Analyzing implementation of public health interventions: A need for rigor, and the challenges of stakeholder involvement.

OBJECTIVES: This article shows how conceptual models can help to develop and evaluate public health interventions. It also reports on the challenges of getting stakeholders involved. METHOD: The analysis is based on the reflexive approach applied by the authors during their participation in two public health intervention research (PHIR) projects, in France and in Burkina Faso. RESULTS: In Paris, PHIR aimed to enable sub-Saharan immigrants to appropriate the existing means of prevention and sexual health care and to strengthen their empowerment in view of preserving their health. Evaluation was carried out using mixed methods. The intervention process theory is based on Ninacs' conceptual model of individual empowerment. The Consolidated Framework For Implementation Research (CFIR) was mobilized a posteriori to analyze the process. PHIR stemmed from collaboration between a research team and two associations. The different stakeholders were involved in the evaluation process, as were, at certain times, persons in highly precarious situations. In Ouagadougou, a community-based dengue vector control intervention was deployed to address an essential but neglected need. As regards evaluation, we opted for a holistic, mixed method approach (effectiveness and process). The contents of the intervention were determined based on tacit knowledge, a community preference survey and solid evidence. The theoretical framework of the intervention consisted in an eco-biological model of vector control. The implementation analysis combined an internal assessment of implementation fidelity with an external CFIR process analysis. All stakeholders were involved in the evaluation process. DISCUSSION: Analysis confirmed not only the value of process evaluations in PHIR, but also the primordial importance of a rigorous approach. Stakeholder involvement is a major challenge to be addressed early in the planning of RISPs; with this in mind, effective and ethically sound assessment mechanisms need to be drawn up. Interdisciplinary evaluative approaches should be preferred, and the use of justified, relevant, and flexible frameworks is highly recommended. CONCLUSION: Lessons learned for those wishing to engage in the process evaluation of a public health intervention are hereby presented.

Occurrence of phlebitis related to peripheral venous catheterization in the emergency services of the Souro Sanou National Teaching Hospital in Burkina Faso.

Patients must receive high-quality and safe health care. Peripheral venous catheterization (PVC) exposes patients to complications, mostly phlebitis. This study investigated the incidence of phlebitis and its PVC-related risk factors among patients in the medical and surgical emergency departments of the Souro Sanou University Hospital Center (CHUSS) in Bobo Dioulasso, Burkina Faso. This prospective cross-sectional study took place from July 4 to August 3, 2018. The incidence of PVC-related phlebitis was calculated and its risk factors were identified by logistic regression, with SPSS software version 20 (entry option), with significance set at 5%. The 511 patients included in the study had a mean age of 44.7 (95% CI 43.1-46.3) years. The mean duration of PVC was 3.1 days. Of these patients, 149 developed phlebitis, for an incidence of 29.2% (95% CI 25.0%-33.0%). There was no statistically significant difference between the two emergency (medical and surgical) departments. Second-degree phlebitis accounted for slightly more than half the cases (53%). Risk factors associated with the occurrence of PVC-related phlebitis were female gender, catheterization duration more than 3 days, small size of the catheter, and the healthcare worker's failure to use friction in washing with a hydroalcoholic hand solution. Preventive measures are essential.

[Funding for national ethics committees for health research in Member States of the Economic Community of West African States]. / Le financement des Comités nationaux d'éthique de la recherche pour la santé dans les États membres de la communauté économique des États de l'Afrique de l'Ouest.

BACKGROUND: The financing of national research ethics committees for health is a decisive factor in their proper functioning and independence. Little information is available concerning the funding of these committees in West Africa. AIM: To analyze the funding of national research ethic committees for health in the Member States of the Economic Community of West African States. METHODS: A review of the documents from two regional workshops with the participation of the representatives of the national ethics committees of each ECOWAS Member State was carried out. These workshops enabled the collection and validation of data on the status of national ethics committees. These data were used to conduct a descriptive analysis of the funding sources of the committees. RESULTS: Three sources of funding for national ethics committees were identified. The first source was the support of the state or a national structure. The second source was the fee for reviewing the submitted protocols and the last source was the support of external donors. The collection of audit fees and the support of external donors were the main sources of funding for most of the national committees. In only one state, there were no fees for review of submitted protocols and all the ethic committee member were motivated by the government. CONCLUSION: In order to ensure the autonomy and independence of the national committees, state support for the funding of these committees should improve. The establishment of a regional network and its recognition by the Assembly of Ministers of Health of ECOWAS allowed for advocacy by WAHO, which should help achieve better results in the future.

Dégénérescence carcinomateuse d'une maladie de Ménétrier. A propos d'une observation et revue de la littérature

La maladie de Ménétrier est une affection rare caractérisée par l'hypertrophie des gros plis gastriques avec un risque accru de dégénérescence. Si la cause reste inconnue, il a été mis en évidence récemment une expression du facteur de croissance épidermique sur les cellules pathologiques de la muqueuse gastrique. Une femme de 25 ans a été reçue pour des épigastralgies associées à des vomissements. L'endoscopie digestive haute évoquait une gastropathie hypertrophique ulcéro-infiltrative évocatrice de dégénérescence de maladie de Ménétrier confirmée par l'histologie (adénocarcinome peu différencié). La patiente a reçu une chimiothérapie par paclitaxel + cysplatine pour obtenir une survie de 6 mois. La Maladie de Ménétrier découverte à un stade précoce est curable. La découverte tardive chez notre patient soulève le problème de l'endoscopie digestive haute chez le sujet jeune devant toute épigastralgie persistante

Le handicap chronique à la marche : résultats d'une enquête en milieu scolaire à Bobo-Dioulasso (Burkina Faso)

Introduction : La survenue d'un trouble chronique de la marche chez l'enfant d'âge scolaire peut influencer son devenir social si une thérapeutique adaptée ne lui est pas opposée. Objectifs : Etablir le profil épidémiologique, clinique et diagnostique du handicap chronique à la marche en milieu scolaire à Bobo Dioulasso. Patients et méthodes : Il s'est agi d'une étude transversale conduite dans les écoles primaires de Bobo-Dioulasso de janvier à mai 2014. Elle a concerné 10 écoles issues d'un tirage aléatoire simple. L'échantillonnage a été exhaustif. Le dépistage des cas a été réalisé grâce à l'observation visuelle de la marche. Seuls les élèves présentant un trouble de la marche évoluant depuis plus de six mois ont été retenus.Résultats : Il a été examiné au total 4 336 élèves. Parmi eux, 62 présentaient un handicap chronique à la marche, soit une prévalence de 14,30‰. Les principales causes de handicap chronique à la marche étaient représentées par les déviations axiales des membres inférieurs (37,30%), suivies de l'ostéonécrose aseptique de la tête fémorale (30,65%) et de la paralysie iatrogène du nerf sciatique (11,30%). La boiterie occupe le premier rang des symptômes avec 77,42% des cas. En moyenne, 3,23% (n = 2) des cas utilisaient une aide technique de marche.Conclusion : Le handicap chronique à la marche occupe une place modeste dans la pathologie infantile au Burkina Faso. Il prend cependant toute son importance à travers son potentiel incapacitant qui peut être source d'exclusion scolaire

[Positive impact on the Expanded Program on Immunization when sending call-back SMS through a Computerized Immunization Register, Bobo Dioulasso (Burkina Faso)]. / Impact positif sur le Programme élargi de vaccinations de l'envoi de SMS de rappel à partir d'un registre informatisé, Bobo-Dioulasso (Burkina Faso).

The impact of a Computerized Immunization Register (CIR) on Expanded Program on Immunization (EPI), with sending SMS to parents before immunization sessions, has never been studied in sub-Saharan Africa. The objective of this study is to measure EPI quickness and completeness of vaccinations after sending call-back SMS to parents through CIR put in place in a health center. In a health center, chosen at random (Colma 1) in the city of Bobo Dioulasso, Burkina Faso, West Africa, mothers, at first EPI session, if they had a mobile phone available at hand or in her surrounding, were randomized for receiving, or not, a call-back SMS before following EPI sessions, after child registration on a Francophone CIR (Siloxane's Intervax ©). Mothers, which were sent SMS and did not correctly followed sessions were asked through mobile phone why their child was late for EPI. 523 newborns were included in the study, with 253 whose parents were sent SMS, and 268 being informed of sessions only by ordinary methods. At second EPI session at 2 months of age, there was a statistical significant increase of coverage for children whose parents received SMS (p<0.001). Quickness to come also to this session was significantly shorter when parents received SMS (p=0.03). At third EPI session at 3 months of age, attendance to EPI for children whose parents were sent SMS was significantly better (p<0.001). Quickness to come to this session was shorter for children with SMS (p=0.02). At fourth EPI session at 4 months of age, attendance for children with SMS was significantly better for children whose parents were sent SMS (p<0.001). Quickness to come to this session was better but not significantly different (p=0.49). Out of 101 children registered as late for EPI sessions in Colma 1 CIR, even with call-back SMS, 19 (19%) parents could not be reached on the telephone. 31/82 (38%) mothers had shifted for EPI to a more proximate vaccination center (Colma 2), and 5 (6%) to private or civil servants clinic. 14/82 (17%) mothers had been travelling far from health center. Ten (12%) admitted neglect of EPI sessions. Two (2%) children had deceased, and one mother did not come back to Colma 1 after her child's AEFI. One child has been dismissed two times of vaccination following recommendation not to open a measles multi-dose vial for a single child, and did not come back. Of 523 children registered in CIR, 77 (14.7%) could not be found in the paper registers of Colma 1. Quickness and completeness for EPI is increased by sending SMS with help of CIR. An official number should be given for each child registered in CIR, consulted by health staff admitting children in urgency, allowing EPI vaccinations completion. With CIR safeguards, CIR should replace paper registers and should be used to send EPI reports by internet at central levels, helping MOH coverage determination and MAPI surveillance. The fall of coverage due to restriction policy not to open a multidose vial for a single child is low. Health staff should institute telephone call-back for badly immunized children registered on CIR and incorporate in it, with SMS call-back, pregnant women, to better complete prenatal sessions and tetanus vaccination.

[Management of suspected cases of malaria before admission to a district hospital in Burkina Faso]. / Chemin de soin des cas présomptifs de paludisme admis dans un hôpital de district au Burkina Faso.

After widespread use and misuse of antimalarial drugs led to the emergence of resistance, new guidelines for malaria treatment with artemisinine-based combination therapy (ACT) were introduced in Burkina Faso in 2005. To describe the management (drug therapy and other practices) of patients with suspected malaria before their admission to the district hospital of Dô, seven years later. This cross-sectional study was conducted during admission to the district hospital, during the low season for malaria, from December 2010 to May 2011. It included all patients aged 6 months or older diagnosed with suspected malaria according to the criteria of the national malaria control program, excluding those with severe comorbidities. The study included 476 suspected cases, 422 (88.7%) uncomplicated and 54 (11.3%) complicated. They accounted for 7.9% of all admissions. Their mean age was 14.4 years, and 35.3% (n = 168) were younger than 5 years. Only 23 (4.8%) had first consulted in a primary health care facility; 346 (72.7%) had used initial self-medication (or, more precisely in some cases, parental administration of medication without medical consultation). Overall, 435 (91.4%) came directly to the district hospital, 331 (76.1%) of them after self-medication; 10 (2.1%) had first consulted a traditional healer. The practice of self-medication did not differ according to age, gender, or complications (p>0.05). The drugs used for self-medication were mainly antipyretics (94.5%) and antimalarials (16.8%); the latter included ACT (39.6%), quinine (19.0%), and non-recommended antimalarial agents (41.4%). During the malaria low season, the treatment itinerary of suspected malaria cases is marked by equal use of ACT and non-recommended antimalarials for self-medication and minimal use of the primary level of care. A study underway of this management and these itineraries during the epidemic season may provide more data about use of ACT, the last armament against malaria in drug-resistant areas such as Burkina Faso.

[Intestinal parasites in prisoners in Ouagadougou (Burkina Faso)]. / Prévalence du parasitisme intestinal en milieu carcéral à Ouagadougou (Burkina Faso).

OBJECTIVES: to analyze the epidemiologic and clinical aspects of intestinal parasitosis in prisoners at the prison in Ouagadougou (MACO). MATERIALS AND METHODS: cross-sectional study from November 2009 to January 2010, including a survey to determine the risk factors and clinical signs of intestinal parasitosis. It also included laboratory examination of feces samples from 403 prisoners, by direct analysis, the Willis and Ritchie methods, and a scotch test for oxyuris (Enterobios vermicularis). RESULTS: The global prevalence of intestinal parasitosis was 71.5%. There was a link between parasitism and the prison section. Amebae were the most frequent parasites (66.7%), with high prevalence of Entamœba coli (55.6%). They were followed by flagellata (16.6%), mainly Trichomonas intestinalis (9.2%). Helminths were less frequent (7.4%). Most subjects with parasites were symptomatic (diarrhea or constipation) (p = 10(-4)). CONCLUSION: our results highlight the need to improve sanitation at the prison and provide hygiene education for the prison population.

Street-level workers' criteria for identifying indigents to be exempted from user fees in Burkina Faso.

OBJECTIVES: Universal healthcare coverage cannot be achieved in Africa as long as the indigent, the poorest, are unable to access healthcare systems. This study was carried out in Burkina Faso to obtain street-level workers' perspectives on what criteria should be used to select indigents to be exempted from user fees. METHODS: Two group consensus techniques were used (Delphi and Concept Mapping). The participants were nurses (CM; n = 24), midwives (CM; n = 23) from a rural district and Social Action agents (CM; n = 31) and healthcare workers (Delphi n = 23) in training at two national schools. RESULTS: Altogether, 446 criteria were proposed. The nurses put forward criteria related to being ill without support and being a victim of society. The midwives focused more on the disabled poor and those who were ill and unsupported. The healthcare workers in training mentioned disabled persons and the elderly with no family support. The Social Action agents spoke about vulnerability related to illness or disability and the fact of being excluded or being a disaster victim. CONCLUSIONS: These criteria proposed by street-level workers add to other studies conducted in Burkina Faso and should help the State to improve indigents' access to care.

[Meningitis epidemic: assessment of surveillance and treatment of cases in the health centers of a Burkina Faso district]. / Épidémie de méningite: évaluation de la surveillance et du traitement des cas dans les formations sanitaires d'un district du Burkina Faso.

Meningococcal meningitis remains a periodical threat in the African meningitis belt. The countries concerned, such as Burkina Faso, provided guidelines for its surveillance, diagnosis, treatment, and prevention during outbreaks. The objective of this study is to assess the quality of the surveillance system and case management during an outbreak in Fada N'Gourma district. A retrospective study of the meningitis outbreak in 2007 was conducted by literature review and interviews of health caretakers across 27 health centers (CSPS) and three units in the regional hospital in the district.We reported all data available about surveillance and case management, and then we compared it with the guidelines of the Ministry of Health. The case definition and notification forms were available in all centers and units. During the outbreak, 861 cases were recorded, but only 89% was notified at the upper level and 87% of notification forms were available. The age is marked on all the forms, while the interval between the onset of symptoms and consultation is noted only in 90.7%. The forms were distributed weekly at the district level. Cerebrospinal fluid (CSF) Gram coloration was performed for a limited number of cases (150/349 samples, 42.9%); it showed Gram-negative diplococcus in 86%. Culture was performed for a limited number of patients (7 cases). According to the results of a central level laboratory study, the outbreak was due to Group A Neisseria meningitidis. The case management guidelines were available in all the centers and units which were supervised during the outbreak. Anti-biotherapy was appropriate in 93.6% of the cases. A shortage of antibiotics (free prepositioning) was observed in 7 centers (23.3%). The mortality rate was 3.5%. This assessment shows an under-notification of cases, despite the existence of a surveillance system and supervision, a weak laboratory contribution in germ identification, appropriate case management, and shortage of antibiotics during the outbreak. Management of a meningitis outbreak may become more efficient by improving the notification, the laboratory's capabilities, and the availability of drugs.

Detecting depression after pregnancy: the validity of the K10 and K6 in Burkina Faso.

OBJECTIVE: The K10 and K6 are short rating scales designed to detect individuals at risk for depressive disorder, with or without anxiety. Despite being widely used, they have not yet been validated for detecting postnatal depression. We describe the validity of these scales for the detection of postnatal depression in Burkina Faso. METHOD: The English language version of the K10 questionnaire was translated into West African French and local languages for use in Burkina Faso. Scores for 61 women were compared with the diagnostic interview made by a local psychiatrist within 3 days of administering the K10. RESULTS: Clinical assessment found that 27 (44%) women were probable cases of depression. Internal consistency of K10 and K6 scores, defined by Cronbach's alpha coefficient, was 0.87 and 0.78, respectively, indicating satisfactory reliability. The performance of the scores was not significantly different, with areas under the curve of 0.77 and 0.75 for the K10 and K6, respectively. To estimate prevalence of depression, we suggest cut-offs of > or =14 for the K10 and between > or =9 and > or =11 for the K6 for identifying women at high risk of depression. At > or =14, the K10 has 59% sensitivity, 91% specificity; at > or =10, the K6 has 59% sensitivity and 85% specificity. CONCLUSION: This study suggests that K10 and K6 are reasonably valid measures of depression among postpartum women in Burkina Faso and can be used as relatively cheap tools for estimating prevalence of postnatal depression in developing countries.

Missing maternal deaths: lessons from Souro Sanou University Hospital in Bobo-Dioulasso, Burkina Faso.

We investigated the location of maternal deaths in the Souro Sanou University Hospital of Bobo-Dioulasso, Burkina Faso. In all, the deaths of 585 women of reproductive age (12-49 years) were reviewed, and 132 (22.6%) were found to be maternal. Of these132, 43 (33.6%) occurred outside of the maternity unit. Some direct causes of death (eclampsia and sepsis) and indirect causes of death (cardiac illness and HIV/AIDS) would be omitted if only cases occurring on the maternity ward are investigated. Alarmingly, 93 (70%) of the 132 maternal deaths would have been missed in this hospital if we had used a narrow search process (excluding non-maternity wards) and narrow definition (excluding indirect causes). In conclusion, the results of this study demonstrate the potential for seriously underestimating the magnitude of maternal mortality within facilities and for neglecting pregnant or recently pregnant women dying in non-maternity wards and from indirect complications.

[Retrospective study of urogenital fistula in Burkina Faso from 2001 to 2003]. / Bilan rétrospectif des fistules urogénitales obstétricales de 2001 a 2003 au Burkina Faso.

The purpose of this study was to analyze aspects of obstetric urogenital fistulae to provide a foundation for implementation of a national control program in Burkina Faso. A cross-sectional study with quantitative and qualitative components was carried out in 47 hospitals in January 2004. The quantitative component consisted of analyzing available data for 2001, 2002 and 2003. The qualitative component consisted of interviewing women with fistulae to evaluate the impact of the disease on the quality of life and persons in charge of the health reference centers to identify the difficulties and needs of the facility. In the 3-year study period, 1,500,000 deliveries were attended and 347 fistulae were identified in the health reference centers. The incidence rate of obstetric fistulae was 23.1 per 100 000 deliveries (CI 95% 20.8-25.7). Women with fistulae were young and usually without paid employment. Many had a history of dystocia during the labor. Most fistulae were recent, small or average in size and located at the level of the vesico-vaginal septum. The failure rate of surgical treatment was about 17.5%. Four of the 12 women interviewed reported social alienation and ostrasization. Only 4 of the 47 hospitals studied had a personnel qualified to manage women with urogenital fistula on a daily basis. One NGO assisted women in obtaining care. Proposals for improvement of the situation were considered at a national validation workshop. These findings support the need to implement a national program that should be evaluated to see lessons learned from this study.

Bilan retrospectif des fistules urogenitales obstetricales de 2001 a 2003 au Burkina Faso

Pour analyser les fistules urogenitales au Burkina Faso en vue de la mise en place d'un programme national; une etude transversale a visee quantitative et qualitative en janvier 2004 a ete realisee dans les formations sanitaires de reference. L'etude quantitative a analyse les donnees disponibles sur les annees 2001; 2002 et 2003. L'etude qualitative a permis d'interviewer des femmes vivant avec la fistule et les responsables des services de sante. Au cours des 3 ans sur environ 1 500 000 accouchements attendus dans le pays; 347 cas de fistules ont ete identifies soit un taux d'incidence de 23;1 pour 100 000 accouchements (IC a 9520;8 - 25;7). Les femmes avec fistules etaient jeunes et surtout sans emploi remunere avec des antecedents de dystocie a l'accouchement. Les fistules etaient le plus souvent recentes; de tailles petites ou moyennes et localisees au niveau de la cloison vesico-vaginale. Les resultats de la chirurgie etaientmarques par un taux d'echec de l'ordre de 17;5. Quatre femmes sur 12 interviewees ont declare avoir ete abandonnees par le conjoint. Sur 47 hopitaux visites; seulement 4 avaient un personnel qualifie pour la realisa- tion de la prise en charge quotidienne des fistules. Une organisation non gouvernementale aidait les patientes pour l'obtention de soins. Un atelier national de validation a permis de faire des propositions pour l'amelioration de la situation. Les resultats montrent la necessite de la mise en place d'un programme national qui devrait etre evalue pour voir les acquis obtenus apres cette etude

Describing safe motherhood programs for priority setting: the case of Burkina Faso.

OBJECTIVE: This study was implemented to describe safe motherhood programs in Burkina Faso for planning and programming purposes. METHODS: Twenty safe motherhood programs were described from November 2003 through May 2004 using a structured questionnaire, interviews with safe motherhood program managers and document reviews. RESULTS: Only 2 of the 20 programs were designed to improve the availability of comprehensive emergency obstetric care, and only 2 comprehensively addressed all components of skilled attendance at delivery. Other gaps identified included poor availability of baseline data, few monitoring measures, and lack of planning for evaluation needs. National geographical coverage was also uneven. CONCLUSION: A systematic overview of safe motherhood programs in a country can help to set priorities and aid in decision making for the allocation of resources towards contextually relevant strategies to curtail maternal mortality and severe morbidity. Planning for program design and evaluation may also be aided by such a process.

Etude de l'insuffisance érectile dans une population d'hommes jeunes et sexuellement actifs au Burkina Faso

Objectif: Notre tude avait pour objectif de dterminer la prvalence de l'insuffisance rectile (IE) dans notre environnement et d'valuer les connaissances et les attitudes des sujets qui en souffrent. Mthodologie: Il s'agissait d'une enqute transversale sur six mois concernant des sujets gs de 18 ans et plus du monde de travail, ralise au cours d'une visite annuelle des travailleurs des entreprises de la place et de quelques fonctionnaires. Les sujets ayant accept de participer l'enqute (855 hommes), avaient remplir deux questionnaires: la version 5 items de l'International Iindex of Erectile Function (IIEF5), qui value la fonction rectile et, un questionnaire labor par nous mme, dans le but d'valuer les connaissances et les attitudes des enquts, vis vis de l'IE. Les questionnaires ont ensuite t dpouills et analyss sur micro ordinateur l'aide du logiciel Epi info. Rsultats: Les 855 sujets qui ont particip l'enqute reprsentaient 80% de tous ceux qui ont t sollicits. L'ge moyen des enquts tait de 37,4 ± 9,1; plus des 2/3 (78%) taient maris et monogames dans 69%. La prvalence globale note tait de 47% et on a remarqu que celle-ci augmentait avec l'ge. Trois facteurs de risque ont t mis en exergue: l'ge, l'hypertension artrielle (HTA) et la maladie hmorrodaire. Si l'ge et l'HTA sont des facteurs de risque classiques, la maladie hmorrodaire l'est moins; par contre il a t beaucoup invoqu par de nombreux enquts. 93,2% des sujets interrogs seraient prts consulter pour IE, alors que seulement 3,8% l'avaient effectivement dj fait. Conclusion: L'insuffisance rectile s'est rvl comme un problme rel vcu dans notre environnement. Cependant nos rsultats ne peuvent pas tre gnraliss et nous envisageons d'autres tudes, en population gnrale, qui nous permettraient de tirer des enseignements et de mieux organiser la prise en charge de ces patients

Review of STI and HIV epidemiological data from 1990 to 2001 in urban Burkina Faso: implications for STI and HIV control.

OBJECTIVES: To better understand the sexually transmitted infection (STI)/HIV dynamics in an urban west African setting in order to adapt STI/HIV control efforts accordingly. METHODS: Review of STI and HIV epidemiological studies performed over the past decade in Bobo-Dioulasso, the second city of Burkina Faso. Trends in STI prevalence among commercial sex workers and the general population were assessed over time through studies that used the same recruitment and laboratory diagnostic procedures. Variations in aetiologies of vaginal discharge, urethral discharge, and genital ulcers were also evaluated among patients consulting for genital infection complaints. Antenatal clinic based surveys provided data to assess HIV trend among the general population. RESULTS: We observed an important decline of classic bacterial STI such as syphilis, Neisseria gonorrhoea, Chlamydia trachomatis, and Haemophilus ducrey infections in all study groups. Trichomoniasis also declined but to a lesser extent. HIV infection followed the same trend at the same time, with a significant decline in the 15-19 year age group of pregnant women, suggesting a possible decrease of HIV incidence. Although no evidence of a causal relation can be drawn from this review, adoption of safer sex behaviour, introduction of the syndromic management (SM) approach, or higher antibiotic use may have contributed to these changes. CONCLUSIONS: Classic bacterial STI declined over the past decade in parallel with a stabilisation of HIV infection. Variations in syndromes aetiology and sexual behaviours should be monitored as part of STI surveillance in order to improve STI syndromic management algorithms and to adapt HIV/STI prevention efforts.

[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.

Sexual and reproductive life of women informed of their HIV seropositivity: a prospective cohort study in Burkina Faso.

BACKGROUND: In the context of the DITRAME-ANRS 049 research program that evaluated interventions aimed at reducing mother-to-child transmission of HIV (MTCT) in Bobo-Dioulasso (Burkina Faso), Voluntary HIV counseling and testing (VCT) services were established for pregnant women. HIV-infected women were advised to disclose their HIV serostatus to their male partners who were also offered VCT, to use condoms to reduce sexual transmission, and to choose an effective contraception method to avoid unwanted pregnancies. This study aimed at assessing how HIV test results were shared with male sexual partners, the level of use of modern contraceptive methods, and the pregnancy incidence among these women informed of the risks surrounding sexual and reproductive health during HIV infection. METHODS: From 1995 to 1999, a quarterly prospective follow-up of a cohort of HIV-positive women. RESULTS: Overall, 306 HIV-positive women were monitored over an average period of 13.5 months following childbirth, accounting for a total of 389 person-years. The mean age at enrollment in the cohort was 25.1 (standard deviation, 5.2 years). In all, 18% of women informed their partners, 8% used condoms at each instance of sexual intercourse to avoid HIV transmission, and 39% started using hormonal contraception. A total of 48 pregnancies occurred after HIV infection was diagnosed, an incidence of 12.3 pregnancies per 100 person-years. Pregnancy incidence was 4 per 100 person-years in the first year of monitoring and this rose significantly to 18 per 100 person-years in the third year. The only predictor of the occurrence of a pregnancy after HIV diagnosis was the poor outcome of the previous pregnancy (stillbirth, infant death). Severe immunodeficiency and change in marital status were the only factors that prevented the occurrence of a pregnancy after HIV diagnosis. CONCLUSION: Our study shows a poor rate of HIV test sharing and a poor use of contraceptive methods despite regular advice and counseling. Pregnancy incidence remained comparable with the pregnancy rate in the general population. To improve this situation, approaches for involving husbands or partners in VCT and prevention of MTCT interventions should be developed, evaluated, and implemented.

[Impaired fertility in women infected with HIV-1. Implications for sentinel serosurveillance]. / Réduction de la fertilité chez les femmes infectées par le VIH-1. Implications pour la sérosurveillance sentinelle.

BACKGROUND: Given the relationship between HIV infection and fertility, antenatal clinic-based HIV prevalence may not provide a good estimate of the community HIV prevalence. The objective of this work was to evaluate the impact of HIV infection on fertility among women attending antenatal clinics in Bobo-Dioulasso (Burkina Faso), and to discuss possible implications on HIV sentinel surveillance. METHODS: In the context of a phase II/III clinical trial of a short course of Zidovudine during pregnancy (DITRAME - ANRS 049 trial) we consecutively proposed voluntary counselling and HIV testing (VCT) to 1349 women aged at least 18 years, carrying a pregnancy of 7 months or less and living in Bobo-Dioulasso. During pre-test counselling session, a standardised questionnaire was administered to collect detailed information regarding socio-demographic characteristics and obstetrical history. Blood samples were then taken and tested for HIV after written informed consent. RESULTS: Mean age (+/- standard deviation) at first sexual intercourse was similar among HIV-infected (HIV+) (16.7+/- 2; n=83) and HIV-negative (HIV-) women (16.9+/- 2; n=1336). However, HIV+ women aged 25 years and above had, on the average fewer pregnancies (3.8+/- 1.5; n=37) than HIV- women (5.0+/- 2.3; n=567), p<0.01. Similarly, these HIV+ women had, on average, less live births (2.8+/- 1.3; n=35) than HIV- ones (3.7+/- 2.1; n=555), p=0.02. Other sexual and obstetrical characteristics such as maternal age, proportion of primigravidae, stillbirths or spontaneous abortions were comparable between HIV+ and HIV- women. CONCLUSIONS: Our data suggest that the level of fertility of HIV+ women aged 25 years and above is significantly lower than for HIV- women. Therefore, HIV+ women in this age group are likely to be under-represented among antenatal clinic attendees. These findings suggest adjusting antenatal clinic-based HIV sentinel surveillance data for age and fertility in order to derive a good estimate of the community HIV prevalence.