Determinants and causes of mortality in HIV-infected patients receiving antiretroviral therapy in Burkina Faso: a five-year retrospective cohort study.

In this study, we investigated the causes of death and the factors associated with mortality in a cohort of patients receiving highly active antiretroviral therapy (HAART) in Burkina Faso, an African country with limited resources. This retrospective cohort study included patients aged 15 years and older who started HAART for the first time between January 2003 and December 2008 in 14 health districts. We used survival analyses, including the Kaplan-Meier method, to examine potential predictors of death and two Cox proportional hazard models to estimate hazard ratios for death, first from baseline covariates and then from time-dependent covariates. A total of 6641 patients initiated HAART during this period; of these, 5608 were included in the analysis. By the end of the study period, 4310 of those patients were still receiving HAART, 690 had died, 207 had been transferred and 401 were lost to follow-up. The median duration of follow-up was 23.2 months [interquartile range (IQR): 12.4-36.9], and the overall incidence of mortality was 6 per 100 person-years. The clinical stage, CD4 count, body mass index (BMI), haemoglobin level, HAART regimen, gender, age, profession and year of initiation were the primary risk factors associated with death. In the multivariate analysis, BMI, clinical stage, treatment regimen and CD4 count remained significantly associated with death. The most frequent causes of death were wasting syndrome, tuberculosis and anaemia. This result highlights the already advanced stage of immunodeficiency among patients in Burkina Faso when they start HAART. Testing patients for HIV and starting antiretroviral therapy earlier are necessary to further reduce the mortality of patients living with HIV. This study provides a solid evidence base with which future evaluations of HAART in Burkina Faso can be compared.

Interet des donnees cliniques dans le diagnostic de la meningite bacterienne aigue : experience du Burkina-Faso

La meningite bacterienne aigue (MBA) est une urgence medicale par ses complications potentielles; elle justifie un diagnostic et traitement precoces. La strategie nationale au Burkina Faso recommande une reference de tous les cas suspects au Centre Hospitalier Universitaire Souro Sanou; habilete a confirmer le diagnostic par analyse du liquide cephalo-rachidien. Methodes. Les auteurs; a travers une etude transversale et analytique; ont recherche les donnees epidemiocliniques des cas suspects referes; en vue de valider l'approche syndromique; dans l'orientation dudiagnostic de la meningite. La specificite; la sensibilite; et la valeur predictive positive des donnees cliniques ont ete determinees; par rapport a la confirmation apportee par la culture du LCR; selon les recommandations de STARD et de l'OMS. Resultats. Au total; 377 patients ont ete enregistres; soit un taux de 2;4; par rapport a l'ensemble des malades admis pendant la periode d'etude. La fievre (81;6) et la raideur de nuque (72;9) ont ete les observations cliniques les plus frequentes ; le bombement de la fontanelle (31;6) et les convulsions ( 23;1); etant l'apanage des patients pediatriques. La culture du liquide cephalorachidien (LCR) a ete positive chez 207 sujets (54;9) avec tableau clinique suggestif; et chez 97 patients sans triade symptomatique classique; meme si la fievre etait presente dans tous les cas (T. 38C). La specificite et la valeur predictive positive du tableau clinique etaient de 100dans la confirmation du diagnostic par la culture. Conclusion. Cette enquete montre la pertinence de l'examen clinique dans l'approche diagnostique de la MBA au niveau des centres de sante; tout en relevant le role determinant de la culture du LCR dans la confirmation de la pathologie

Tsetse control in cattle from pyrethroid footbaths.

In Burkina Faso, we assessed the efficacy of treating cattle with a footbath containing aqueous formulations of pyrethroids to control two tsetse-fly species, Glossina tachinoides Westwood, 1850 (Diptera, Glossinidae) and Glossina palpalis gambiensis Vanderplank 1949. Legs were the most targeted parts of the body for tsetse-fly blood meals: 81% (95% CI: 73, 89) for G. tachinoides and 88% (81, 95) for G. palpalis. The in-stable efficacy of footbath treatments was compared with manual full spraying with a 0.005% alphacypermethrin (Dominex, FMC, Philadelphia, USA) formulation (250mL versus 2L). The proportions of knocked-down flies were the same with footbath and full spray but the latter was more protective against fly bites. In field use, the efficacy of both methods should be similar given the recommended treatment frequency: 3 days for footbath versus 7 days for full spray. Among 96 cattle drinking at the same water point in Dafinso (Burkina Faso), 68 (71%) were treated with a footbath containing a 0.005% deltamethrin formulation (Vectocid, CEVA SA, Libourne, France). We observed the effect of this live-bait technique on the one hand on released cohorts of reared, irradiated flies, and on the other hand on wild tsetse flies. In both cases, the footbath treatment was associated with a reduction of the apparent fly density probably related to an increased mortality.

Female genital cutting practices in Burkina Faso and Mali and their negative health outcomes.

Observations of the types of female genital cutting and possible associated gynecological and delivery complications were undertaken in 21 clinics in rural Burkina Faso and in four rural and four urban clinics in Mali. Women who came to the clinics for services that included a pelvic exam were included in the study, and trained clinic staff observed the presence and type of cut and any associated complications. Ninety-three percent of the women in the Burkina Faso clinics and 94 percent of the women in the Mali clinics had undergone genital cutting. In Burkina Faso, type 1 (clitoridectomy) was the most prevalent (56 percent), whereas in Mali the more severe type 2 cut (excision) was the most prevalent (74 percent); 5 percent of both samples had undergone type 3 cutting (infibulation). Logistic regression analyses show significant positive relationships between the severity of genital cutting and the probability that a woman would have gynecological and obstetric complications.

PIP: This study examines the type of female genital cutting and its possible associated gynecological and delivery complications among females in Burkina Faso and Mali, Africa. Included in the study were women who came to 21 clinics in rural Burkina Faso and in four rural and four urban clinics in Mali seeking medical services that include a pelvic exam. Trained clinical staff observed the presence and type of cut and any associated complications. It was observed that 93% of the women in Burkina Faso and 94% in Mali had undergone genital cutting. The most prevalent type of female genital cutting in Burkina Faso is clitoridectomy, which is 56% among women observed. In Mali, excision was the most prevalent (74%). About 5% of both samples had undergone type 3 cutting, which is the infibulation. Furthermore, there exist a significant relationship between the severity of genital cutting and the possibility of gynecological and obstetric complications.

Improvement of cattle productivity through rapid alleviation of African animal trypanosomosis by integrated disease management practices in the agropastoral zone of Yalé, Burkina Faso.

Investigations to identify the causes of high mortalities in cattle in the agropastoral zone (ZAP) of Yalé started in March 1993. African animal trypanosomosis (AAT) was found to be the major constraint, with incidence rates exceeding 30%, justifying a tsetse control programme, which started in March/ April 1994. The treatment of all cattle at bimonthly intervals with deltamethrin 1% pour on and the display of 1500 insecticide impregnated targets during the 6 months of the dry season each year helped to reduce the tsetse populations (Glossina tachinoides and G. morsitans submorsitans) by more than 90%. In less than 7 months, the incidence of AAT dropped below 5% and remained there throughout the intervention until June 1996, in spite of an increase to 3 months in the interval between the treatments. Mean PCV values increased significantly from 26.5-30.9%, before, to 30.7-36.3% during the intervention. The improvement in the overall health resulted in a resumption in fertility and milk production, allowing the sale of dairy products in Léo, thus creating a gross income of about $US3/day for the Fulani women.

Polymerase chain reaction characterization of trypanosomes in Glossina morsitans submorsitans and G. tachinoides collected on the game ranch of Nazinga, Burkina Faso.

The polymerase chain reaction was used to characterize the trypanosomes infecting Glossina morsitans submorsitans and G. tachinoides in the game ranch of Nazinga, Burkina Faso, situated near an agropastoral zone. Dissection of 435 tsetse flies, and PCR analysis of 166 infected flies were conducted to assess the epidemiological situation. Trypanosomes of the Nannomonas subgenus were the most abundant in the two tsetse species (80.4% and 73.7% of identified infections in G. m. submorsitans and G. tachinoides respectively). T. vivax and T. brucei infection rates were comparable between the two tsetse species. Mature infection pattern identified by PCR differed from overall infections, mainly because T. simiae infections did not mature, whereas T. vivax represented the predominant taxon. Parasitological and PCR results showed some discrepancies; possibly some typical Duttonella strains could not be recognized by the sets of primers used. The technologies used in this work helped to determine the high trypanosomosis risk in this area.

[Evaluation of the pre-introduction of contraception by means of subcutaneous levonorgestrel implants in Burkina Faso]. / Evaluation de la pré-introduction de la contraception par les implants sous-cutanés de levonorgestrel au Burkina Faso.

It is a prospective study based on the pre introduction evaluation of Norplant implants conducted from September 92 to September 93 in the city of Ouagadougou. 197 women were selected for the study. Based on unemployed women with an average age of 31 years old. The average parity was of 5.47% of patients were multiparas. A gain of weight of an average of 2.43 kg was observed. The main side effects observed was cycle disorders and headache. The continuing rate after 12 months was 96.5%. Conclusion from this study is that Norplant Implants are well tolerated and accepted by women.

PIP: According to the 1989 census, Burkina Faso has a fertility rate of 7.1%. In 1992, the rate of contraceptive use was 8.2%. In an effort to expand the selection of contraceptive methods available in the country, the government of Burkina Faso worked with the Population Council to introduce the Norplant subcutaneous implant method of contraception. Norplant is a long-term, reversible, hormonal contraceptive method employing levonorgestrel. A prospective study based upon the preintroduction evaluation of Norplant was conducted from September 1992 to September 1993 in Ouagadougou. 197 women aged 18-47 years were chosen for the study. They were of mean age 31.9 years with 67% aged 30-39 years. Their mean parity was 5 children with the extremes of 1-11 children. 47% were multiparous, and 69% had already ever used a contraceptive method. The women weighed 42-91 kg, of mean weight 60 kg upon Norplant insertion and 62.43 kg 12 months later. Main secondary effects were cycle disorders and cephaly. The continuation rate of Norplant use after 12 months was 96.5%. These data indicate that Norplant is well accepted and tolerated by women in this setting.

New epidemiological features on animal trypanosomiasis by molecular analysis in the pastoral zone of Sideradougou, Burkina Faso.

A multidisciplinary work was undertaken in the agropastoral zone of Sidéradougou, Burkina Faso to try to elucidate the key factors determining the presence of tsetse flies. In this study the PCR was used to characterize trypanosomes infecting the vector (Glossina tachinoides and Glossina palpalis gambiensis) and the host, i.e. cattle. A 2-year survey involved dissecting 2211 tsetse of the two Glossina species. A total of 298 parasitologically infected tsetse were analysed by PCR. Trypanosoma vivax was the most frequently identified trypanosome followed by the savannah type of T. congolense and, to a lesser extent, the riverine forest type of T. congolense, and by T brucei. No cases of T. simiae were found. From the 107 identified infections in cattle, the taxa were the same, but T. congolense savannah type was more frequent, whereas T. vivax and T. congolense riverine forest types were found less frequently. A correlation was found between midgut infection rates of tsetse, nonidentified infections and reptile bloodmeals. These rates were higher in G.p. gambiensis, and in the western part of the study area. T. vivax infections were related to cattle bloodmeals, and were more frequent in G. tachinoides and in the eastern study area. The PCR results combined with bloodmeal analysis helped us to establish the relationships between the vector and the host, to assess the trypanosome challenge in the two parts of the area, to elucidate the differences between the two types of T. congolense, and to suspect that most midgut infections were originating from reptilian trypanosomes.

PCR analysis and spatial repartition of trypanosomes infecting tsetse flies in Sidéradougou area of Burkina Faso.

A parasitological and entomological survey was conducted in the Sideradougou area (south of Bobo Dioulasso, Burkina Faso) in order to identify transmission factors of African trypanosomosis. A total of 3600 tsetse flies (Glossina tachinoides, Glossina palpalis gambiensis) were captured along 120 km of linear gallery forest and half of them were dissected. PCR analysis was undertaken on parasitologically positive flies (161 G. tachinoides, 92 G. palpalis gambiensis) to characterize the different trypanosomes. All the results were integrated in a GIS (Geographical Information System). Spatial repartition of the characterized trypanosomes enabled to recognize different areas with specific patterns of infection. Relations with environmental factors are discussed.

Trypanosome characterization by polymerase chain reaction in Glossina palpalis gambiensis and G.tachinoides from Burkina Faso.

Following the discovery of four cases of African human trypanosomiasis, an entomological survey was conducted along the Mouhoun river in southwest Burkina Faso to collect Glossina palpalis gambiensis and G.tachinoides. Among 226 flies dissected, 4.87% (eleven individuals) were infected in midgut or proboscis, but never in the salivary glands. Polymerase chain reaction analysis was undertaken, and was able to characterize all the proboscis infections, and half of the midgut infections. Only Trypanosoma simiae and T. vivax were found in the organs of infected flies, in single or mixed-species infections. Ten more flies, negative with parasitological examination, were tested with Trypanozoon primers and remained negative. The epidemiological significance of the absence of T.brucei group infections in wild tsetse populations and the presence of T.simiae in G.p.gambiensis are discussed.

Successful application of deltamethrin pour on to cattle in a campaign against tsetse flies (Glossina spp.) in the pastoral zone of Samorogouan, Burkina Faso.

1,500-2,000 head of cattle were treated with deltamethrin 1% Spot On in an area of high tsetse densities, notably of Glossina morsitans submorsitans. After four treatments at monthly intervals, the time between two treatments was increased to two months. 11 months after the commencement of the campaign the fly population had decreased from initially 54.2 flies/trap/day to densities varying between 0.06-2.0 flies/trap/day, mostly G. palpalis gambiensis. Blood-meal analysis showed that this species was surviving in limited areas, mainly feeding on monitor lizards; consequently it is unlikely that this species can be eradicated solely by the use of cattle treated with a pyrethroid. The resistance of Trypanosoma congolense to all commercially available trypanocides necessitated the epidemiological monitoring of calves which were born after the start of the campaign in order to reasses the real challenge. The risk of new infections was low, basically due to contracts between the cattle and tsetse outside the ranching area. A weight increase from 122.3 kg to 213.6 kg of calves aged 6-12 months was recorded from October 1993 to October 1994. An average daily weight gain of more than 400 g was observed from the end of April 1994 to the beginning of August 1994.

Contribution a l'etude chimique et microbiologique de Nauclea latifolia sm. (Rubiaceae) : possibilite d'utilisation des feuilles comme succedane des racines dans le traitement traditionnel de gastro-enterites

Nauclea latifolia Sm. est une Rubiaceae medicinale tres utilisee dans la therapeutique medico-traditionnelle au Burkina-Faso. Elle est preconisee dans le traitement d'un certain nombre d'affections et plus particulierement les gastro-enterites infantiles. Ce travail presente les resultats d'une etude sur la mise en evidence d'une activite antibacterienne des extraits hydro-alcooliques et alcaloidiques (feuilles et ecorces de racines) vis-a-vis de quatre germes pathogenes testes in vitro. L'effet antimicrobien engendre par les extraits des feuilles de la drogue offre une opportunite de proposer l'utilisation des feuilles comme substitut aux racines. Cette substitution des feuilles aux racines contribue a la sauvegarde de cette plante dont l'exploitation traditionnelle des racines compromet la survie

Development of multiple drug resistance of Trypanosoma congolense in Zebu cattle under high natural tsetse fly challenge in the pastoral zone of Samorogouan, Burkina Faso.

Preliminary data from an ongoing epidemiological survey in the pastoral zone of Samorogouan (Kénédougou) indicate the occurrence of multiple-drug-resistant Trypanosoma congolense. Despite frequent trypanocidal drug treatments with diminazene aceturate (Berenil, Hoechst) at 7 mg/kg body weight (bw) at intervals of 2 to 4 weeks, no significant drop in the prevalence of African animal trypanosomosis (AAT) was observed. To examine a suspected drug resistance, 20 Zebu cattle, naturally infected with T. congolense and/or T. vivax, were transferred in December 1989 from Samorogouan into a fly-proof stable. Diminazene aceturate at 7 mg/kg bw cured infections of T. vivax, but was ineffective against T. congolense. Likewise, treatments with homidium bromide (Ethidium, FBC) at 1 mg/kg bw and isometamidium chloride (Trypamidium, Rhône Mérieux) at 1 mg/kg bw, respectively, proved to be ineffective. Corresponding chemotherapeutic trials in previously unexposed Zebu bulls and Sahelian goats infected with one primary T. congolense isolate from Samorogouan demonstrated a high level of resistance to diminazene aceturate (7 mg/kg bw in cattle and 17.5 mg/kg bw in goats), isometamidium chloride (1 and 2 mg/kg bw i.v. in goats) and quinapyramine sulphate (Trypacide'S', Rhône Mérieux) at 5 mg/kg bw in goats. The appearance of a multiple-drug-resistant strain of T. congolense emphasizes the urgent need for new chemical substances as trypanocidal drugs and the increasing importance of efficient vector control.

The residual effect of deltamethrin Spot On when tested against Glossina palpalis gambiensis under fly chamber conditions.

Groups of single zebu cattle were exposed to infestations of the tsetse fly Glossina palpalis gambiensis in fly chambers following treatment with a pour on formulation of deltamethrin, Coopers* Spot On. During the experiment one animal was maintained in a stall, the other exposed at intervals to sunlight. Both mortality and knockdown of exposed flies was demonstrated. Mortality rates of greater than 90% were recorded during the period 0-20 days after treatment and values in excess of 50% during the period, 41-59 days after treatment. Knockdown was more marked with rates in excess of 90% and 65% being recorded for respectively 45 and 75 days after treatment. Exposure to sunlight did not significantly effect the performance of Spot On. Flies were observed to repeatedly land on the deltamethrin treated cattle, so contributing to the overall pick-up of effective concentrations of the chemical. It was considered that this effect of the chemical could considerably reduce the risk of transmission of trypanosomosis from the start of a tsetse campaign.

Simultaneous control of ticks and tsetse flies in Satiri, Burkina Faso, by the use of flumethrin pour on for cattle.

Treatments of 2000 cattle at monthly intervals with flumethrin pour on (1 mg active ingredient/kg b.w.) resulted in a rapid decrease of African Animal Trypanosomosis (AAT). After an initial curative treatment of the sentinel herd with diminazene aceturate (7 mg/kg b.w.) only positive cases were treated. Three applications of flumethrin were sufficient to reduce the prevalence of AAT to below 5%. Apart from a slight increase at the end of the first year the infection rate varied between 0 and 5%. A tsetse population disappeared from a heavily infested habitat after six treatments. The average tick infestation was 3-10 times lower than in a control site inspite of the repeated use of another acaricide. Between 3282 and 8624 animals were treated five times in the second year at intervals of about two months. 130 monoconical insecticide impregnated traps were deployed in habitats which were inaccessible for the cattle. The highest infection rate of the sentinel herd was 1.4%. Among another 150 eartagged cattle scattered over a district of about 1000 m2 the prevalence of AAT dropped to 4.8% at the end of the second year. Emphasis is put on an active and financial participation of the rural communities to ensure a viable campaign and good prospects of a taking over by local organizations once the external interventions have stopped.

Mise en evidence d'une activite antibacterienne de nauclea latifolia Sm. (Rubiaceae); vis-a-vis d'enterobacteries responsables de gastro-enterites infantiles au Burkina-Faso

L'extrait hydroalcoolique de maceration de la poudre d'ecorces de racines de nauclea latifolia Sm. (Rubiaceae) de meme que la solution hydroalcoolique du totum alcaloidique des ecorces de racines ont montre une action inhibitrice sur la croissance des souches microbiennes isolees de produits pathologiques au Centre Hospitalier National de Ouagadougou et testees au cours de cette etude. Cette propriete antibacterienne mise en evidence in-vitro; justifierait l'utilisation de nauclea latifolia en medecine traditionnelle locale; notamment dans le traitement d'un grand groupe d'affections dont les gastro-enterites infantiles constituent l'une des plus frequentes

Effects of flumethrin pour-on against Glossina palpalis gambiensis (Diptera, Glossinidae) during releases in a fly proof stable.

2000 males and females of Glossina palpalis gambiensis were released in the presence of a Zebu treated with flumethrin pour-on in a fly proof stable. From the first day after treatment until day 15, the flies were released at intervals of two days. The mortalities were highest during the first five days after treatment. With the exception of the first two releases the "knock down" effects were distinctly higher than the corresponding mortalities, ranging between 60% and 100% during the observation period.

Effects of Flumethrin Pour-on against Glossina palpalis gambiensis (Diptera, Glossinidae).

1920 males and females of Glossina palpalis gambiensis were fed 3 times on a Zebu treated with Flumethrin Pour-on. This resulted in a significant increase of the mortality and abortion rate of the flies. The fly-specific effects of Flumethrin Pour-on were time-dependent: Clear effects on the performance of the flies were observed during the first 20 days after treatment of the Zebu; an initial 90% "knock down" effect decreased to 40% during the first 15 days.