significantly higher with Hepanostika® UniformII B9 (16.9%) than with HBsAg (V2) AxSYM system assay (12.1%), with

An exploratory analysis of the regionalization policy for the recruitment of health workers in Burkina Faso

BACKGROUND: Health personnel retention in remote areas is a key health systems issue wordwide. To deal with this issue, since 2002 the government of Burkina Faso has implemented a staff retention policy, the regionalized health personnel recruitment policy, aimed at front-line workers such as nurses, midwives, and birth attendants. This study aimed to describe the policy’s development, formulation, and implementation process for the regionalization of health worker recruitment in Burkina Faso. METHODS: We conducted a qualitative study. The unit of analysis is a single case study with several levels of analysis. This study was conducted in three remote areas in Burkina Faso for the implementation portion, and at the central level for the development portion. Indepth interviews were conducted with Ministry of Health officials in charge of human resources, regional directors, regional human resource managers, district chief medical officers, and health workers at primary health centres. In total, 46 indepth interviews were conducted (February 3 - March 16, 2011). RESULTS: Development The idea for this policy emerged after finding a highly uneven distribution of health personnel across urban and rural areas, the availability of a large number of health officers in the labour market, and the opportunity given to the Ministry of Health by the government to recruit personnel through a specific budget allocation. Formulation The formulation consisted of a call for job applications from the Ministry of Health, which indicates the number of available posts by region. The respondents interviewed unanimously acknowledged the lack of documents governing the status of this new personnel category. Implementation During the initial years of implementation (2002-2003), this policy was limited to recruiting health workers for the regions with no possibility of transfer. The possibility of job-for-job exchange was then approved for a certain time, then cancelled. Starting in 2005, a departure condition was added. Now, regionalized health workers can leave the regions after undergoing a competitive selection process. CONCLUSION: The policy was characterized by the absence of written directives and by targeting only one category of personnel. Moreover, there was no associated incentive—financial or otherwise—which poses the question of long-term viability

Production Locale De Médicaments Issus De La Médecine Et Pharmacopée Traditionnelles : Analyse Des Déterminants De La Survie De L’unité De Production (UPHARMA))

Introduction: L’accès durable à des médicaments de qualité et abordables par la production locale contribue au développement sanitaire et socioéconomique d’un pays. L’unité de production pharmaceutique (UPHRAMA) a été créée pour pallier à ce besoin au Burkina Faso. Cependant, elle rencontre d'énormes difficultés susceptibles d'entrainer sa fermeture. Objectif: L’objectif de cette étude est d’analyser les déterminants de la survie de l’unité de production de médicaments (UPHARMA). Méthodes: La méthodologie utilisée a combiné la recherche bibliographique et l’enquête de terrain qui a consisté en une série d’entretiens. Résultats/Discussion: Les résultats obtenus indiquent que l’unité n'a pas de personnalité juridique lui permettant de jouir d'une autonomie dans la gestion de ses activités. L'encrage institutionnel ne la permet pas de mener ses activités dans une logique d'entreprise commerciale compétitive. Les activités de l’unité se trouvent piégées par la procédure de gestion des actes administratifs et financières de la fonction publique. Au regard de ce constat, elle doit être envisagée comme étant une société à capitaux publics avec une personnalité juridique ayant une autonomie financière et de gestion. Conclusion: Au regard des analyses, il ressort que l’unité est soumise de façon caractéristique aux principes de l’administration publique marqué par la subordination, la dépendance et le contrôle qui reflètent le pouvoir de l'Etat. La création d’un nouveau statut juridique, celui d’entreprise publique autonome avec des modes de gestion et de financements adéquats favorisera la mobilisation de ressources pour booster les activités de recherche-développement de nouveaux phytomédicaments au sein de l’IRSS. Introduction: Sustainable access to quality and affordable medicines through local production contributes to health and socio-economic development of a country. The pharmaceutical production unit (UPHRARMA) was created to address this issue in Burkina Faso. However, it encounters serious difficulties which could lead to its closure. Objective: The objective of this study is to analyze the determinants of the survival of this production unit. Methods: The method combined a bibliographic review and field survey which consisted of a number of interviews. Results/Discussion: The results showed that the unit has no legal form enabling autonomy in management activities. Its institutional anchor does not allow it to perform its activities as a competitive commercial enterprise. The activities of the unit are trapped by the public procedures of administrative and financial management. In that line, the status of the unit should be revised as a public shareholding company with a legal form allowing financial and management autonomy. Conclusion: Regarding the results, U-PHARAMA is subject to the public administration’s principles such as subordination, dependence and control. The new legal status will allow an autonomy of a public company with adequate management and financing mechanisms. This will encourage funds raising in order to mobilize resources for boosting research and development of new phytomedicines within the health sciences research institute

Health of women after severe obstetric complications in Burkina Faso: a longitudinal study.

BACKGROUND: Little is known about the health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect a range of health, social, and economic indicators in the first year post partum. METHODS: We did a prospective cohort study of women with severe obstetric complications recruited in hospitals when their pregnancy ended with a livebirth (n=199), perinatal death (74), or a lost pregnancy (64). For every woman with severe obstetric complications, two unmatched control women with uncomplicated delivery were sampled in the same hospital (677). All women were followed up for 1 year. FINDINGS: Women with severe obstetric complications were poorer and less educated at baseline than were women with uncomplicated delivery. Women with severe obstetric complications, and their babies, were significantly more likely to die after discharge: six (2%) of the 337 women with severe obstetric complications died within 1 year, compared with none of the women with uncomplicated delivery (unadjusted p=0.001); 17 babies of women with severe obstetric complications died within 1 year, compared with 18 of those born by uncomplicated delivery (hazard ratio for mortality 4.67, 95% CI 1.68-13.04, adjusted for loss to follow-up and confounders; p=0.003). Women with severe obstetric complications were significantly more likely to have experienced depression and anxiety at 3 months (odds ratio 1.82, 95% CI 1.18-2.80), to have experienced suicidal thoughts within the past year at all time points (2.27, 1.33-3.89 at 3 months; 2.30, 1.17-4.50 at 6 months; 2.26, 1.30-3.95 at 12 months), and to report the pregnancy having had a negative effect on their lives at all time points (1.54, 1.04-2.30 at 3 months; 2.30, 1.56-3.39 at 6 months; 2.44, 1.63-3.65 at 12 months) than were women with uncomplicated delivery. INTERPRETATION: Women who give birth with severe obstetric complications are at greater risk of death and mental-health problems than are women with uncomplicated delivery. Greater resources are needed to ensure that these women receive adequate care before and after discharge from hospital

Diagnostic et prévalence du syndrome métabolique chez les diabétiques suivis dans un contexte de ressources limitées : cas du Burkina-Faso

Introduction: les conséquences du syndrome métabolique impliquent son diagnostic effectif pour une prise en charge globale des comorbidités dépistées. Objectif : Déterminer la capacité à diagnostiquer le syndrome métabolique en routine, sa prévalence chez les diabétiques, leurs connaissances et pratiques vis-à-vis du risque cardio-métabolique. Méthodes: il s'est agi d'une étude transversale auprès de 388 diabétiques au CHU de Bobo-Dioulasso. Les critères de la fédération internationale du diabète (2009) ont été utilisés. Résultats: l'âge moyen était de 53,5±13,5 ans, le sex ratio de 0,7. L'obésité abdominale était présente dans 61,9% des cas; L'HTA l'était dans 56,4% des cas. La prescription du bilan lipidique a été documentée dans 55,4% des cas pour le HDL et 56,2% pour les triglycérides pour un taux de réalisation de 49,3% et 62,9%. Le taux de dépistage des critères lipidiques était de 26,8%. Un taux de HDL bas a été noté dans 46 cas (43,4%) et une hypertriglycéridémie dans 24 cas (17,6%). In fine, la prévalence du syndrome métabolique était de 48,9% (n=190). Seuls 27,4% savaient que d'autres facteurs de risque cardiovasculaire pouvaient être associés au diabète et seulement 6,7% pratiquaient une activité physique régulière. Conclusion: malgré la faible contribution du laboratoire, le syndrome métabolique est fréquent parmi nos diabétiques. Les patients sont peu sensibilisés sur le risque vasculaire et la pratique d'une activité physique régulière reste faible. Un programme d'éducation adaptée contribuerait à un meilleur dépistage et à une prise en charge optimale des cas