Human Immunodeficiency Virus type-1 and cytokines in colostrum from HIV-infected mothers in Burkina Faso

Background: The colostrum of HIV-infected mothers contains a high number of HIV copies and is considered highly infectious. Furthermore it contains large numbers of macrophage and other mononuclear cells that are known to incorporate virus. While prevention protocols in Western countries suggest the interruption of breast feeding, at least for the first few months of life, this practice is not advisable in developing countries. Methodology: The aim of this study was to determine the HIV load and the concentrations of IL-18, IL-16, IL-12, TGF-beta1 and TGF-beta2 in the colostrum of HIV-infected mothers living in Burkina Faso. The women all received nevirapine prophylaxis during labour. Results: The viral load in the colostrum decreased rapidly during the first three days following delivery, while the concentration of IL-18 and IL-16 increased in the same period. IL-12, TGF-beta1 and TGF-beta2 did not show significant variations in the first three days after delivery. Conclusions: Since the viral load decreases in the colostrum of nevirapine-treated expectant mothers, our data suggest single dose nevirapine combined with interruption of early feeding may have potential as a way to reduce the risk of MTCT

Determinants of Mortality in Children under Five Years of Age with Severe Acute Malnutrition Admitted to the Yalgado Ouédraogo Teaching Hospital (Burkina Faso)

Background: To determine critical factors associated with severely malnourished children under five this case-control study was conducted. Methods: The data of a total of 433 children aged 0-59 months and admitted to the Hospital Yalgado Ouedraogo, (CHU – YO) between January 31, 2009 to January 31, 2013, were included in the analysis: 72 for the case group and 361 for the control group. Clinical and treatment records were accessed and data were analyzed. Results: For clinical signs, determinants of mortality were diarrhea [OR = 4.6; (95%CI 2.6-8.2], anorexia [OR = 2.7; (95%CI 1.4-5.0] and hepatomegaly [OR = 2.6; (95%CI 1.4-4.8]. For infections, determinants of mortality were pediatric HIV/AIDS [OR = 10.9; (95%CI 5.6-21.5] and digestive illnesses [OR = 5.1 (95%CI 2.8-9.4)]. Regarding the complications of malnutrition, determinants of mortality were severe dehydration [OR = 16.4 (95%CI 8.0-33.5)], skin lesions [OR = 14.3 (95%CI 6.4 -31.9)], heart failure [OR = 6.8 (95%CI 2.5-19.0)] and severe anemia [OR = 3.2(95%CI 1.4-7.1)]. For biochemical indicators, low serum sodium [OR = 0.7(95%CI 0.5-1.0)] and potassium levels [OR = 0.9(95%CI 0.9-1.0)] were the critical factors. In addition the risk of death was associated with low value of MUAC [OR = 0.9 (95% CI 0.8-0.9)]. Conclusions: The risk of death of children with severe acute malnutrition varies according to different factors studied

Assessment of the performance of malaria rapid diagnostic test in acutely malnourished children under five years of age in Nanoro - Burkina Faso

The interaction of malaria with malnutrition is complex. In areas where malnutrition among children is prevalent, management of malaria is not standardized. In Burkina Faso, malaria treatment is prescribed after positive malaria rapid diagnostic test (RDT) or thick blood smears confirmation regardless of the nutritional status of the child. The study aims to assess the performance of malaria RDT in acute malnourished children under five years of age. A descriptive cross-sectional study was carried out from June 1st to August 31th 2014 in the health district of Nanoro in Burkina Faso. The study involved the children less than 5 years of age who were admitted for acute malnutrition and tested for malaria using RDT. The diagnostic values were then assessed for their agreement with the gold standard of the World Health Organization (thick blood smears) using Cohen-Kappa coefficient. In total, RDT and thick blood smear results were obtained from 131 children (aged 1-59 months). RDT was positive in 87 tested children (66.4%), while the thick smear indicated that only 47 were infected by malaria (35.9%) and Cohen kappa coefficient was 0.44. The sensitivity, specificity, positive predictive value and negative predictive value of RDT for malaria compared to microscopy were respectively 100% (95% CI: 92.5 - 100), 52.4% (95% CI: 51.1 - 52.9), 54% (95% CI: 43 - 64.8), 100% (95% CI: 92.5 - 100). Their timeliness was 8 min (± 3.47 min). Using malaria RDT in acutely malnourished children results in high number of false positive

Effects of a Cereal and Soy Dietary Formula on Rehabilitation of Undernourished Children at Ouagadougou, in Burkina Faso

The New Misola consists of millet soybean, peanut, vitamins, minerals, and industrial amylase. Our objective is to demonstrate that porridge made from local grains and legumes restores the nutritional balance of malnourished children. The study was carried on 304 malnourished children aged 6–48 months including 172 girls and 132 boys from Saint Camille Medical Centre. At the beginning, these malnourished children had a WHZ z-score of −3.10 and a WAZ z-score of −3.85, which reflected, according to WHO, a severe malnutrition. After eight weeks of nutritional rehabilitation, a normal WHZ of −1.41 was obtained. These children recovered more than those in a similar study performed in 2006 with the old formula of Misola. This study shows that malnutrition remains a public health problem in Burkina Faso. It should be necessary that public health services and the epidemiologists work in synergy with nutritionists and “nutrigenetics” in order to combat malnutrition efficiently

Factors predicting uptake of voluntary counselling and testing in a real‐life setting in a mother‐and‐child center in Ouagadougou, Burkina Faso

SummaryObjective  To identify factors predicting uptake of voluntary HIV counselling and testing in pregnant women.Methods  All pregnant women receiving ante‐natal group health education at St Camille Medical Center, Ouagadougou, Burkina Faso from 1 May 2002 to 30 April 2004 were offered voluntary HIV counselling and testing. If they consented, the women were pre‐test counselled, tested by two rapid tests giving immediate results and post‐test counselled.Results  Less than one‐fifth of pregnant women [1216/6639 (18.3%, CI 17.4–19.3%)] accepted voluntary HIV counselling and testing, mainly at the first ante‐natal visit (83.4%) and at early gestational age (73.4% before week 24). The HIV seroprevalence rate was 10.6% (8.8–12.5%). The uptake rate was independently associated with age, the number of previous pregnancies and the number of previous miscarriages.Conclusions  Our two‐step approach of group education followed by voluntary HIV counselling and testing yielded a low uptake rate in this setting. However, the drop‐out rate after enrolling in the programme was nearly zero. The timing of programme uptake would permit implementation of earlier prophylactic courses. Effective scaling‐up of voluntary HIV counselling and testing outside the clinical trial requires a mass sensibilization campaign pointing out the programme's benefits and addressing the stigma of HIV. The independent value of age and previous obstetrical episodes show how important social factors are in influencing the voluntary HIV counselling and testing uptake rate

Towards the complete eradication of mother-to-child HIV/HBV coinfection at Saint Camille Medical Centre in Burkina Faso, Africa

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Diagnostic moléculaire du complexe Mycobacterium tuberculosis résistant à l’isoniazide et à la rifampicine au Burkina Faso

Introduction: cette étude a eu pour objectifs de diagnostiquer la tuberculose pulmonaire par l'examen microscopique et par la PCR des crachats et de déterminer les bases moléculaires de la résistance à la rifampicine et à l'isoniazide. Méthodes: le diagnostic du Complexe Mycobacterium Tuberculosis (CMTB) a été effectué par microscopie après coloration au Ziehl Nielsen et par PCR en temps réel en utilisant le kit d'identification du complexe MTB (Sacace Biotechnologie, Italie). Les résistances à la Rifampicine et à l'Isoniazide ont été étudiées par la technique de la PCR en utilisant le kit MTB résistance 8 (Sacace, Biotechnologie). Résultats: sur les 59 patients diagnostiqués pour la tuberculose pulmonaire, 59,3% étaient positifs en microscopie optique et 44,1% étaient positifs par PCR en Temps réel. Les résistances à la rifampicine (rpoB) et à l'isoniazide (katG et inhA) ont été observées chez 9 patients. La résistance à la rifampicine était due aux mutations (Asp516Val, Ser531Trp, Leu533Pro) et celle à l'isoniazide par les substitutions Ser315Thr du gène katG et C209T du gène inhA. Les multi résistances à la rifampicine et à l'isoniazide ont été observées dans 55,5% des échantillons et concernaient les associations : ropBAsp513Val + inhAC209T et rpoBLeu533Pro + katGSer315Thr. Conclusion: la PCR en temps réel qui permet l'identification des allèles mutants rpoB, katG et inhA de M. tuberculosis est un outil de diagnostic épidémiologique de grande importance car elle permet de déterminer le niveau de résistance à la rifampicine et à l'isoniazide.Keywords: Mycobacterium tuberculosis, résistance, rifampicine, isoniazid

Antiretroviral (ARV) Therapy in Resource Poor Countries: What do we Need in Real Life?

Significant progresses have been made in the last 5 years towards the ultimate goal to provide universal access to care for all HIV/AIDS patients needing antiretroviral treatment in resource-poor countries. However, many barriers are still to be overcome, including (●) cost of care for the individual, (●) stigma, (●) lack of qualified human resources and infrastructure, especially in the rural setting, (●) rescue drugs for failing patients and (●) pediatric formulations. Priority actions to be promoted if the fight against HIV/AIDS is to be successful include: (i) promoting access to care in the rural areas, (ii) strengthening of basic health infrastructures, (iii) waiving of users’ fee to get ARV, (iv) a larger variety of drugs, with particular regard to fixed dose combination third line drugs and pediatric formulations, (v) local quality training and (vi) high quality basic and translational research. While the universal access to HIV care is crucial in developing countries, a strong emphasis on prevention should be maintained along