[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.

[Antibiotic susceptibility of bacteria isolated from diabetic foot infections and prospects for empiric antibiotic therapy in Ouagadougou (Burkina Faso)]. / Étude de la sensibilité aux antibiotiques des bactéries isolées lors de l'infection du pied diabétique et perspectives d'antibiothérapie à Ouagadougou (Burkina Faso).

INTRODUCTION: The aim of this study was to study the antibiotic susceptibility of bacteria isolated from diabetic foot infections to help improve empiric antibiotic prescription in Ouagadougou, where bacteriological testing is rarely possible. METHOD: This cross-sectional study took place from July 1, 2011, to June 30, 2012, in the departments of internal medicine and general and gastrointestinal surgery in the Yalgado Ouédraogo teaching hospital. Bacteria were isolated from diabetic foot infections and their antibiotic sensitivity was tested by the qualitative method (Kirby-Bauer). RESULTS: The study included 64 patients, with a median age of 57 years (interquartile range: 48-75) and a M/F sex ratio of 1.37. Among them, 39 had received antibiotics before hospitalization. Among the 71 samples, 62 cultures (87%) were positive: 53 for a single microbe (85%) and 9 for two microbes (15%). Microorganisms were mainly aerobic and anaerobic Gram-positive cocci (76%), including Staphylococcus aureus (SA) (33%) and Streptococcus spp (18%). These Gram-positive cocci were highly sensitive to amoxicillin-clavulanic acid and oxacillin. No methicillin-resistant SA (MRSA) were isolated. Enterobacteriaceae (24 %) were highly susceptible to imipenem and ticarcillin, but not to ceftriaxone or ciprofloxacin. No extended-spectrum beta-lactamase Enterobacteriaceae (ESBL) were isolated. Pseudomonas aeruginosa was highly susceptible to ciprofloxacin and imipenem. CONCLUSION: Despite our study's limitations, our findings show that most diabetic foot infections can be successfully treated with standard antibiotics.

[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.

[Blood exposure accidents: Knowledge, attitudes and practices of nursing and midwifery students at the Bobo-Dioulasso teaching hospital (Burkina Faso)]. / Connaissances, attitudes et pratiques des élèves des formations paramédicales face aux accidents d'exposition au sang au CHU Sanou-Sourô de Bobo-Dioulasso (Burkina Faso).

Blood exposure accidents are the source of major risks of contamination of healthcare personnel. The objective of this study was to describe the knowledge of standard precautions, and the attitudes and practices of nursing and midwifery students in relation to this accidental exposure. This cross-sectional survey, conducted in November 2011, was based on voluntary anonymous questionnaires completed by students working in the medical ward of the Bobo-Dioulasso teaching hospital. Of the 275 students asked to participate, 219 (92.8%) completed the questionnaire: 138 (63,0%) were student nurses and 81 (37.0%) student midwives. Their mean age was 27.9 ± 5 years. Among them, 64 (29.1%) acknowledged accidental exposure to blood during treatment performed as part of their hospital work. Only 30 of these 64 cases were reported at the time. The standard precautions for the prevention of these accidents were known to 131 students (59.8%); 58.4% always wore gloves for invasive procedures; 74.9% reported that the syringe container was "always" or "often" used. The needles used were "always" or "often" recapped before disposal in only 39.1% of cases. Only 11.0% were fully vaccinated against hepatitis B. Blood exposure accidents were not uncommon among these students and their knowledge of the standard precautions and actions to take in case of an accident is insufficient. These data show the need for further training and awareness campaigns to improve these hospital practices.

[Impact of a conjugated anti meningococcal A vaccine on notification of bacterial meningitis in West Burkina Faso (2009-2012)]. / Impact d'un vaccin conjugué antiméningococcique « A ¼ sur les méningites bactériennes notifiées à l'ouest du Burkina Faso (2009-2012).

Burkina Faso is a sub-saharan African country completely included in the meningococcal meningitis belt. The western part of the country suffered from many meningococcal A epidemics, in spite of reactive collective campaigns with polysaccharide A vaccine. On 6th December 2010, Burkina Faso was the first African country to conduct a collective vaccination campaign of all the 1-29 years old population with a new conjugated meningococcal Avaccine (MenAfriVac™). Before this campaign, in Western Burkina (4,064,928 inhabitants, 27.5% of total population), a rehearsal of the staff of all peripheral medical laboratories has been conducted, with delivery of laboratory equipment, reactants, and possibility to transfer CSF specimens at the central level to confirm bacteriologic species in cause by latex, culture and PCR analysis. For this campaign, an administrative coverage of 100.3% was reached. A nearly complete disappearance of meningitis due to meningococcus A was recorded, but an increase of cases due to meningococcus X, W135. With the increase of quality of surveillance, and MenAfriVac™ vaccination showed its beneficial effect on meningococcus A meningitis. If we want however to impact on the number of recorded acute bacteriological meningitis, we will have to use multi-antigenic, if possible conjugated, meningococcal vaccines against locally circulating meningococcal species, the number of pneumococcal meningitis being contained by the recent inclusion in EPI of a 13-valent conjugated pneumococcal vaccine.

[Acute bacterial meningitis with soluble antigen detected by latex particle agglutination tests at the Sourô-Sanou University Hospital of Bobo-Dioulasso (Burkina Faso)]. / Méningites bactériennes aiguës à recherche d'antigène soluble positive au CHU de Sourô-Sanou de Bobo-Dioulasso (Burkina Faso)

INTRODUCTION: Acute bacterial meningitis constitutes a major public health problem in Burkina Faso, in part because of its high lethality rate, estimated in 2004 at 17.5%. Failure to confirm suspected cases of meningitis results in overestimating reported cases and incorrectly treating false positives. The latex particle agglutination test is a diagnostic alternative that overcomes these limitations. OBJECTIVE: Determine the bacteriological and therapeutic profile as well as the course of cases of acute meningitis confirmed by the latex agglutination test at Sourô-Sanou University Hospital. METHODS: This prospective longitudinal study took place over a one-year period (2008 to 2009). Data were collected from clinical and laboratory records. The diagnosis of meningitis was confirmed by testing for specific soluble antigens in the spinal fluid. We used the Pastorex(™) Meningitis Kit for that purpose. The threshold of significance selected for our study was 0.05. RESULTS: In all, 457 samples of spinal fluid from patients with suspected acute bacterial meningitis were analyzed and the latex test was performed in 438 of these samples: 154 (35.2%) were positive. The average age of our cases confirmed by the latex test was 13.2 ± 4.2 years old. This test confirmed more cases than any other method of identification. The therapeutic strategy used from one to four treatment agents. Streptococcus pneumoniae was the most virulent and the most lethal pathogen, with a 64.7% lethality rate. CONCLUSION: The earliness of the consultation and the treatment of the bacterial meningitis seem to have a positive effect on the course of disease.

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

Snakebite in Bobo-Dioulasso, Burkina Faso: illustration of realities and challenges for care based on a clinical case

We report herein the case of 19-year-old female farmer who suffered a double snakebite on the right foot. After an unsuccessful traditional treatment, she consulted a health center, 48 hours after the bite. Upon arrival at the hospital, she showed signs of severe damage, including hemorrhagic syndrome, extensive gangrene of the bitten limb and severe acute renal failure. Due to financial constraints, neither antivenom nor the scheduled amputation was performed. After 35 days of hospitalization, she returned home, against the advice of medical personnel. Our case summarizes the daily challenges of patients and practitioners that suffer snakebite envenomation in Bobo-Dioulasso, western Burkina Faso.(AU)

[Case management and diagnosis of severe malaria in adults and the application of national guidelines in Burkina Faso]. / Diagnostic et prise en charge du paludisme grave chez l'adulte : observance des directives nationales au Burkina Faso.

UNLABELLED: The purpose of this study was to assess the application of national guidelines on the diagnosis and treatment of severe malaria in adults in Burkina Faso. We conducted a retrospective study of medical records of the patients admitted for severe malaria in the emergency service of the regional hospital of Fada N'Gourma in the east of Burkina Faso in the year 2008; 165 records were chosen by simple random sampling. We reported all the severe clinical and biological signs of malaria and its treatment. We compared them with the criteria of severe malaria diagnosis and its treatment according to the national guidelines. The mean age of patients was 38 ± 16.2 and male to female ratio was 0.96. The most frequent period of admissions was between July and October. Fever or recent past of fever was reported in 142 cases (86.1%). According to the two criteria for severe malaria (means existing of at least one of the severe signs associated and positive parasitemia with Falciparum plasmodium), we noted that only 74 cases had at least one of the severe signs (44.8%) which were: anemia (51.3%), cardiovascular collapse (7.9%), jaundice (7.3%), dyspnea (6.7%), impairment of consciousness (5.5%), prostration (5.5%), renal failure (4.8%), hypoglycemia (2.4%), hemorrhage (1.8%) and seizures (1.2%). The biological signs were not systematically searched. Parasitological exam was conducted in 91 cases (55.1%). Only 18 were positive (19.8%). In total, only 18 cases (10.9%) met the guidelines' criteria of severe malaria. The other cases were over-diagnosed; note that the investigation was not complete for 74 of these cases (50.3%). Among the 165 cases, the treatment was appropriate in 146 (88.5%) and 19 cases (11.5%) didn't receive treatment for malaria. CONCLUSION: So much we observed an over diagnosis of severe malaria in adults that we can suggest an under diagnosis of the disease due to the lack of biological investigations.

[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.

[Acute bacterial meningitis: the role of molecular biology in the epidemiological surveillance and epidemic alert in Burkina Faso]. / Meningites Bacteriennes Aiguës : Interet De La Biologie Moleculaire Dans La Surveillance Epidemiologique Et D'Alerte Aux Epidemies Au Burkina Faso.

In Burkina Faso, monitoring of acute meningitis epidemics is difficult to be implemented by routine bacteriology. The Polymerase Chain Reaction (PCR) that freed us from some constraints should allow better documentation of acute bacterial meningitis epidemics [7]. It was about a transverse study with descriptive aim along one year. The recruitment of cases was exhaustive and sample was representative of population at risk. Among the suspected ABM, 87 cases were confirmed by all biological diagnosis methods. Among these 87 confirmed cases, 82.7% were PCR positive. The culture was performed in 82 cases and 54.5% were positive. A statistical difference was observed. The sex ratio was 1.4:1, the average age of patients was 11± 4, 6 years [0-59], 26.4% of cases were observed on less than one year. Meningococcal meningitis ranked first with a rate of 46%. The peak incidence was observed during week 13-2003 or 15, 3%. The weeks pre and per epidemic (week11-week 13) PCR had the highest rate of confirmation for Neisseria meningitidis 78, 8%. The W135 was the most represented or 91%. PCR is thus an excellent alert tool for acute meningitis epidemics.

[Surveillance system for adverse events following immunization against yellow fever in Burkina Faso in 2008. Good practice recommendations]. / Dispositif de surveillance des effets indésirables graves lors de la campagne de vaccination preventive contre la fièvre jaune au Burkina Faso en 2008. Recommandations de bonnes pratiques.

Yellow fever (YF) remains a public health problem in Africa. In 2007 and 2008, Togo, Senegal, Mali and Burkina Faso became the first countries to implement mass YF immunization campaigns within the framework of the Yellow Fever Initiative. The goal of this initiative led by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) with the support of The Global Alliance for Vaccines and Immunization (GAVI) is to organize mass YF immunization campaigns in 12 African countries at high risk forYF transmission between 2006 and 2013. A total of 290 million USD have been allocated for vaccination of 180 million people with the highly effective attenuated 17DYF vaccine. Working in partnership with the WHO, the 12 member states are to identify and target high risk areas with the dual aim of preventing epidemics and increasing immunization coverage. Surveillance of adverse events following immunization (AEFI) is a mandatory component for organization of these campaigns. Purpose. The purpose of this article is to describe the AEFI surveillance system implemented in Burkina Faso in 2008. Methods. The strategy used in Burkina Faso was based on a combination of regular passive surveillance and active surveillance. General guidelines and related operational processes were established including reporting forms, investigation forms, and procedures for collection, storage and transport of biological specimens. Classification of cases was based on clearly defined criteria. Any patient meeting the defined criteria and requiring hospitalization was considered as a serious case. In addition to case definition criteria, serious cases were tracked according to presented signs and symptoms using a line-listing form at two university hospital centers in Ouagadougou and one regional hospital center. Emergency room admission records and patient charts were examined during the surveillance period (30 days after the end of the immunization campaign) and on-duty hospital staff were interviewed. The Ministry of Health appointed an 11-member National Expert Committee (NEC) to investigate and judge the status of reported cases. After eliminating coincidental events, program errors, and undetermined cases, vaccination was established as the suspected cause. Suspected cases were classified as viserotrophic or neurotrophic AEFI and recorded as probable cases pending confirmation by virologic studies. An AEFI center with a duly mandated coordinator was designated to coordinate the activities of the different teams involved and to serve as an interface for the expert committee. Detection and investigation teams were formed at each of the hospital locations. A national laboratory as well as an international virology laboratory were designated as reference centers for performance of further testing. Results. Between November 28, 2008, and December 9, 2008, a total 7,566,218 people (aged 9 months and older) excluding pregnant women, critically ill patients, and individuals allergic to eggs, were immunized in 37 of the 63 districts in Burkina Faso. Administrative vaccination coverage was 102.3%. Systematic line-listing at the 3 hospital centers accounted for most of the suspected serious AEFIs identified from reported cases. During the AEFI surveillance period, the NEC met once a week to discuss the suspected serious AEFI. Some cases were excluded and others were designated for further testing. At least one biological specimen was available for all retained cases. Each case benefited from laboratory testing to achieve differential clinical diagnosis as well as from virological testing (results pending). Conclusion. Experiences in Burkina Faso demonstrates the value of active surveillance and of systematic line listing. However, the duration of case investigation and data management was at least six months. To improve AEFI surveillance in future campaigns, several measures can be recommended. Planning should begin well in advance with appropriate funding. Training should be given to raise awareness at all levels of the health system. Mechanisms should be developed for systematic and timely collection and processing of biological samples and data at national level.

[Toxic epidermal necrolysis. Epidemiologic, clinic and therapeutic aspects at Cotonou University and National Teaching Hospital]. / Nécrolyse épidermique toxique. Revue des cas observés dans le service de réanimation du centre national hospitalier et universitaire de Cotonou.

INTRODUCTION: Toxic epidermal necrolysis (TEN) is usually a drug-induced disease, involving vital or functional prognosis with 20 to 30% mortality rates. OBJECTIVES: The aim was to collect cases of TEN in an intensive care unit in Cotonou National University and Teaching Hospital, and describe epidemiologic, clinical, therapeutic and evolutive patterns. STUDY DESIGN: Retrospective and descriptive study over five years. PATIENTS AND METHODS: The medical report-forms of patients admitted between January 1998 and December 2002, for toxic dermatitis with total skin injury area more than 10% were reviewed. RESULTS: Fourteen patients with TEN were identified. The average incidence was three cases per year, accounting for 0.25% of the admissions in the unit. Sulphonamides (n=4), antituberculous drugs (n=2), penicillin (n=3) were the main cause of TEN. In five patients, the cause was not found. Self-medication was found in 7 patients. Total skin injury area reached from 26 to 87%. Mucosal and viscera injury occurred in respectively 11 and 9 patients. The treatment was usual as in extended burns. Four patients died (28.5%). The average time before hospitalisation was 11.4 days. CONCLUSION: The growing-awareness of people can prevent/reduce the morbidity and improve the prognosis of TEN.