Prevalence of symptoms of vaginal fi stula in 19 sub-Saharan Africa countries: a meta-analysis of national household survey data

Background Vaginal fi stula is a serious medical disorder characterised by an abnormal opening between the vagina and the bladder or rectum, which results in continuous leakage of urine or stool. The burden of this disorder in sub- Saharan Africa is uncertain. We estimated the lifetime and point prevalence of symptoms of vaginal fi stula in this region using national household surveys based on self-report of symptoms. Methods We considered all Demographic and Health Surveys (DHS) and Multiple Indicators Cluster Surveys (MICS) from sub-Saharan Africa and included data for women of reproductive age (15–49 years). We estimated lifetime prevalence and point prevalence of vaginal fi stula with use of Bayesian hierarchical meta-analysis. Findings We included 19 surveys in our analysis, including 262 100 respondents. Lifetime prevalence was 3·0 cases (95% credible interval 1·3–5·5) per 1000 women of reproductive age. After imputation of missing data, point prevalence was 1·0 case (0·3–2·4) per 1000 women of reproductive age. Ethiopia had the largest number of women who presently have symptoms of vaginal fi stula. Interpretation This study is the fi rst to estimate the burden of vaginal fi stula in 19 sub-Saharan Africa countries using nationally representative survey data. Point prevalence was slightly lower than previously estimated but these earlier estimates are within the prevalence’s credible intervals. Although vaginal fi stula is relatively rare, it is still too common in sub-Saharan Africa

Geographic and Sociodemographic Disparities in Cardiovascular Risk in Burkina Faso: Findings from a Nationwide Cross-Sectional Survey.

BACKGROUND: Cardiovascular disease (CVD) risk assessment is a critical step in the current approach to the primary prevention of CVD, particularly in low-income countries such as Burkina Faso. In this study, we aimed to assess the geographic and sociodemographic disparities of the ten-year cardiovascular risk in Burkina Faso. METHODS: We conducted a secondary analysis of the data from the first nationwide survey using the World Health Organization (WHO) STEPwise approach. Ten-year cardiovascular risk was determined using the WHO 2019 updated risk chart (WHO risk) as main outcome, and the Framingham risk score (FRS) and the Globorisk chart for secondary outcomes. We performed a modified Poisson regression model using a generalized estimating equation to examine the association between CVD risk and sociodemographic characteristics. RESULTS: A total of 3081 participants aged 30 to 64 years were included in this analysis. The overall age and sex-standardized mean of absolute ten-year cardiovascular risk assessed using the WHO risk chart was 2.5% (95% CI: 2.4-2.6), ranging from 2.3% (95% CI: 2.2-2.4) in Centre Est to 3.0% (95% CI: 2.8-3.2) in the Centre region. It was 4.6% (95% CI: 4.4-4.8) for FRS and 4.0% (95% CI: 3.8-4.1) for Globorisk. Regarding categorized CVD risk (absolute risk ≥10%), we found out that the age and sex-standardized prevalence of elevated risk was 1.7% (95% CI: 1.3-2.1) for WHO risk, 10.4% (95% CI: 9.6-11.2) for FRS, and 5.9% (95% CI: 5.1-6.6) for Globorisk. For all of the three risk scores, elevated CVD risk was associated with increasing age, men, higher education, urban residence, and health region (Centre). CONCLUSION: We found sociodemographic and geographic inequalities in the ten-year CVD risk in Burkina Faso regardless of risk score used. Therefore, population-wide interventions are needed to improve detection and management of adult in the higher CVD risk groups in Burkina Faso

Fistula in sub-Saharan Africa – Authors' reply

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Epidemiology of sexually transmitted infections and HIV in Burkina Faso implications for control programs

Because of the absence of vaccines, control of Sexually Transmitted Infections (STIs) is a real challenge. Estimates of prevalent or incident infection are useful in order to monitor disease spread, to know who is infected and in which areas of a country, and to guide public-health policy to target groups at need. In Burkina Faso,, where data are particularly lacking, generating estimates of the burden of STIs is of first importance. Currently, estimates for some regions are severely limited in quantity and in quality, and it is these regions for which data are most needed. This thesis addresses the epidemiology of STIs including HIV-1 in groups at varying risks of HIV in order to help national authorities in strengthening their STI prevention and control strategies in Burkina Faso. Chapter 3 presents the main findings of our research project, which has focused on assessing the prevalence of STIs and risk factors in Burkina Faso. The report explores three infections: Bacterial vaginosis (BV), Syphilis and HSV-2 infection. The prevalence of BV in this group was 6.4%, with a 95% confidence interval (CI]: 5.5 to 7.6) and BV was strongly associated with HSV-2, the history of abortion and geographical origin. Overall seroprevalence of active syphilis was 1.7% (95% CI: 1.3 to 2.2) in Ouagadougou, with similar rates between women (1.2%, 95% CI: 0.7 to 2.3) and men (1.8%, 95% CI: 1.0 to 3.0), and with a trend for higher prevalence among pregnant women from semi-urban areas (2.2%, 95% CI: 1.0 to 4.5) compared with rural areas (1.7%, 95% CI: 1.2 to 2.4, p=0.06). The prevalence tended to be higher among women aged 20-24 years (2.6%, 95% CI: 1.3 to 7.6) and men aged 30-34 years (3.9%, 95% CI: 0.8 to 11.0) than at other ages. However, age, marital status, location and education were not associated with syphilis. The prevalence of HSV-2 among pregnant women was 18.0%, with a trend for lower rates in rural (17.3%) versus semi-urban areas (21.4%) (P=0.08).The prevalence of HSV-2 was 23.7% among non-pregnant women in Ouagadougou, and 15.3% among men. Using multivariate logistic regression analysis among women, HSV-2 infection was significantly more frequent in older women, married women, contraceptive users, women infected with BV and HIV. Among men, only increased age and HIV were independently associated with a higher HSV-2 prevalence. It is widely accepted that the HIV/AIDS epidemic will seriously affect the education and health sector in Sub-Saharan Africa. However, little systematic empirical research has been undertaken, particularly in Burkina Faso, to assess the actual and likely future impacts of HIV in educational and health services. A total of 97 heath care facilities and 336 schools across the country were surveyed and interviewed. Chapter 4 presents the prevalence of HIV infection among health care workers (HCWs) and teachers throughout Burkina Faso, and compares it to HIV prevalence in the general population from a Demographic Health survey (DHS). Overall crude prevalence of HIV among HCWs was 3.5%. HIV prevalence was 0.7% among students and trainees, 3.8% for nurses and midwives, 4.5% among administrative workers, and 4.6% for laboratory workers. After age and area standardisation, men from the DHS had similar HIV prevalence (2.3%,95% CI: 1.4 to 2.9) as male HCW (2.5%, 95% CI: 1.1 to 4.0), while female HCWs were more infected (4.5%, 95% CI: 2.5 to 6.0) than women from the DHS (2.1%, 95% CI: 1.3 – 2.4). Overall crude prevalence of HIV among teachers was 2.8%, with no difference between those from primary schools (2.9%, 95% CI: 2.1 to 4.0) and those from secondary schools (2.5%, 95% CI: 0.5 to 4.5). After age and area standardisation, men from the DHS had higher HIV prevalence (2.3%) than male teachers (Prevalence Ratio (PR)=0.4, 95% CI: 0.2 to 0.6), while female teachers were more infected than women from DHS. Chapter 5 assesses the knowledge, awareness and practices surrounding STI/HIV in the general population of Ouagadougou and among HCWs and teachers. Among the 1694 subjects enrolled in a population-based survey in Ouagadougou, Burkina Faso, men had much better knowledge of HIV than women; they were more likely to have heard about HIV, to know that consistent condom use is an effective way of preventing HIV, to know that HIV can be sexually transmitted, to know that HIV can be transmitted by contact with infected blood, and to know that a person with HIV can feel healthy. Overall, 10.2% of individuals had used Voluntary and Counselling testing (VCT). Older age, marriage and a high educational status were independent factors associated with more frequent VCT use. 75.8% of HCWs had good knowledge of the main routes of HIV transmission (unprotected sexual intercourse, direct injection with HIV-contaminated needles, syringes, blood or blood products, mother-to-child transmission through pregnancy, delivery or breastfeeding) and more than 42.0% of HCWs had poor knowledge of the mechanisms of HIV prevention (abstinence, safe sex, and caution regarding the use of needles, syringes, blood or blood products. The majority (96.5%) of interviewed HCWs have considered their occupation as being a risk for contracting HIV/AIDS. Overall, 38.2% (34.6% of women and 42.6% of men) had experience using VCT services. A striking result of the study is that 40% of HCWs reported that fear of knowing the outcome was the main reason for not taking the HIV test. Male HCWs, laboratory workers, those having at least two years of experience, and those who had sex with a non regular partner within the last 12 months preceding the survey (high-risk sex) were more likely to have tested for HIV. One fifth of HCWs reported high-risk sex. Of these, thirteen percent did not use condoms. HCWs who had occasional partners were significantly more likely to be men, single, living in rural areas, aged less than 29 and to be students or trainees. Only 50.5% of teachers had good knowledge of the main routes of HIV transmission and more than half of teachers had poor knowledge of the mechanisms of HIV prevention. The majority (78.9%) of interviewed teachers did not consider their occupation as being a risk for contracting HIV/AIDS (professional vulnerability for HIV). Overall, 21.6% of teachers had experience using VCT services. Men (p=0.01), teachers in primary schools (p=0.002) and those who had a negative HIV test were less likely to have tested for HIV (p=0.02). About 20% of teachers reported a non regular partner within the last 12 months. Of these, 19% did not use condoms. Teachers who had an occasional partner were significantly more likely to be men, single, living in rural areas, aged less than 29 years, and teaching in primary schools. Based on our results, research on appropriate interventions aiming towards change, and orienting to men, seems to be a priority. Adolescents are an important group for interventions aiming at behavioural changes, and strategies targeting this group should be established. Strategies for improving health-seeking behaviour related to STIs are also needed, especially oriented to women. A study on syphilis screening that uses point-of-care tests should be able to complement our findings and constitute a more founded basis for deciding on the future of the screening program. In the meantime, continuous monitoring of the syphilis-screening program and of trends in seroprevalence rates is necessary. In order to improve treatment of STIs, one priority is to educate about genital herpes, its clinical signs, how it is transmitted and the fact that treatment is available if clinical recurrences are frequent and poorly tolerated. In this 'program', serology can be considered. In addition, the syndromic management algorithm, based on the low prevalence of bacterial infections and the high prevalence of genital herpes, should be developed, implemented and evaluated as soon as possible.(ESP 3) -- UCL, 201

Medication during pregnancy in Belgium: Linking three administrative databases: Challenges and opportunities

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Increasing Prescriptions of Misoprostol Dispensed Before Delivery in Belgium (2003-2017): Evidence from Healthcare Administrative Database

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Using administrative healthcare database records to study trends in prescribed medication dispensed during pregnancy in Belgium from 2003 to 2017

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Using administrative healthcare database records to study trends in prescribed medication dispensed during pregnancy in Belgium from 2003 to 2017

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