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

Patients infected by tuberculosis and human immunodeficiency virus facing their disease, their reactions to disease diagnosis and its implication about their families and communities, in Burkina Faso: a mixed focus group and cross sectional study

BACKGROUND: Patients facing tuberculosis (TB) and human immunodeficiency virus (HIV) infection receive particular care. Despite efforts in the care, misconceptions about TB and HIV still heavily impact patients, their families and communities. This situation severely limits achievement of TB and HIV programs goals. This study reports current situation of TB patients and patients living with HIV/AIDS (PLWHA) facing their disease and its implications, by comparing results from both qualitative and quantitative study design. METHODS: Cross sectional study using mixed methods was used and excluded patients co-infected by TB and HIV. Focus group included 96 patients (6 patients per group) stratified by setting, disease profile and gender; from rural (Orodara Health District) and urban (Bobo Dioulasso) areas, all from Hauts-Bassins region in Burkina Faso. Quantitative study included 862 patients (309 TB patients and 553 PLWHA) attending TB and HIV care facilities in two main regions (Hauts-Bassins and Centre) of Burkina Faso. RESULTS: A content analysis of reports found TB patients and PLWHA felt discriminated and stigmatized because of misconceptions with its aftermaths (rejection, emotional and financial problems), mainly among PLWHA and women patients. PLWHA go to healers when facing limited solutions in health system. There are fewer associations for TB patients, and less education and sensitization sessions to give them opportunity for sharing disease status and learning from other TB patients. TB patients and PLWHA still need to better understand their disease and its implication. Access to care (diagnosis and treatment) remains one of the key issues in health system, especially for PLWHA. Individual counseling is centered among PLWHA but not for TB patients. With research progress and experiences sharing, TB patients and PLWHA have some hope to implement their life project, and to receive psychosocial and nutritional support. CONCLUSION: Despite international aid, TB patients and PLWHA are facing misconceptions effects. There is a need to reinforce health education towards patients and healers, inside community, health centers and associations, and for specific settings. International aid must be adapted to specific targets and strategies implementing programs. Maintaining psychosocial and nutritional support is crucial for better outcomes of medication adherence. Individual counseling has to be centered among TB patients and PLWHA

How to strengthen a health research system: WHO's review, whose literature and who is providing leadership?

Background Health research is important for the achievement of the Sustainable Development Goals. However, there are many challenges facing health research, including securing sufficient funds, building capacity, producing research findings and using both local and global evidence, and avoiding waste. A WHO initiative addressed these challenges by developing a conceptual framework with four functions to guide the development of national health research systems. Despite some progress, more is needed before health research systems can meet their full potential of improving health systems. The WHO Regional Office for Europe commissioned an evidence synthesis of the systems-level literature. This Opinion piece considers its findings before reflecting on the vast additional literature available on the range of specific health research system functions related to the various challenges. Finally, it considers who should lead research system strengthening. Main text The evidence synthesis identifies two main approaches for strengthening national health research systems, namely implementing comprehensive and coherent strategies and participation in partnerships. The literature describing these approaches at the systems level also provides data on ways to strengthen each of the four functions of governance, securing financing, capacity-building, and production and use of research. Countries effectively implementing strategies include England, Ireland and Rwanda, whereas West Africa experienced effective partnerships. Recommended policy approaches for system strengthening are context specific. The vast literature on each function and the ever-growing evidence-base are illustrated by considering papers in just one key journal, Health Research Policy and Systems, and analysing the contribution of two national studies. A review of the functions of the Iranian system identifies over 200 relevant and mostly national records; an analysis of the creation of the English National Institute for Health Research describes the key leadership role played by the health department. Furthermore, WHO is playing leadership roles in helping coordinate partnerships within and across health research systems that have been attempting to tackle the COVID-19 crisis. Conclusions The evidence synthesis provides a firm basis for decision-making by policy-makers and research leaders looking to strengthen national health research systems within their own national context. It identifies five crucial policy approaches — conducting situation analysis, sustaining a comprehensive strategy, engaging stakeholders, evaluating impacts on health systems, and partnership participation. The vast and ever-growing additional literature could provide further perspectives, including on crucial leadership roles for health ministries.Health Evidence Network Evidence Synthesis; NIH

Compression tumorale des voies biliaires d’origine metastatique: etude retrospective de 62 cas a l’hopital de l’Archet II a Nice en France

Objectifs: Evaluer la fréquence et l’étiologie des compressions biliaires d’origine métastatique et analyser l’impact sur la survie de la pose de prothèse biliaire.Méthodes: Etude rétrospective réalisée sur 62 patients sélectionnés à partir des comptes rendus de 1387 CPRE à l’Unité d’endoscopie de la Fédération des maladies de l’appareil digestif au CHU de Nice en France sur une période de 5 ans.Résultats: Il s’agissait de 38 hommes et 24 femmes d’âge moyen, 65 ans. L’origine de la compression a été rapportée à des adénopathies pour 55 malades. Des métastases hépatiques étaient présentes dans 22 cas (35,5%) mais seulement 4 parmi eux avaient plus de 3 métastases. Une prothèse plastique a été positionnée dans 14 cas et une prothèse métallique dans 48 cas. Les principales étiologies tumorales retrouvées ont été : le colo-rectum (46,8%), l’estomac (27,4%), et les seins (11,3%). La survie à 1 an était de 11 ,3%. Il y avait une différence de survie en faveur des sujets porteurs de prothèse plastique. Il y avait de même une différence de survie en faveur des patients n’ayant pas de métastases hépatiques. Un remplacement de prothèse plastique par prothèse métallique a dû être réalisé dans 57% des cas, aussi 19 patients ayant bénéficié de la pose initiale d’une prothèse métallique (39,5%) ont nécessité un geste de désobstruction.Conclusion: les cancers du tube digestif représentent la principale cause de compression tumorale de la voie biliaire si l’on excepte les tumeurs bilio-pancréatiques. En accord avec les données connues de la littérature, les complications secondaires à la pose des prothèses sont rares. Cependant une obstruction prothétique par  envahissement tumoral est relativement fréquente (1/3 des cas) dans un délai de 3 mois. La survie à 1 an reste faible mais des survies prolongées peuvent s’observer.Mots-clés: compression tumorale-voies biliaires-endoscopie-FranceEnglish Title: Biliary tracts compression by metastatic tumor: a retrospective study of 62 cases at the Archet II Hospital in Nice, FranceEnglish AbstractObjectives: Evaluate the frequency and etiology of metastatic biliary compression and analyze the impact on survival of biliary prosthesis.Methods: Retrospective study performed on 62 patients selected from the reports of 1387 CPRE at the Endoscopy Unit of the Federation of Digestive System Diseases at Nice University Hospital in France over a period of 5 years.Results: There were 38 men and 24 middle-aged women, 65 years old. The origin of compression has been reported in lymphadenopathies for 55 patients. Hepatic metastases were present in 22 cases (35.5%) but only 4 of them had more than 3 metastases. A plastic prosthesis was placed in 14 cases and a metal prosthesis in 48 cases. The main tumor etiologies found were: colo-rectum (46.8%), stomach (27.4%), and breasts (11.3%). Survival at 1 year was 11.3%. There was a difference in survival for subjects with plastic prostheses. There was also a difference in survival in favor of patients without liver metastases. A plastic prosthesis replacement with metal prosthesis had to be performed in 57% of the cases, and 19 patients who had benefited from the initial placement of a metal prosthesis (39.5%) required a clearing gesture.Conclusion: Cancers of the digestive tract are the main cause of tumor compression of the biliary tract, with the exception of bilio-pancreatic tumors. In agreement with known data from the literature, complications secondary to prosthesis placement are rare. However, a prosthetic obstruction by tumor invasion is relatively common (1/3 of the cases) within 3 months. 1-year survival remains low but prolonged survivals may be observedKeywords: tumor compression-biliary tracts-endoscopy-Franc

PHYSICOCHEMICAL QUALITY AND LYODISPONIBILITY OF FIXED-DOSE ARTEMETHER-LUMEFANTRINE COMBINATIONS DISPENSED IN BURKINA FASO

peer reviewedThe purpose of this study was to evaluate the pharmaceutical quality and lyodisponibility of fixed-dose combinations of artemether-lumefantrinere found on the market in Burkina Faso. For this purpose, 122 samples were collected from dispensing sites in public and private health facilities and routine physico-chemical parameters were evaluated. Routine physicochemical parameters were evaluated. The in vitro comparative dissolution test was used to assess the lyodisponsibility of the samples in comparison to the originator drugs

Contrôle qualité et étude de comprimabilité des poudres de feuille de Moringa oleifera (lam) et de pulpe du fruit de Adansonia digitata

Moringa oleifera (LAM), arbre tropical à usages multiples, constitue de nos jours une nouvelle ressource alimentaire et économique pour les pays du Sud. Ces feuilles sont faciles d’accès et très riches en protéines, en vitamines et en minéraux. Elles sont de plus en plus utilisées dans des projets luttant contre la malnutrition. Cependant, le goût, la présentation et la qualité de ces produits demeurent une préoccupation majeure nécessitant des adaptations innovantes. L’objectif de cette étude était d’étudier la comprimabilité des poudres de feuilles de Moringa oleifera en améliorant le goût avec des matières premières locales et facilement accessibles comme la poudre de pulpe de Andansonia digitata. Les propriétés physico-chimiques et les tests pharmacotechniques ont permis de contrôler la qualité des poudres, des comprimés et orienter le choix du procédé de fabrication. Cinq (5) types de formulations (F1 à F5) ont été réalisés et les comprimés ont été fabriqués par compression après granulation par la voie sèche. Les comprimés des formulations F4 et F5 ont donné de meilleures propriétés pharmacotechniques selon les recommandations de la pharmacopée Européenne 6.0. L’association des deux poudres offre une alternative pour la fabrication de comprimés à croquer avec un goût acceptable.Mots-clés : Moringa oleifera, Adansonia digitata, poudre, comprimé, contrôle qualité