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BACKGROUND: A 20-valent pneumococcal conjugate vaccine (PCV20), containing 13-valent PCV (PCV13) components and 7 additional polysaccharide conjugates, was developed to extend protection for pneumococcal disease. This phase 3 study assessed the safety and immunogenicity of PCV20 in children. METHODS: In this single-arm study, children (≥15 months-<18 years of age) received 1 dose of PCV20. Children <5 years of age had ≥3 prior doses of PCV13; children ≥5 years were recruited regardless of previous PCV receipt. Serotype-specific IgG concentrations and opsonophagocytic activity (OPA) titers were measured before and 1 month after PCV20. Local reactions and systemic events, adverse events (AEs), serious AEs, and newly diagnosed chronic medical conditions were collected. RESULTS: Of 839 enrolled participants, 831 (>99%) were vaccinated, and 819 (>97%) completed all study visits. Local reactions and systemic events were mostly mild to moderate in severity. No serious AEs were considered PCV20-related. IgG geometric mean fold rises (GMFRs) from before to 1 month after PCV20 ranged from 27.9-1847.7 (7 additional serotypes) and 2.9-44.9 (PCV13 serotypes) in children <5 years of age, and 10.5-187.7 (7 additional serotypes) and 4.3-127.9 (PCV13 serotypes) in children ≥5 years old. OPA GMFRs from before to 1 month after PCV20 ranged from 12.4-983.6 to 2.8-52.9 in children <5 years of age and from 11.5-499.0 to 5.3-147.9 in children ≥5 years of age. CONCLUSIONS: Among children ≥15 months through <18 years of age, PCV20 was well tolerated and induced robust responses to all 20 serotypes, supporting the use of PCV20 in children.
Subject(s)
Antibodies, Bacterial , Immunoglobulin G , Pneumococcal Infections , Pneumococcal Vaccines , Vaccines, Conjugate , Humans , Pneumococcal Vaccines/immunology , Pneumococcal Vaccines/adverse effects , Pneumococcal Vaccines/administration & dosage , Infant , Female , Male , Child, Preschool , Antibodies, Bacterial/blood , Adolescent , Child , Vaccines, Conjugate/immunology , Vaccines, Conjugate/adverse effects , Vaccines, Conjugate/administration & dosage , Pneumococcal Infections/prevention & control , Pneumococcal Infections/immunology , Immunoglobulin G/blood , Immunogenicity, Vaccine , Streptococcus pneumoniae/immunology , SerogroupABSTRACT
INTRODUCTION: General anaesthesia and surgery increase morbidity and mortality in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) who are not known to have OSAHS and therefore not treated before surgery. The objective of this study is to evaluate the risk of OSAHS using the STOP-BANG questionnaire (SBQ) in patients undergoing general anaesthesia in Burkina Faso. MATERIAL AND METHOD: This is a cross-sectional study concerning patients having received pre-anaesthetic consultation from 1st July 2020 to 30th June 2021. Risk of OSAHS is considered "medium to high" when the risk of obstructive sleep apnea is medium or high on SBQ. RESULTS: Our population consisted in 599 persons. A medium to high risk of OSAHS was found in 11.18%. The ASA score and the Mallampati scale were independently associated with moderate to high risk of OSAHS (P<0.001; P<0.001). ASA score of I and Mallampati class of I decreased the risk of OSAHS by 17 and 45% respectively (P=0.012; P=0.031). CONCLUSION: The risk of OSAHS in this population is comparable to that of the general population. Confirmation of OSAHS by ventilatory polygraphy or polysomnography would help to achieve further precision.
Subject(s)
Sleep Apnea, Obstructive , Humans , Burkina Faso/epidemiology , Cross-Sectional Studies , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/epidemiology , Polysomnography , Syndrome , Anesthesia, General/adverse effectsABSTRACT
Many New Approach Methodologies (NAMs) have been developed for the safety assessment of new ingredients. Research into reproductive toxicity and teratogenicity is a particularly high priority, especially given their mechanistic complexity. Forty-six non-teratogenic and 39 teratogenic chemicals were screened for teratogenic potential using the in silico DART model from the OECD QSAR Toolbox; the devTox quickPredict™ (devTox assay) test and the Zebrafish Embryotoxicity Test (ZET). The sensitivity and specificity were 94.7% and 84.1%, respectively, for the DART tree (83 chemicals), 86.1% and 35.6% for the devTox (81 chemicals) and 77.8% and 76.7% for the ZET (57 chemicals). Fifty-three chemicals were tested in all three assays and when results were combined and based on a "2 out of 3 rule", the sensitivity and specificity were 96.0% and 71.4%, respectively. The specificity of the devTox assay for a sub-set of 43 chemicals was increased from 26.1% to 82.6% by incorporating human plasma concentrations into the assay interpretation. When all 85 chemicals were assessed in a decision tree approach, there was an excellent predictivity and assay robustness of 90%. In conclusion, all three models exhibited a good sensitivity and specificity, especially when outcomes from all three were combined or used in "2 out of 3" or a tiered decision tree approach. The latter is an interesting predictive approach for evaluating the teratogenic potential of new chemicals. Future investigations will extend the number of chemicals tested, as well as explore ways to refine the results and obtain a robust Integrated Testing Strategy to evaluate teratogenic potential.
Subject(s)
Toxicity Tests , Zebrafish , Animals , Humans , Toxicity Tests/methods , Teratogens/toxicity , Reproduction , Biological AssayABSTRACT
Background: The tobacco epidemic is one of the biggest public health threats the world has ever faced. Shisha use has recently been gaining increased popularity in many developed and developing countries. Objectives: To determine the prevalence of shisha use among students in Ouagadougou, Burkina Faso, and associated knowledge, smoking practices and beliefs about health effects. Methods: A total of 443 students were selected for this cross-sectional study, using a stratified sampling method. Data on shisha use, knowledge about shisha, shisha smoking practices, and factors associated with use of shisha were collected via a questionnaire. The association between the independent variables and shisha use was assessed using a χ² test (p<0.05). Binary logistic regression analysis was used to determine variables that were independently associated with shisha smoking. Results: Of the 421 respondents, 162 (38.5%) indicated that they had smoked shisha; 14.0% were regular smokers. We found that 183 students (43.5%) had poor knowledge about the health effects of shisha. The main reasons for shisha smoking were being in the company of friends who were users (57.4%), the pleasant flavour and fragrance of shisha (25.9%), and fashion (22.2%). Ninety-nine shisha smokers (61.1%) also consumed alcohol. Factors associated with shisha smoking included age <20 years (p<0.001), gender (p=0.034), and educational level of the respondent's father (p=0.0001) and mother (p=0.0004). Conclusion: We found a relatively high prevalence of shisha smoking among the students, and that 43.5% of them had poor knowledge about its effects on health. Developing surveillance, intervention and regulatory/policy frameworks specific to shisha has become a public health priority. Study synopsis: What the study adds. The study provides additional data from resource-poor settings such as Burkia Faso, where there is an overall high prevalence of Sisha smoking, and also among students who are poorly informed about the health effects of smoking. Implications of the findings. The data informs advocacy and intervention strategies to combat smoking and decrease overall tobacco use in an African setting.
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INTRODUCTION: Chronic respiratory diseases, particularly asthma and Chronic Obstructive Pulmonary Disease (COPD), pose a significant threat to public health. This study aims to determine the accessibility and affordability of means of diagnosis and treatment. METHODS: This was a cross-sectional study covering the period from August to December 2021 in Ouagadougou, Burkina Faso. This study involved 107 health centers and 135 pharmacies. The World Health Organization/Health Action International definition was used as a benchmark for accessibility to medicines. RESULTS: Out of 107 health centers, 29 (27.1%) had a spirometer. The average cost of spirometry represented 19.88 days of salary for a patient paid at the minimum wage. The most widely available drugs were salbutamol in a pressurized metered dose inhaler (pMDI) (88.1%) and prednisone 20mg tablet (87.4%). No disease-modifying drug was available in public pharmacies. Affordable drugs were salbutamol 4mg tablet and aminophylline 100mg tablet. CONCLUSION: The means of diagnosis and treatment of asthma and COPD are insufficiently available, especially in the public sector, which is characterized by a nearly total absence of basic treatment.
Subject(s)
Asthma , Pulmonary Disease, Chronic Obstructive , Humans , Burkina Faso/epidemiology , Cross-Sectional Studies , Asthma/diagnosis , Asthma/drug therapy , Asthma/epidemiology , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/epidemiology , Albuterol/therapeutic use , Costs and Cost Analysis , Health Services AccessibilityABSTRACT
Background.The tobacco epidemic is one of the biggest public health threats the world has ever faced. Shisha use has recently been gaining increased popularity in many developed and developing countries.Objective. To determine the prevalence of shisha use among students in Ouagadougou, Burkina Faso, and associated knowledge, smoking practices and beliefs about health effects.Method. A total of 443 students were selected for this cross-sectional study, using a stratified sampling method. Data on shisha use, knowledge about shisha, shisha smoking practices, and factors associated with use of shisha were collected via a questionnaire. The association between the independent variables and shisha use was assessed using a χ2 test (p<0.05). Binary logistic regression analysis was used to determine variables that were independently associated with shisha smoking.Results.Of the 421 respondents, 162 (38.5%) indicated that they had smoked shisha; 14.0% were regular smokers. We found that 183 students (43.5%) had poor knowledge about the health effects of shisha. The main reasons for shisha smoking were being in the company of friends who were users (57.4%), the pleasant flavour and fragrance of shisha (25.9%), and fashion (22.2%). Ninety-nine shisha smokers (61.1%) also consumed alcohol. Factors associated with shisha smoking included age <20 years (p<0.001), gender (p=0.034), and educational level of the respondent's father (p=0.0001) and mother (p=0.0004).Conclusion. We found a relatively high prevalence of shisha smoking among the students, and that 43.5% of them had poor knowledge about its effects on health. Developing surveillance, intervention and regulatory/policy frameworks specific to shisha has become a public health priority.
Subject(s)
Humans , Male , Female , Students , Nicotiana , Tobacco Use Disorder , Smoking , Public Health Practice , Cross-Sectional Studies , Smoking Water Pipes , CultureABSTRACT
Objectif. L'apparition de plusieurs cas de pneumopathie d'origine inconnue en Chine a conduit à l'identification du SARS-CoV-2. L'objectif de ce travail était de décrire le profil épidémioclinique et évolutif des patients hospitalisés dans notre centre de prise en charge afin de contribuer à l'amélioration de la lutte contre cette pandémie. Population et Méthodes. Il s'est agi d'une étude de cohorte rétrospective qui s'est déroulée du 19 mars au 31 septembre 2020 au CHUSS de Bobo Dioulasso. Résultats. Au total, 44 patients ont été inclus dans l'étude. La moyenne d'âge des patients était de 46,8 ans [14-84 ans]. Le sex ratio était de 0,7. La tranche d'âge la plus représentée était celle 50 et 64 ans avec 38,4% des patients. Les patients diabétiques et hypertendus représentaient respectivement 25% et 29,5% des cas. Les principaux symptômes étaient la dyspnée, la fièvre et la toux notées respectivement chez 54,5%, 54,5 % et 47,7% des cas. A la radiographie thoracique, les opacités de type micronodulaire étaient les plus représentées dans 66,7% des cas. L'oxygénothérapie a été nécessaire dans 38,6% des cas. Le protocole Covid-19 en vigueur dans le pays était instauré chez 90,9% des cas. Avec une durée d'hospitalisation moyenne de 12,4 jours, l'évolution clinique a été marquée par un décès chez 22,7 % des cas. Conclusion. Dans notre contexte, cette maladie reste l'apanage des sujets âgés présentant des comorbidités. L'une de difficultés de sa prise en charge était l'insuffisance du plateau technique expliquant en grande partie ce fort taux de létalité.
Objective. The occurrence of several cases of pneumonia of unknown origin in China led to the identification of SARS-CoV-2. The aim of this study was to describe the epidemiological and clinical profile of patients admitted to our care center to contribute to the improvement of the control of this pandemic. Population and methods. This was a retrospective cohort study which took place from 19 March to 31 September 2020 at the CHUSS of Bobo Dioulasso. Results. A total of 44 patients were included in the study. The mean age of the patients was 46.8 years [14- 84 years]. The sex ratio was 0.7. The most represented age group was 50-64 years with 38.4% of patients. Diabetic and hypertensive patients represented 25% and 29.5% of the cases respectively. The main symptoms were dyspnea, fever and cough, which were noted in 54.5%, 54.5% and 47.7% of cases respectively. On chest X-ray, micronodular opacities were the most common in 66.7% of cases. Oxygen therapy was required in 38.6% of cases. The Covid-19 protocol in force in the country was implemented in 90.9% of cases. With an average hospital stay of 12.4 days, the clinical course was marked by death in 22.7% of cases. Conclusion. In our context, this disease remains the prerogative of elderly subjects with comorbidities. One of the difficulties of its management was the insufficiency of the technical platform explaining in large part this high rate of lethality.
Subject(s)
Male , Female , Epidemiology , Diagnosis , COVID-19 , InpatientsABSTRACT
Next generation risk assessment (NGRA) is an exposure-led, hypothesis-driven approach that has the potential to support animal-free safety decision-making. However, significant effort is needed to develop and test the in vitro and in silico (computational) approaches that underpin NGRA to enable confident application in a regulatory context. A workshop was held in Montreal in 2019 to discuss where effort needs to be focussed and to agree on the steps needed to ensure safety decisions made on cosmetic ingredients are robust and protective. Workshop participants explored whether NGRA for cosmetic ingredients can be protective of human health, and reviewed examples of NGRA for cosmetic ingredients. From the limited examples available, it is clear that NGRA is still in its infancy, and further case studies are needed to determine whether safety decisions are sufficiently protective and not overly conservative. Seven areas were identified to help progress application of NGRA, including further investments in case studies that elaborate on scenarios frequently encountered by industry and regulators, including those where a 'high risk' conclusion would be expected. These will provide confidence that the tools and approaches can reliably discern differing levels of risk. Furthermore, frameworks to guide performance and reporting should be developed.
Subject(s)
Animal Testing Alternatives/methods , Consumer Product Safety/standards , Cosmetics/standards , Risk AssessmentABSTRACT
INTRODUCTION: The development of acute respiratory distress syndrome indicates a serious form of COVID-19. Although there have been several studies on the prognostic factors of its severe form, no such study has been conducted in Burkina Faso. METHODS: This was a retrospective cohort study conducted from March 9 to June 9, 2020 in Ouagadougou, Burkina Faso which involved 456 patients with COVID-19. RESULTS: Nearly a quarter of the patients (23.2%) had presented with acute respiratory distress and 44.3% of them died. Being over 65 years old (HR: 2.7; 95% CI: 1.5-5.1) and having hypertension (HR: 1.9; 95% CI: 1-3.5) were independently associated with the risk of mortality. However, after adjustment, only age over 65 years (HR: 2.3; 95% CI: 1.2-4.3) was a risk factor for death. The survival rate for patients over 65 was 38.5% at 7 days and 30.3% at 15 days. CONCLUSIONS: Acute respiratory distress leading to death is mainly found in older people with COVID-19. Close monitoring of these high-risk patients may reduce the risk of death.
Subject(s)
COVID-19/complications , COVID-19/mortality , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/mortality , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Burkina Faso/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , Child , Child, Preschool , Female , Humans , Hypertension/complications , Hypertension/epidemiology , Hypertension/mortality , Infant , Infant, Newborn , Male , Middle Aged , Mortality , Prognosis , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/epidemiology , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2/physiology , Severity of Illness Index , Young AdultABSTRACT
BACKGROUND: To sustain the efficacy of malaria vector control, the World Health Organization (WHO) recommends the combination of effective tools. Before designing and implementing additional strategies in any setting, it is critical to monitor or predict when and where transmission occurs. However, to date, very few studies have quantified the behavioural interactions between humans and Anopheles vectors in Africa. Here, we characterized residual transmission in a rural area of Burkina Faso where long lasting insecticidal nets (LLIN) are widely used. METHODS: We analysed data on both human and malaria vectors behaviours from 27 villages to measure hourly human exposure to vector bites in dry and rainy seasons using a mathematical model. We estimated the protective efficacy of LLINs and characterised where (indoors vs. outdoors) and when both LLIN users and non-users were exposed to vector bites. RESULTS: The percentage of the population who declared sleeping under a LLIN the previous night was very high regardless of the season, with an average LLIN use ranging from 92.43 to 99.89%. The use of LLIN provided > 80% protection against exposure to vector bites. The proportion of exposure for LLIN users was 29-57% after 05:00 and 0.05-12% before 20:00. More than 80% of exposure occurred indoors for LLIN users and the estimate reached 90% for children under 5 years old in the dry cold season. CONCLUSIONS: LLINs are predicted to provide considerable protection against exposure to malaria vector bites in the rural area of Diébougou. Nevertheless, LLIN users are still exposed to vector bites which occurred mostly indoors in late morning. Therefore, complementary strategies targeting indoor biting vectors in combination with LLIN are expected to be the most efficient to control residual malaria transmission in this area.
Subject(s)
Anopheles , Insecticide-Treated Bednets , Insecticides , Malaria , Animals , Burkina Faso/epidemiology , Child , Child, Preschool , Humans , Malaria/epidemiology , Malaria/prevention & control , Mosquito Control , Mosquito Vectors , SeasonsABSTRACT
"Blast hand" is a traumatic hand injury related to an explosion. Artisanal gold miners use dynamite to excavate gold pits; such activities expose them to blast hand injuries. This work aims to study blast injuries to gold miners' hands. A 25-month retrospective study was performed. Data on the traumatic event, patients, and injuries were collected and analyzed. Dedicated classifications and scores were used to evaluate the injury topography, injury severity, physical dependence, and aesthetic impact. Data were analyzed statistically. Thirty patients with 46 blast hand injuries among 516 hand injuries were collected. All patients were males and full-time artisanal gold miners. They were seen in the emergency room an average of 10.2hours (1-72) after the explosion. Explosions were caused by a 500g dynamite charge in all cases. The detonation was mainly thermal (n=13), triggered by the patient himself (n=24) and inside the gold pit (n=20). Injuries were bilateral (53%) or left side predominant (59%). Complex injuries were present in 21 hands. The MHISS (Modified Hand Injury Severity Score) was severe (n=7) and major (n=32). Associated injuries were musculoskeletal (n=12), ophthalmologic (n=14) and maxillofacial (n=10). Complexes injuries were correlated to being inside the pit at the time of the explosion. Treatment was conservative more often (n=33) than amputation (n=13). The functional recovery was complete in 22 hands (10 patients). Return to work at the same level was possible for only eight hands (5 patients). The presence of local sequelae or associated injuries negatively impacted the return to work. In Burkina Faso, gold miner's blast hand injuries cause post-traumatic social and professional reintegration issues. Better regulation of artisanal gold mining and expansion of treatment modalities (microsurgery, hand rehabilitation, splinting) may improve the outcome.
Subject(s)
Blast Injuries/surgery , Explosions , Hand Injuries/surgery , Miners , Adult , Amputation, Surgical , Burkina Faso , Debridement , Humans , Injury Severity Score , Male , Retrospective Studies , Return to Work , Young AdultABSTRACT
BACKGROUND: Studies indicate that responses to HIV-2 treatment regimens are worse than responses to HIV-1 regimens during the first 12 months of treatment, but longer-term treatment responses are poorly described. We utilized data from Côte d'Ivoire's RETRO-CI laboratory to examine long-term responses to HIV-2 treatment. METHODS: Adult (≥15 years) patients with baseline CD4 counts < 500 cells/µl that initiated treatment at one of two HIV treatment centers in Abidjan, Côte d'Ivoire between 1998 and 2004 were included in this retrospective cohort study. Patients were stratified by baseline CD4 counts and survival analyses were employed to examine the relationship between HIV type and time to achieving CD4 ≥ 500 cells/µl during follow up. RESULTS: Among 3487 patients, median follow-up time was 4 years and 57% had documented ART regimens for > 75% of their recorded visits. Kaplan-Meier estimates for achievement of CD4 ≥ 500 cells/µl after 6 years of follow-up for patients in the lower CD4 strata (< 200 cells/µl) were 40% (HIV-1), 31% (HIV-dual), and 17% (HIV-2) (log-rank p < 0.001). Cox Regression indicated that HIV-1 was significantly associated with achievement of CD4 ≥ 500 cells/µl during follow-up, compared to HIV-2. CONCLUSIONS: Sub-optimal responses to long-term HIV-2 treatment underscore the need for more research into improved and/or new treatment options for patients with HIV-2. In many West African countries, effective treatment of both HIV-1 and HIV-2 will be essential in the effort to reach epidemic control.
Subject(s)
HIV Infections/drug therapy , HIV Infections/immunology , HIV-2/pathogenicity , Adult , CD4 Lymphocyte Count , Cohort Studies , Cote d'Ivoire , Female , HIV Infections/mortality , HIV-1/pathogenicity , Humans , Male , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
Cattle production is an essential livelihood strategy in south-western Burkina Faso. Although having a distinct cultural role and known to be resistant against African animal trypanosomosis, the Lobi taurine cattle breed is endangered due to its low market value. As the first step in preservation efforts, our study aimed to develop a typology of production systems at the farm level. We used a structured questionnaire and focus group discussions for collecting data on household characteristics, socioeconomic activities, livestock, and access to services. The sample comprised 169 households in three communities. The analytical strategy included factor analysis of mixed data and hierarchical clustering. We identified four distinct types of cattle production systems: (1) sedentary Lobi farms, (2) sedentary crossbreed farms, (3) semi-transhumant Fulani zebu farms, and (4) transhumant Fulani zebu farms. Significant factors in developing this typology were the farmers' ethnic group, crop diversity, cattle herd size, cattle herd composition, number of small ruminants, and livestock management strategies. Across all production systems, men were considered being primary decision-makers in cattle production, with women, herders, and children being responsible for specific tasks. All identified production systems are increasingly confronting disease pressure and scarcity of water and land. Future efforts in preservation and breeding will need to respond to these trends in the agroecosystem, integrate risk management measures, and resonate with the specific needs of the different household members involved in cattle rearing.
Subject(s)
Animal Husbandry , Breeding , Farmers , Livestock , Animals , Burkina Faso , Cattle , Family Characteristics , Farms , Female , Focus Groups , Humans , Male , Surveys and QuestionnairesABSTRACT
BACKGROUND: High demand for HIV-services and extensive clinical guidelines force health systems in low-resource settings to dedicate resources to service delivery at the expense of other priorities. Simplifying services may reduce the burden on health systems and pre-antiretroviral therapy (ART) laboratory screening is among the services under consideration for simplification. METHODS: We assessed the frequencies of conditions linked to ART toxicities among 34,994 adult, ART-naïve patients with specimens referred to the RETRO-CI laboratory in Abidjan, Côte d'Ivoire between 1998 and 2017. Screening included tests for serum creatinine, alanine aminotransferase (ALT) and haemoglobin (Hb) to identify renal dysfunction (estimated glomerular filtration rate < 50 mL/min), hepatic abnormalities (ALT > 5× upper limit of normal) and severe anaemia (Hb < 6.5 g/dL), respectively. We considered screening results across four eras and identified factors associated with the conditions in question. RESULTS: The prevalence of renal dysfunction, hepatic abnormalities and severe anaemia were largely unchanged over time and just 8.4% of patients had any of the three conditions. Key factors associated with renal dysfunction and severe anaemia were age > 50 years (adjusted odds ratio (aOR): 2.53; 95% confidence interval (CI): 2.19-2.92; P < 0.001) and CD4 < 100 cells/µl (aOR: 2.57; 95% CI: 2.30-2.88; P < 0.001). CONCLUSION: The relative infrequency of conditions linked to toxicity in Côte d'Ivoire supports the notion that simplification of pre-ART laboratory screening may be undertaken with limited negative impact on identification of adverse events. Targeted screening may be a feasible strategy to balance detection of conditions associated with ART toxicities with simplification of services.
CONTEXTE: La forte demande de services VIH et les directives cliniques détaillées obligent les systèmes de santé des pays à faibles ressources à consacrer des ressources à la prestation de services au détriment d'autres priorités. La simplification des services peut réduire la charge pesant sur les systèmes de santé et les analyses de laboratoire avant la thérapie antirétrovirale (ART) fait partie des services envisagés pour la simplification. MÉTHODES: Nous avons évalué la fréquence des conditions liées aux toxicités dues à l'ART chez 34.994 patients adultes naïfs pour l'ART avec des échantillons référés au laboratoire RETRO-CI à Abidjan, en Côte d'Ivoire entre 1998 et 2017. Les analyses comprenaient les tests de créatinine sérique, d'alanine aminotransférase (ALT) et d'hémoglobine (Hb) pour identifier respectivement la dysfonction rénale (débit de filtration glomérulaire estimé <50 mL/min), les anomalies hépatiques (ALT >5x la limite supérieure normale) et l'anémie sévère (Hb <6,5 g/dL). Nous avons examiné les résultats des analyses sur quatre époques et identifié les conditions associées aux conditions en question. RÉSULTATS: La prévalence de la dysfonction rénale, des anomalies hépatiques et de l'anémie sévère est restée largement inchangée au fil du temps et seulement 8,4% des patients présentaient l'une des trois conditions. Les facteurs clés associés à la dysfonction rénale et à l'anémie sévère étaient l'âge >50 ans (odds ratio ajusté (aOR): 2,53; intervalle de confiance (IC) à 95%: 2,19 à 2,92; p <0,001) et les CD4 <100 cellules/µl (aOR: 2,57; IC95%: 2,30 à 2,88; P < 0,001). CONCLUSION: La relativement faible fréquence des conditions liées à la toxicité en Côte d'Ivoire soutient la notion selon laquelle une simplification des analyses de laboratoire pré-ART peut être entreprise avec un impact négatif limité sur l'identification des événements adverses. Le ciblage des analyses peut être une stratégie réalisable pour aligner la détection des conditions associées aux toxicités ART à la simplification des services.
Subject(s)
Anti-Retroviral Agents/toxicity , HIV Infections/drug therapy , Health Care Rationing , Adult , Anemia/chemically induced , Anemia/epidemiology , Cote d'Ivoire/epidemiology , Female , HIV Infections/blood , HIV Infections/economics , Humans , Laboratories, Hospital , Liver Failure/chemically induced , Liver Failure/epidemiology , Male , Prevalence , Referral and Consultation , Renal Insufficiency/chemically induced , Renal Insufficiency/epidemiologyABSTRACT
BACKGROUND: Obstructive sleep apnoea syndrome (OSAS) is the most common respiratory disorder related to sleep. Its prevalence in developed countries varies from 3% to 28%. In several African countries, including Burkina Faso, this syndrome is still under-diagnosed and goes largely untreated. It is necessary to conduct studies in different contexts to determine the characteristics and develop the strategies for management of OSAS. OBJECTIVES: To determine the prevalence of OSAS in Burkina Faso. METHODS: This prospective study recruited 106 patients coming for consultation for sleep disorders at the Yalgado Ouedraogo University Hospital Center, who responded to a self-questionnaire and were diagnosed by respiratory polygraphy. RESULTS: A total of 77 patients (72.6%) had OSAS. The male to female ratio was 1.4:1 and the mean (standard deviation) age was 47.8 (12.8) years. The majority of the patients (53.8%) were obese. The main reason for consultation was snoring (84%), followed by hypopnea-apnoea reported (59.4%) and daytime sleepiness (45.3%). The most common comorbidity factor was hypertension (50%), followed by decreased libido (16%) and diabetes (13.2%). A continuous positive-pressure (CPAP) machine was prescribed to 51.25% of the patients, but only 22% were able to acquire it. CONCLUSION: The monitoring of OSAS is relatively new in Burkina Faso. This study showed the profile of patients with OSAS and difficulties in accessing continuous positive airway pressure (CPAP) devices for treatment.
ABSTRACT
BACKGROUND: Up to now, immunisation regimens that have been assessed for development of HIV vaccines have included purified envelope (Env) protein among the boosting components of the regimen. We postulated that co-administration of Env protein with either a DNA or NYVAC vector during priming would result in early generation of antibody responses to the Env V1/V2 region, which are important markers for effective protection against infection. We aimed to assess the safety and immunogenicity of a multivalent HIV vaccine including either DNA or NYVAC vectors alone or in combination with Env glycoprotein (gp120) followed by a co-delivered NYVAC and Env protein boost. METHODS: We did a single-centre, double-blind, placebo-controlled phase 1b trial at the Centre Hospitalier Universitaire Vaudois (Lausanne, Switzerland). We included healthy volunteers aged 18-50 years who were at low risk of HIV infection. We randomly allocated participants using computer-generated random numbers to one of four vaccination schedules or placebo (4:1), and within these schedules participants were allocated either active treatment (T1, T2, T3, and T4) or placebo (C1, C2, C3, and C4). T1 consisted of two doses of NYVAC vector followed by two doses of NYVAC vector and gp120 Env protein; T2 comprised four doses of NYVAC vector and gp120 Env protein; T3 was two doses of DNA vector followed by two doses of NYVAC vector and gp120 Env protein; and T4 was two doses of DNA vector and gp120 Env protein followed by two doses of NYVAC vector and gp120 Env protein. Placebo injections were matched to the corresponding active treatment group. Doses were administered by injection at months 0, 1, 3, and 6. Primary outcomes were safety and immunogenicity of the vaccine schedules. Immune response measures included cross-clade and epitope-specific binding antibodies, neutralising antibodies, and antibody-dependent cell-mediated cytotoxicity measured 2 weeks after the month 1, 3, and 6 vaccinations. This trial is registered with ClinicalTrials.gov, NCT01799954. FINDINGS: Between Aug 23, 2012, and April 18, 2013, 148 healthy adult volunteers were screened for the trial, of whom 96 participants were enrolled. 20 individuals were allocated to each active treatment group (groups T1-4; n=80) and four were assigned to each placebo group (groups C1-4; n=16). Vaccines containing the NYVAC vector (groups T1 and T2) were associated with more frequent severe reactogenicity and more adverse events than were vaccines containing the DNA vector (groups T3 and T4). The most frequent adverse events judged related to study product were lymphadenopathy (n=9) and hypoaesthesia (n=2). Two participants, one in the placebo group and one in the DNA-primed T3 group, had serious adverse events that were judged unrelated to study product. One participant in the T3 group died from cranial trauma after a motor vehicle accident. Across the active treatment groups, IgG responses 2 weeks after the 6-month dose of vaccine were 74-95%. Early administration of gp120 Env protein (groups T2 and T4) was associated with a substantially earlier and higher area under the curve for gp120 Env binding, production of anti-V1/V2 and neutralising antibodies, and better antibody-response coverage over a period of 18 months, compared with vaccination regimens that delayed administration of gp120 Env protein until the 3-month vaccination (groups T1 and T3). INTERPRETATION: Co-administration of gp120 Env protein components with DNA or NYVAC vectors during priming led to early and potent induction of Env V1/V2 IgG binding antibody responses. This immunisation approach should be considered for induction of preventive antibodies in future HIV vaccine efficacy trials. FUNDING: National Institutes of Health, National Institute of Allergy and Infectious Diseases, and the Bill & Melinda Gates Foundation.
Subject(s)
AIDS Vaccines/administration & dosage , Antibodies, Neutralizing/metabolism , HIV Antibodies/metabolism , HIV Envelope Protein gp120/administration & dosage , HIV Infections/prevention & control , Vaccines, DNA/administration & dosage , AIDS Vaccines/adverse effects , AIDS Vaccines/immunology , Adult , Area Under Curve , Double-Blind Method , Drug Administration Schedule , Drug Therapy, Combination , Female , HIV Envelope Protein gp120/adverse effects , HIV Envelope Protein gp120/immunology , HIV Infections/immunology , Humans , Male , Middle Aged , Vaccines, DNA/adverse effects , Vaccines, DNA/immunology , Young AdultABSTRACT
INTRODUCTION: Sleep apnoea syndrome (SAS) is a frequent and underdiagnosed pathology. Epidemiological studies in sub-Saharan Africa are few. Our study aimed to determine the prevalence of SAS symptoms in an adult population in Burkina Faso. METHODS: A cross-sectional study whose data collection took place at the Yalgado Ouédraogo Teaching Hospital, from 1 September to 31 October 2014. We randomly enrolled all subjects aged at least 25 accompanying an outpatient t the time of a visit. A strong suspicion of SAS was established for every combination of ordinary snoring with excessive daytime sleepiness and/or sleep apnoea. RESULTS: The study included 311 subjects - 181 men and 130 women. The mean (standard deviation (SD)) age was 31.84 (8.25) years and the average (SD) BMI was 23.14 (3.67) kg/m². The prevalence of excessive daytime sleepiness, snoring and sleep apnoea was 4.5%, 26% and 9.6%, respectively. A strong suspicion of SAS was found in 9.6% of respondents and the risk factors associated with this strong suspicion were BMI≥25 kg/m² (odds ratio (OR) 2.7; p=0.012), and poor-quality sleep (OR 3.7; p<0.001). CONCLUSION: A significant proportion of our sample had symptoms suggestive of SAS. Testing with either respiratory polygraphy or polysomnography should be proposed to the presumptive cases for early diagnosis and treatment.
ABSTRACT
Background: Despite the recommendations now in force for the management of asthma, evidence suggests that many asthmatic patients still have their disease uncontrolled. Objective: to assess asthma control and to identify the fac-tors associated with uncontrolled disease among the patients received for consultation in the department of Pneumology in Ouagadougou, Burkina Faso.Patients and methods: We conducted a cross-sectional study from 02/01/2015 to 01/31/2016 in the department of Pneu-mology of Yalgado Ouedraogo University Hospital in Oua-gadougou. All asthma patients seen during this time frame participated in this study. The 2014 GINA criteria were used to assess the asthma control status.Results: One hundred and two asthmatic patients were in-cluded (76 women and 26 men) with a mean age of 38.7 ± 18.6 years. Asthma was found to be well controlled in 26.5% of cases, partially controlled in 34.3% of cases and uncontrolled in 39.2% of cases. The following factors were found to be associated with an uncontrolled asthma: age >36 years (p = 0.002), low level of education (p = 0.04), allergic rhinitis (p = 0.01), overweight (p = 0.03), duration of asthma ⥠10 years (p = 0.04), therapeutic non-compliance (p = 0.00).Conclusion: Asthma was insufficiently controlled in our study. A tremendous emphasis must be put on not only on the therapeutic education of asthma patients, but also on a better management of comorbiditie
Subject(s)
Asthma , Burkina Faso , Patients , Public HealthABSTRACT
The necrotizing and not necrotizing acute bacterial dermohypodermitis (DHD) are acute bacterial infections of tissues situated between the skin and the muscles. The localizations of the face are infrequent, and sometimes put diagnostic difficulties with other current facial dermatosis. We report in this article 4 cases of DHD of the face with skin source, hospitalized in the service of the Infectious and Tropical Diseases of the Teaching Hospital Yalgado Ouédraogo of Ouagadougou (Burkina Faso). The objective is to make a current situation of their etiologies and complications, and to look for the difficulties to take care of them in a country with limited resources. The patient's care journey for this disease is long while it constitutes a medical or medical-surgical emergency. Imaging, which is essential for the diagnosis of heart valve disease and the daunting complications of necrotizing fasciitis and mediastinitis, is generally available only in tertiary hospitals. Antibiotic therapy is most often inadequate or insufficient. Anti-inflammatories, widely used, according to several authors contribute to serious forms and excess mortality. Health workers in resource-limited settings need to be better educated and guidelines issued to recognize the signs of this condition in order to enable early referral of patients in specialized settings. In addition, education of the population and hygiene awareness of skin lesions should be a priority to reduce complications.
Subject(s)
Erysipelas/pathology , Face/pathology , Facial Dermatoses/microbiology , Facial Dermatoses/pathology , Adult , Erysipelas/diagnosis , Erysipelas/drug therapy , Facial Dermatoses/diagnosis , Facial Dermatoses/drug therapy , Female , Humans , Male , Middle Aged , Necrosis , Tropical Climate , Young AdultABSTRACT
INTRODUCTION: Abnomalies of the aortic arches are rare and account for 1% of congenital cardiovascular malformations. They constitute one of the causes of compression of the airways with attacks of dyspnea sometimes simulating an asthma. We report the case of an infant with an anomaly development of aortic arches with impact breathing. CASE REPORT: It was a 22-month-old infant who consulted for a dyspnea with a type of stridor associated with a fat cough. This clinical table started 45 days after its birth and led to many hospitalizations in the pediatric emergency. Clinical exam found polypnea, with a wheezing, bronchial groan and diffuse sibilants on the auscultation. The chest X-ray revealed a slightly retractile right lung. The angioscanner of the thoracic and abdominal aorta showed a double aortic arch with retro-oesophageal left ventricular artery. A thoracotomy was performed and the operative sequences were simple. CONCLUSION: The congenital anomalies of the aortic arch are rare and varied, sometimes asymptomatic. This case reminds us that, in front of any recurrent or digestive respiratory signs in the infant, malformation of the aortic arches should be considered.