Implémentation du Field Epidemiology Training Programme Frontline au Burkina Faso, 2016 à 2019: leçons apprises et Défis: Implementation of the Frontline Field Epidemiology Training Programme in Burkina Faso, 2016 to 2019: Lessons Learned and Challenges

Introduction: Dans le contexte de l'agenda de la sécurité mondiale de la santé lancé en 2015. The Centers for Disease Control and Prevention (CDC Atlanta) a initié le renforcement de capacités des acteurs dans l'épidémiologie de terrain Frontline (FETP). Pour l'implémentation du programme, des réunions, une évaluation de base, le recrutement et formation de mentors, sélection et formation de participants en utilisant l'approche « One Health », travaux de terrain, supervision et interviews de sortie ont été menés. Au Burkina Faso ce programme a commencé en avril 2016. L'objectif de cette étude était de décrire le processus d'implémentation, les défis et les leçons apprises. Méthodes: Une étude transversale rétrospective qualitative à visée descriptive conduite d'avril 2016 à septembre 2019 incluant tous les participants. Des interviews et une revue documentaire avaient été réalisés. Résultats: L'évaluation de base avait montré un besoin dans le renforcement des capacités pour le système de surveillance. Au total 22 mentors formés. Fin décembre 2019, neuf cohortes (100%) formées dont 6 (75%) avec approche « One Health ». Au total 210 participants devraient être formés sans distinction de sexe, ainsi 267 capacités (127%). Sur les 267 formés, 22 femmes (8%). Deux qui n'ont pas achevé la formation (0,7%), un décès (0,3%). Au total 1040 travaux réalisés. Les défis restent le suivi post formation, les mutations des agents formés et la pérennisation. Conclusion: L'implémentation de FETP Frontline au Burkina Faso a été effective et a fait face à plusieurs défis et des leçons apprises ont été tirées. Il est recommandé la poursuite de ces formations pour le renforcement des capacités des acteurs de la surveillance. Introduction: In the context of the global health security agenda launched in 2015, the Center for Disease Control and Prevention (CDC Atlanta) initiated capacity building for stakeholders in Frontline Field Epidemiology (FETP). To implement the programme, meetings, a baseline assessment, recruitment and training of mentors, selection and training of participants using the "One Health" approach, fieldwork, supervision and exit interviews were conducted. In Burkina Faso this programme started in April 2016. The objective of this study was to describe the implementation process, challenges and lessons learned. Methods: A retrospective qualitative descriptive cross-sectional study conducted from April 2016 to September 2019 including all participants. Interviews and a literature review were conducted. Results: The baseline assessment showed a need in capacity building for the surveillance system. In total 22 mentors trained. By the end of December 2019, nine cohorts (100%) trained, of which six (75%) with a "One Health" approach. A total of 210 participants should be trained regardless of gender, thus 267 were trained (127%). Of the 267 trained, 22 were women (8%). Two did not complete the training (0.7%), one died (0.3%). A total of 1,040 works were completed. The challenges remain post-training follow-up, transfers of trained agents and sustainability. Conclusion: The implementation of FETP Frontline in Burkina Faso was effective, faced several challenges and lessons were learned. It is recommended that these training sessions be continued in order to strengthen the capacities of surveillance actors

Laboratory and experimental hut trial evaluation of VECTRON™ T500 for indoor residual spraying (IRS) against insecticide resistant malaria vectors in Burkina Faso

Background: Malaria cases in some areas could be attributed to vector resistant to the insecticide. World Health Organization recommended insecticides for vector control are limited in number. It is essential to find rotational partners for existing Indoor Residual Spraying (IRS) products. VECTRON™ T500 is a novel insecticide with broflanilide as active ingredient. It has a mode of action on mosquitoes completely different to usually used. The aim of this study was to determine the optimum effective dose and efficacy of VECTRONTM T500 against susceptible and resistant strains of Anopheles in Burkina Faso. Methods: VECTRON™T500 was sprayed at 50, 100 and 200 mg/m² doses onto mud and concrete blocks using Potter Spray Tower. The residual activity of broflanilide was assessed through cone bioassays 1 week and then monthly up to 14 months post spraying. Its efficacy was evaluated at 100 and 150 mg/m² against wild free-flying mosquitoes in experimental huts on both substrates. Actellic 300CS was applied at 1000 mg/m² as reference product. Cone assays were conducted monthly, using susceptible and resistant mosquito strains. Results: In the laboratory, VECTRON™ T500 showed residual efficacy (≥80% mortality) on An. gambiae Kisumu up to 12 and 14 months, respectively, on concrete and mud blocks. Similar results were found with 100 and 200 mg/m² using An. coluzzii pyrethroid resistant strain. In experimental huts, a total of 19,552 An. gambiae s.l. were collected. Deterrence, blood-feeding inhibition and exophily with VECTRON™ treated huts were very low. At 100 and 150 mg/m², mortality of wild An. gambiae s.l. ranged between 55% and 73%. Monthly cone bioassay mortality remained >80% up to 9 months. Conclusions: VECTRON™ T500 shows great potential as IRS formulation for malaria vector control. It can be added to the arsenal of IRS products for use in rotations to control malaria and manage mosquito insecticide resistance

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

Maternal Mortality at the Dori Regional Hospital in Northern Burkina Faso, 2014-2016

Background: Maternal mortality is of considerable magnitude. It is particularly relevant to developing countries, including those in Sub-Saharan Africa. The aim of this work was to study the cases of maternal deaths in the Dori Regional Hospital, Burkina Faso in the Sahel region, by analyzing the epidemiological aspects of these deaths in order to guide decision-making. Methods: This was a descriptive cross-sectional study which spanned the period from January 1, 2014 to December 31, 2016. Cases of maternal death and live births that occurred in the hospital during this period were collected by documentary review. Results: A total of 141 maternal deaths and 2,626 live births were recorded with a maternal mortality ratio of 5,369 for 100,000 live births. In 99 (72.20%) cases, death occurred in the postpartum. A home delivery had been reported in 33.70% of cases. Direct obstetric causes were found in 72.10% of cases. They were mainly represented by infections (32.40%) and hemorrhages (23%). Anemia was the indirect cause of death in 25 women (17.80%). The delay in health care access and the lack of blood products contributed to maternal deaths in 64.50% and 26.20% of cases. Conclusion and Global Health Implications: An intensification of awareness-raising messages about the importance of the rapid use of health care is necessary. Also, systematic audits of maternal deaths in the care environment and in the community would make it possible to clarify the determinants of maternal mortality in the Sahel region and to provide adequate solutions. Key words: Maternal Death • Maternal Mortality • Women’s Health • Burkin Faso • Dori Hospital • Sahel Regio

Dengue Fever in Burkina Faso, 2016

We report 1,327 probable cases of dengue in Burkina Faso in 2016. Of 35 serum samples tested by a trioplex test, 19 were confirmed dengue virus (DENV)‒positive: 11 DENV-2, 6 DENV-3, 2 nontypeable, and 1 DENV-2/DENV-3 co-infection. Molecular testing should be conducted to correctly identify causative agents in this complex infectious disease landscape

Leprosy in wild chimpanzees.

Humans are considered as the main host for Mycobacterium leprae1, the aetiological agent of leprosy, but spillover has occurred to other mammals that are now maintenance hosts, such as nine-banded armadillos and red squirrels2,3. Although naturally acquired leprosy has also been described in captive nonhuman primates4-7, the exact origins of infection remain unclear. Here we describe leprosy-like lesions in two wild populations of western chimpanzees (Pan troglodytes verus) in Cantanhez National Park, Guinea-Bissau and Taï National Park, Côte d'Ivoire, West Africa. Longitudinal monitoring of both populations revealed the progression of disease symptoms compatible with advanced leprosy. Screening of faecal and necropsy samples confirmed the presence of M. leprae as the causative agent at each site and phylogenomic comparisons with other strains from humans and other animals show that the chimpanzee strains belong to different and rare genotypes (4N/O and 2F). These findings suggest that M. leprae may be circulating in more wild animals than suspected, either as a result of exposure to humans or other unknown environmental sources