[Quality of care and sexually transmitted infections algorithm acceptability in Burkina Faso]. / Qualité des soins et acceptabilité des algorithmes de prise en charge des infections sexuellement transmissibles au Burkina Faso.

BACKGROUND: To assess sexually-transmitted infections (STIs) quality of care, syndromic approach acceptability and applicability by patients and health workers in Burkina Faso. METHOD: Three approaches were used: simulated patients method to assess quality of STIs care, patients interview and focus discussion with health workers to assess syndromic approach acceptability and applicability. RESULTS: Sixty-two anonymous visits were made in 17 Bobo-Dioulasso primary care clinics. Overall, history taking were assessed in 77.4% of visits, 47% patients were physically examined. Women (71%) were examined more frequently than men (41%) (P=0.01), 42% of patients were not examined in an isolated room. Medication was prescribed for 87.1% of the patients but only 37.5% of the treatments were applied according to national recommendations. Counselling was poor concerning critical messages regarding risk of HIV transmission, STI prevention. Patients and health workers found the syndromic approach acceptable and applicable, but the question of sexual behaviour was considered difficult to address. CONCLUSION: Quality of STIs care is poor in Burkna Faso. Staff training must emphasize interpersonal communication and motivation, with introduction of a sexually-transmitted infection syndrome package consisting of drugs and condoms in order to improve syndromic case management.

[HIV infection in truck drivers in Burkina Faso: a seroprevalence survey]. / L'infection á VIH chez les chauffeurs routiers au Burkina Faso: une enquête de séroprévalence.

Truck drivers are a well recognized high risk population for sexually transmitted diseases. Prior to start-up of a health care program and an information/education campaign, a cross-sectional study using the unlinked, anonymous screening method was carried out to assess seroprevalence of HIV and syphilis infections in truck drivers in Bobo Dioulasso, Burkina Faso. During the month of November 1994, 236 truck drivers were recruited at a cotton-producing factory. The prevalence of HIV infection was 18.6% and the prevalence of syphilis was 9.3%. Multivariate logistic regression analysis showed a statistically significant association between HIV infection and the following factors: age under 30 years, claimed systematic use of condoms, and previous genital ulcers. These findings suggest that truck drivers are highly exposed to the risk of contracting and disseminating HIV infection due to their high mobility and the high incidence of sexually transmitted diseases among their ranks. Prevention of HIV infection in truck drivers in Burkina Faso will require education to promote systematic use of condoms at each sexual contact as well as screening and treatment of sexually transmitted diseases at truck stops.

Prevalence and risk of HIV infection among female sex workers in Burkina Faso.

Little information is available regarding human immunodeficiency virus (HIV) infection among female sex workers (FSW) in Burkina Faso, West Africa. A cross-sectional study was conducted in Ouagadougou and Bobo-Dioulasso, the 2 largest cities of the country, to determine the prevalence of HIV infection and other sexually transmitted diseases (STDs) among FSWs, and to investigate the factors which were associated with HIV infection in this population. From October to November 1994, 426 FSWs were recruited. The method of anonymous and unlinked HIV screening recommended by the World Health Organization (WHO) was used. The overall HIV seroprevalence was 58.2% (95% confidence interval: 53.4-62.9) and 52.6% of FSWs had at least one STD agent. The most common STDs were trichomoniasis (23%), syphilis (15%) and gonorrhoea (13%). In a logistic regression analysis, risk factors for HIV infection were high gravidity (> or = 2 pregnancies), low perception of personal risk of HIV infection, syphilis and the presence of genital warts. These results suggest that FSWs in Burkina Faso need better information about HIV transmission and prevention and then need better access to STD detection and management services.

[The HIV epidemic in Burkina Faso: current status and the knowledge level of the population about AIDS, 1994-1995]. / L'épidémie à VIH au Burkina Faso: situation actuelle et niveau des connaissances de la population sur le SIDA, 1994-1995.

BACKGROUND: It is important for HIV/AIDS control programmes to determine population knowledge on AIDS in order to develop appropriate Information, Education and Communication (IEC) messages. The objectives of our study were to determine the seroprevalence of HIV and syphilis among pregnant women, female prostitutes and long-distance truck drivers and to evaluate knowledge, attitudes, beliefs, and practice (KABP) with respect to the HIV/AIDS epidemic in these three groups in Burkina Faso. METHODS: We performed three cross-sectional serosurveys including face-to-face interviews on KABP between October 1994 and February 1995 in three population groups. RESULTS: Overall, 1,294 pregnant women, 236 long-distance truck drivers and 426 female prostitutes were recruited. HIV seroprevalence was 8% (95% Confidence Interval (CI): 6.6-9.6) among pregnant women, 18.6% (95% CI: 13.9-24.2) among long-distance truck drivers and 58.2% (95% CI: 53.4-62.9) in female prostitutes. The prevalence of syphilis was 2.5%, 9.3% and 15%, respectively. Most pregnant women (98%), long-distance truck drivers (96%) and female prostitutes (98%) had already heard of AIDS. However, the level of knowledge of HIV transmission routes, of risk factors for HIV transmission and of available preventive measures was very low. Consequently, 41% of pregnant women, 40% of long-distance truck drivers and an alarming 61% of female prostitutes reported that they did not feel themselves at risk for HIV. In each group, high levels of knowledge on AIDS were associated with increased awareness of AIDS risk and the adoption of preventive behaviours. Level of education was associated with knowledge of AIDS and condom use. However, in the 12 months preceding the surveys, condom use was very low among pregnant women (0.1%), long-distance truck drivers (18%) and among female prostitutes (42%). CONCLUSIONS: These results indicate that HIV is widespread in Burkina Faso and that there is an urgent need to develop and evaluate HIV prevention strategies in the general population and among core groups such as female prostitutes and long-distance truck drivers. Interventions must include information campaigns, condom promotion and distribution, and sexually transmitted diseases control.

HIV infection among pregnant women in Burkina Faso: a nationwide serosurvey.

To determine the prevalence of HIV infection among pregnant women in Burkina Faso and to identify factors associated with HIV infection in this population, we performed in 4 antenatal clinics in 4 urban centres located in the centre, the north, the east and the south-west of the country cross-sectional serological surveys between 7 October 1994 and 7 February 1995 using unlinked anonymous HIV screening method. In the towns included in the study more than 94% of pregnant women attend at least 2 antenatal consultations. In each centre all pregnant women attending an antenatal consultation during a 2-week period were invited to take part in a study to measure the prevalence of syphilis. Women with positive syphilis serology were offered treatment free of charge. A total of 1294 pregnant women were recruited into the study. There were no refusals. Thirty-two women (2.5%) had positive syphilis serology. The overall seroprevalence of HIV infection was 8% (95% confidence interval [CI]: 6.6-9.6). There was no evidence that the prevalence of syphilis or HIV infection varied between the 4 towns (P=0.12 and 0.52 respectively). In logistic regression analyses only the presence of syphilis infection was associated with risk of HIV (odds ratio=3.4; 95% CI: 1.4-7.9). The prevalence of syphilis among pregnant women in Burkina Faso is relatively low compared with that of HIV infection. These results suggest that HIV epidemic in Burkina Faso is important and that there is an urgent need to intensify HIV-prevention activities. The need for HIV surveillance in this sentinel population is urgent to follow the course of the epidemic and to measure the impact of interventions. One of the consequences of the high prevalence of HIV infection among pregnant women which requires greater attention in Burkina Faso is the increasing number of children who will be infected with HIV by vertical transmission.

[Large dams, health and nutrition in Africa: beyond the controversy]. / Grands barrages, santé et nutrition en Afrique: au-delà de la polémique.

The population in sub-Saharan Africa is growing faster than increases in food production, resulting in a net decrease in food production per capita. The Food and Agriculture Organization has stated that there is a "risk of widespread hunger" which could be prevented by "effective planning of water resources". However, the potential effects of such schemes on the human population are often inadequately assessed and the effect of large dams on human health is not clear. The potential risk to human health of water resources was emphasized a few years ago but no effective preventive programs were implemented, probably because of inadequate availability of information and lack of awareness. The effects on health of "large" water resource projects are not uniform within a population. Decision-makers have tended to focus on the positive effects, to obtain support for their plans. These include: 1) improvement in the well-being of the population (safe water more readily available, new infrastructure, better access to health care) and 2) increases in the food supply (more vegetables and fish available due to irrigation). Thus, there has been a logical expectation that more, better quality food will become available as a result of these schemes, whereas in fact, health and nutrition has often worsened, particularly in young children. Most of the diseases associated with water resource management are communicable, including diseases directly related to the presence of large quantities of water, such as: malaria, which increases in incidence immediately after the building of the dam, after which a new balance develops between the human population and the parasites, schistosomiasis, the disease which increases most in response to the building of dams, particularly in its most severe gastrointestinal form, diarrhea, as water is a major means of dissemination for many organisms, including those causing digestive tract infections and gastroenteritis (amebiasis, salmonellosis, cholera), due to poor sanitation, other parasitic infections, such as onchocerciasis and trypanosomiasis, which should be monitored as they may also threaten the population. Other communicable diseases may appear or increase in incidence with the influx of migrants to the irrigated area. Sexually-transmitted diseases and HIV infection are a particular problem. The large numbers of insects (mosquitoes, blackflies) may also have harmful effects on populations adapting to the new environment. These effects are related to each other and to the environmental changes. New types of food affect people's feeding habits and generate new sources of income. However, they may also lead to new and higher expenditure. There are also likely to be major socio-demographic changes associated with changes in reproductive behavior and women's activities. The location and nature of new homes and infrastructure (e.g. schools, health centers, roads) also contribute to the success or failure of the dam project. There are many constraints to be considered and a more comprehensive approach to the problem is required. Health and nutritional status may be used as simple indicators of the ability of the population to adapt to a new environment. This makes it possible to construct a causal model to identify the most effective and relevant areas of intervention. Health and nutrition issues are of vital importance and scientific findings should be used in decision-making processes for planning future large dam schemes.