A case-control study to investigate determinants of preterm delivery and intrauterine growth retardation (IUGR) in Bobo-Dioulasso, Burkina Faso, was conducted between December 1991 and November 1992. A total of 581 cases were recruited,... more
A case-control study to investigate determinants of preterm delivery and intrauterine growth retardation (IUGR) in Bobo-Dioulasso, Burkina Faso, was conducted between December 1991 and November 1992. A total of 581 cases were recruited, 281 preterm infants with birthweight < 2500 g and 300 term infants with birthweight < 2500 g. 578 infants born at term with birthweights of 2500 g or more were recruited as controls. Logistic regression analyses identified three factors linked independently to both preterm delivery and IUGR: maternal illness during the pregnancy, nulliparity and failure to attend three antenatal consultations. In addition, primiparity and a maternal weight < 50 kg were associated with an increased risk of preterm delivery. Other factors associated with increased risk of IUGR were maternal height less than or equal to 155 cm, mid-upper arm circumference < 24 cm, and female sex of the infant. Improvements in the pre-pregnancy weight of women and in antenatal care focused on nulli- and primiparous women might in this population, reduce substantially the incidence of preterm delivery and IUGR.
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Truck drivers are a well recognized high risk population for sexually transmitted diseases. Prior to start-up of a health care program and an information/education campaign, a cross-sectional study using the unlinked, anonymous screening... more
Truck drivers are a well recognized high risk population for sexually transmitted diseases. Prior to start-up of a health care program and an information/education campaign, a cross-sectional study using the unlinked, anonymous screening method was carried out to assess seroprevalence of HIV and syphilis infections in truck drivers in Bobo Dioulasso, Burkina Faso. During the month of November 1994, 236 truck drivers were recruited at a cotton-producing factory. The prevalence of HIV infection was 18.6% and the prevalence of syphilis was 9.3%. Multivariate logistic regression analysis showed a statistically significant association between HIV infection and the following factors: age under 30 years, claimed systematic use of condoms, and previous genital ulcers. These findings suggest that truck drivers are highly exposed to the risk of contracting and disseminating HIV infection due to their high mobility and the high incidence of sexually transmitted diseases among their ranks. Prevention of HIV infection in truck drivers in Burkina Faso will require education to promote systematic use of condoms at each sexual contact as well as screening and treatment of sexually transmitted diseases at truck stops.
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Despite advances in cataract surgery, many peoples in the Sub-Saharan region are still treated by the traditional lens couching technique. The purpose of this study is to investigate the factors leading to the choice of lens couching for... more
Despite advances in cataract surgery, many peoples in the Sub-Saharan region are still treated by the traditional lens couching technique. The purpose of this study is to investigate the factors leading to the choice of lens couching for cataract treatment. A total 34 patients (40 eyes) from the northern Burkina Faso who underwent lens couching were examined and interviewed. Most patients (56%) did not understand the etiology of cataracts and attributed the disease to fate. Nor did they know of any other cataract treatment than lens couching. Only 13 patients (38.2%) would recommend modern cataract treatment and 52% suggested that health workers should come out into the villages and operate as traditional healers do. In spite of its potentially dramatic complications, lens couching is still the only method of cataract treatment known in some communities of Burkina Faso. Public information campaigns are needed to put an end to the ancestral practice of lens couching.
Research Interests: Decision Making, Humans, Burkina Faso, Female, Male, and 4 moreCataract, Aged, Middle Aged, and Rural Population
Lacquer cracks are breaks in the Bruch membrane by alteration of the elastic layer. They are often associated with pseudoxanthoma elasticum. The authors report the first case in Burkina Faso involving a 51-year-old woman who was seen for... more
Lacquer cracks are breaks in the Bruch membrane by alteration of the elastic layer. They are often associated with pseudoxanthoma elasticum. The authors report the first case in Burkina Faso involving a 51-year-old woman who was seen for visual acuity loss. She had pseudoxanthoma elasticum associated with lacquer cracks complicated by choroidal neovascularization in both eyes. She was treated with laser photocoagulation of the neovessels in the left eye, and no recurrence was reported after 6 months.
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The aims of this study were: (1) to investigate the relationship between pre-delivery hemoglobin (Hb) concentration and the outcome of the pregnancy for the mother and child and (2) to assess the extent to which the pallor of the... more
The aims of this study were: (1) to investigate the relationship between pre-delivery hemoglobin (Hb) concentration and the outcome of the pregnancy for the mother and child and (2) to assess the extent to which the pallor of the conjunctiva indicates severe anemia in pregnancy (Hb < 7 g/dl). We carried out a prospective study in 1995, in the maternity department of the National Sourô Sanou Hospital (Bobo-Dioulasso, Burkina Faso). Women arriving to give birth at the maternity unit gave verbal consent and underwent a physical examination including the assessment of conjunctiva coloration. Finger-prick blood samples were taken from all the women selected and Hb was determined with a portable hemoglobin meter (HemoCue AB, Sweden). For each woman, information about age, obstetric history, the condition of mother and child at admission and delivery and any post-delivery complications in the first 48 hours was collected before discharge from the maternity unit, 3 to 5 days after the delivery. Women with multiple pregnancies were excluded from the study and 247 women were included overall. Endometriosis was observed in only three cases. Three women died, two due to septic shock. The third woman died from hypovolemic shock. The Hb concentrations of these women were 8 g/dl, 10.2 g/dl and 2.6 g/dl respectively. The mean Hb concentration for our population was 10.1 g/dl (SD = 2.08), with 165 women (67%) having less than 11 g Hb/dl. Forty-one women (17%) had less than 9 g Hb/dl and 16 (6%) had less than 7 g Hb/dl. Severe maternal anemia and pallor of the conjunctiva were significantly associated with pre-term delivery and perinatal death, but not with low birth weight. The sensitivity of the pallor of the conjunctiva for detection of severe maternal anemia was 87%, and its specificity was 88%. We found no evidence that maternal Hb levels of 9 to 10.9 g/dl were associated with a high risk of poor pregnancy outcome for either the mother or the child, although women with such levels of Hb are classed as anemic by the World Health Organization criteria. These results show that poor pregnancy outcome is associated with severe maternal anemia. Examination of the coloration of the conjunctiva is a suitable and affordable screening method for the detection of severe anemia. Mothers with severe anemia present with signs and symptoms of anemia and could therefore be given iron treatment to improve their health. This demonstrates the importance of nutritional intervention during pregnancy.
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ABSTRACT
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To identify the epidemiological features of ocular traumas in Burkina Faso. A retrospective study was conducted in the eye department of the National Hospital of Ouagadougou, from January 1995 to 31 December 1997. All cases of eye trauma... more
To identify the epidemiological features of ocular traumas in Burkina Faso. A retrospective study was conducted in the eye department of the National Hospital of Ouagadougou, from January 1995 to 31 December 1997. All cases of eye trauma during this period were included. The study showed that ocular traumas represented 9.80% of the reasons for consultation in the unit. 73% of the patients were male. The median age was 21. School children and students were the most frequently involved 25.8%) and 58.9% of the patients came from Ouagadougou while 41.1% came from the rural areas. Public thoroughfare accidents (were the main causes of the trauma (25%). Among the traumatic agents, 26% involved vegetal materials. Ocular traumas are a major cause of blindness in Western Africa and concern mostly young people. Prevention strategies based on education and information about road safety could reduce the incidence of ocular traumatisms.
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The ideal response to HIV would be the discovery of an effective vaccine. Evaluation of the benefit/risk balance of this vaccine must include Africa, where the majority of HIV infections are observed. This study was designed to identify... more
The ideal response to HIV would be the discovery of an effective vaccine. Evaluation of the benefit/risk balance of this vaccine must include Africa, where the majority of HIV infections are observed. This study was designed to identify the perceptions and the medium-term acceptability of a potential vaccine trial in Ouagadougou (Burkina Faso). After a "literature review", data were collected from key informants, "pimps" of prostitutes, representatives of HIV and/or AIDS associations, facilitators and peer educators. Data were transcribed and analysed manually. The vast majority of respondents considered that it would be relevant to test an HIV vaccine in Ouagadougou (Burkina Faso). Almost all prostitutes would participate in such a trial and would be motivated by several factors. Potential participants were willing to play the role expected of them. A real communication strategy will be needed to conduct this trial. The results of this study are similar to those...
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Intrauterine growth retardation is a major predictor of child health in developing countries. We tested whether providing pregnant women with the UNICEF/WHO/UNU international multiple micronutrient preparation (UNIMMAP), rather than iron... more
Intrauterine growth retardation is a major predictor of child health in developing countries. We tested whether providing pregnant women with the UNICEF/WHO/UNU international multiple micronutrient preparation (UNIMMAP), rather than iron and folic acid alone, improved fetal growth and its correlates. An intention-to-treat, double-blind, randomized controlled trial including 1426 pregnancies was carried out in rural Burkina Faso. Tablet intake was directly observed. Pregnancy outcome was known in 96.3% of the participants. After adjustment for gestational age at delivery, both birth weight (52 g; 95% CI: 4, 100; P = 0.035) and birth length (3.6 mm; 95% CI: 0.8, 6.3; P = 0.012) were significantly higher in the UNIMMAP group. UNIMMAP had a differential effect by percentiles of birth weight and length distributions: the risk of large-for-gestational-age infants was higher in the UNIMMAP group (OR: 1.58; 95% CI: 1.04, 2.38; P = 0.03), although the risk of low birth weight remained unchan...
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Introduction: Community Advisory Committees (CAC) have become indicators of good community involvement in health research all over the world. CACs have been developed only recently in several Sub-Saharan African countries. Many countries... more
Introduction: Community Advisory Committees (CAC) have become indicators of good community involvement in health research all over the world. CACs have been developed only recently in several Sub-Saharan African countries. Many countries wonder about how to create and ensure good functioning of a community advisory committee. The objective of this article is to describe the creation of two CACs in Burkina Faso. Methods: This qualitative study comprised a literature review phase, a data collection phase conducted on a sample of 27 subjects (research scientists, representatives of AIDS associations or networks and the local technical and/or financial partners of these associations) and an implementation phase. Study participants were selected on a rational basis, the study complied with the ethical principles of research and data were transcribed and analysed manually. Results: Scientists and/or community workers may initiate the creation of a CAC based on the following main elements:...
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There is a scarcity of reliable data on perinatal mortality (PNM) in Sub-Saharan Africa. The PROMISE-EBF trial, during which we promoted exclusive breastfeeding, gave us the opportunity to describe the epidemiology of PNM in Banfora... more
There is a scarcity of reliable data on perinatal mortality (PNM) in Sub-Saharan Africa. The PROMISE-EBF trial, during which we promoted exclusive breastfeeding, gave us the opportunity to describe the epidemiology of PNM in Banfora Health District, South-West in Burkina Faso. To measure the perinatal mortality rate (PNMR) in the PROMISE-EBF cohort in Banfora Health District and to identify potential risk factors for perinatal death. We used data collected prospectively during the PROMISE-EBF-trial to estimate the stillbirth rate (SBR) and early neonatal mortality rate (ENMR). We used binomial regression with generalized estimating equations to identify potential risk factors for perinatal death. 895 pregnant women were enrolled for data collection in the EBF trial and followed-up to 7 days after birth. The PNMR, the SBR and the ENMR, were 79 per 1000 (95% CI: 59-99), 54 per 1000 (95% CI: 38-69) and 27 per 1000 (95% CI: 9-44), respectively. In a multivariable analysis, nulliparous w...
Research Interests: Nursing, Multivariate Analysis, Prospective studies, Pregnancy, Humans, and 15 moreBurkina Faso, Female, Male, Regression Analysis, Cohort Study, Data Collection, Risk factors, Adult, Pregnant Women, Neonatal Mortality, Risk Factors, Perinatal mortality, South West, Generalized estimating equation, and Dry Season
Background:Intrauterinegrowthretardationisamajorpredictorof child health in developing countries. Objective: We tested whether providing pregnant women with the UNICEF/WHO/UNU international multiple micronutrient prepara- tion (UNIMMAP),... more
Background:Intrauterinegrowthretardationisamajorpredictorof child health in developing countries. Objective: We tested whether providing pregnant women with the UNICEF/WHO/UNU international multiple micronutrient prepara- tion (UNIMMAP), rather than iron and folic acid alone, improved fetal growth and its correlates. Design: An intention-to-treat, double-blind, randomized controlled trial including 1426 pregnancies was carried out in rural Burkina Faso. Tablet intake was directly observed. Results: Pregnancy outcome
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Research Interests: Nutrition and Dietetics, Nutrition, Linear models, Animal Production, Micronutrients, and 15 moreFetal development, Birth Weight, Pregnancy, Humans, Burkina Faso, Female, Dietary Supplements, Nutritional Status, Intervention Studies, Adult, Food Sciences, Gestational Age, Logistic Models, Premature Birth, and Rural Population
Research Interests: Research Methodology, Evaluation, Developing Countries, Population Dynamics, Cardiovascular disease, and 15 morePlanning, Maternal Mortality, Population, Social Development, Developing Country, Burkina Faso, Measurement, Probabilistic Model Checking, Population Health Metrics, Validity, Standardisation, Public health systems and services research, Death Rate, Probabilistic Model, and Cause of death
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This paper aims to describe the design, methods and approaches used to assess the effectiveness and cost-effectiveness of the Skilled Care Initiative in reducing pregnancy-related and perinatal mortality in Ouargaye district, Burkina... more
This paper aims to describe the design, methods and approaches used to assess the effectiveness and cost-effectiveness of the Skilled Care Initiative in reducing pregnancy-related and perinatal mortality in Ouargaye district, Burkina Faso. The evaluation used a quasi-experimental design, mixed methods and a composite of tools to compare mortality and severe morbidity (near-miss) of women in reproductive age, perinatal mortality, facility functionality, perceived quality of care, utilisation of maternal health services, and costs borne by families and the health care system for maternal health care in Ouargaye and Diapaga districts. Structured questionnaires and interview guides were developed, pre-tested and piloted prior to the main survey. The evaluation was carried out from January to July 2006. A household census was used to retrospectively assess pregnancy-related and perinatal mortality over the previous 5 years, and causes of pregnancy-related death were identified using a newly developed and tested probabilistic model for interpreting verbal autopsy data. Data were directly entered into Personal Digital Assistant devices at the point of interview. Analyses included univariate and multivariate regressions and incremental cost-effectiveness ratios. A population census covering over half a million people, three qualitative surveys and facility surveys in 47 health centres have been carried out. A partnership with key stakeholders and the use of mixed methods proved feasible for evaluating complex safe motherhood strategies, and the use of hand-held computers proved possible for direct data capture, even in this remote rural environment.
Research Interests: Program Evaluation, Mixed Methods, Tropical Medicine, Health Services Research, Adolescent, and 15 moreTropical medicine (Health Sciences), Maternal Mortality, Pregnancy, Humans, Child, Burkina Faso, Female, Young Adult, Cost effectiveness, Middle Aged, Adult, Public health systems and services research, Cost Benefit Analysis, Rural Health Services, and Quality of health care
In a WHO-coordinated, mother-to-child HIV transmission (MTCT) prevention trial in Burkina Faso, HIV-1-infected mothers were advised to either stop breast-feeding by 6 mo or totally avoid it. Participants were provided with cereal-based,... more
In a WHO-coordinated, mother-to-child HIV transmission (MTCT) prevention trial in Burkina Faso, HIV-1-infected mothers were advised to either stop breast-feeding by 6 mo or totally avoid it. Participants were provided with cereal-based, infant fortified mix (IFM) from 6 to 12 mo postpartum along with infant feeding counseling. Our objective was to describe nonbreast-fed infants' food consumption and adequacy of nutrient intake. A 1-d weighed food record and one 24-h dietary recall were performed in 68 nonbreast-fed, non-HIV-infected 6- to 11-mo-old infants. Mean food energy density and feeding frequency were satisfactory in 6-8 mo olds [0.8 ± 0.2 kcal/g (3.3 ± 0.9 kJ/g) and 7.2 ± 1.6 times/d] and in 9-11 mo olds [0.9 ± 0.2 kcal/g (3.6 ± 0.8 kJ/g) and 7.7 ± 2.1 times/d]. Median energy intake was 523 kcal [range: 82-1053 (2187 kJ, range: 345-4401)] in 6-8- and 811 kcal [range: 34-1543 (3392 kJ, range: 144-6452)] in 9-11-mo-old infants, respectively. Approximately 75% of their energy intake was provided by subsidized foods (milk that mothers obtained from support networks and IFM). One-half of the infants had intakes < 80 kcal/kg (<334 kJ/kg) on the day of the survey, mainly because IFM and milk were consumed in amounts that were too low. Thus, coverage of energy needs required a diet with sufficient amounts of both IFM and milk in these vulnerable infants. These findings argue for the development of adequate, sustainable infant fortified foods and their rapid integration into MTCT prevention services. They also lend support to the recent revision of WHO infant feeding guidance for future MTCT prevention programming that recommends breast-feeding up to 12 mo postpartum (under cover of antiretroviral prophylaxis) as the safest feeding option for infants of HIV-infected mothers.
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Research Interests: Anthropology, Focus Groups, Developing Countries, Pregnancy, Humans, and 15 moreDeveloping Country, Health Services, Female, Health Care Services, Patient Compliance, Dietary Supplements, Iron, Iron supplementation, Maternal Nutrition, Adult, Ethnic Group, Large Scale, Pilot Projects, Ministry of Health, and Interviews as topic
Genitourinary infections have a major impact on public health, especially in Africa. Relative distribution of the different pathogens is unknown in Bobo-Dioulasso. To describe the etiology of genitourinary infections, to establish the... more
Genitourinary infections have a major impact on public health, especially in Africa. Relative distribution of the different pathogens is unknown in Bobo-Dioulasso. To describe the etiology of genitourinary infections, to establish the sensitivity of Neisseria gonorrhoeae to antibiotics, and to provide epidemiologic and biologic evidence to optimize the treatment of genitourinary infections. Clinical and biologic diagnoses were performed on 223 women with genitourinary infections. Etiologies found were trichomoniasis (27.8%), chlamydia (26.9%), bacterial vaginosis (19.7%), candidiasis (16.6), and N. gonorrhoeae infection (10.9%). Human immune deficiency virus antibodies were present in 42% of the patients. Spectinomycin or ceftriaxone should be recommended for the treatment of gonorrhoeae in Bobo-Dioulasso. The prevalence of Chlamydia trachomatis is higher than that of N. gonorrhoeae in Bobo-Dioulasso. This should be taken into account in clinical management of sexually transmitted diseases in this setting.
Research Interests: Nonparametric Statistics, Adolescent, Chlamydia trachomatis, Biological Sciences, Syphilis, and 15 moreHumans, Burkina Faso, Female, Animals, Sexually transmitted infections, Microbial genetic and drug resistance, Trichomonas vaginalis, Middle Aged, Adult, Chi Square Distribution, Bacterial Vaginosis, Sexually Transmitted Diseases, Gardnerella vaginalis, Neisseria gonorrhoeae, and Socioeconomic Factors
... Road safety, public health and injury politics in Africa (Respond to this article at) author(s): Lamont M. source: Anthropology Today; 26(2010)5 ... linked to the chondroitin 4-sulfotransferase genes and its association with placental... more
... Road safety, public health and injury politics in Africa (Respond to this article at) author(s): Lamont M. source: Anthropology Today; 26(2010)5 ... linked to the chondroitin 4-sulfotransferase genes and its association with placental malaria author(s): Valente B., Campos PA, Rosario ...
Research Interests: Humans, Burkina Faso, Infant, Lancet, Newborn Infant, and 4 moreYear, Child mortality, Child preschool, and The Lancet
In-vitro research has suggested that bacterial vaginosis may increase the survival of HIV-1 in the genital tract. Therefore, we investigated the association of HIV-1 infection with vaginal flora abnormalities, including bacterial... more
In-vitro research has suggested that bacterial vaginosis may increase the survival of HIV-1 in the genital tract. Therefore, we investigated the association of HIV-1 infection with vaginal flora abnormalities, including bacterial vaginosis and depletion of lactobacilli, after adjustment for sexual activity and the presence of other sexually transmitted diseases (STDs). During the initial survey round of our community-based trial of STD control for HIV-1 prevention in rural Rakai District, southwestern Uganda, we selected 4718 women aged 15-59 years. They provided interview information, blood for HIV-1 and syphilis serology, urine for detection of Chlamydia trachomatis and Neisseria gonorrhoeae, and two self-administered vaginal swabs for culture of Trichomonas vaginalis and gram-stain detection of vaginal flora, classified by standardised, quantitative, morphological scoring. Scores 0-3 were normal vaginal flora (predominant lactobacilli). Higher scores suggested replacement of lactobacilli by gram-negative, anaerobic microorganisms (4-6 intermediate; 7-8 and 9-10 moderate and severe bacterial vaginosis). HIV-1 frequency was 14.2% among women with normal vaginal flora and 26.7% among those with severe bacterial vaginosis (p < 0.0001). We found an association between bacterial vaginosis and increased HIV-1 infection among younger women, but not among women older than 40 years; the association could not be explained by differences in sexual activity or concurrent infection with other STDs. The frequency of bacterial vaginosis was similar among HIV-1-infected women with symptoms (55.0%) and without symptoms (55.7%). The adjusted odds ratio of HIV-1 infection associated with any vaginal flora abnormality (scores 4-10) was 1.52 (95% CI 1.22-1.90), for moderate bacterial vaginosis (scores 7-8) it was 1.50 (1.18-1.89), and for severe bacterial vaginosis (scores 9-10) it was 2.08 (1.48-2.94). This cross-sectional study cannot show whether disturbed vaginal flora increases susceptibility to HIV-1 infection. Nevertheless, the increased frequency of HIV-1 associated with abnormal flora among younger women, for whom HIV-1 acquisition is likely to be recent, but not among older women, in whom HIV-1 is likely to have been acquired earlier, suggests that loss of lactobacilli or presence of bacterial vaginosis may increase susceptibility to HIV-1 acquisition. If this inference is correct, control of bacterial vaginosis could reduce HIV-1 transmission.
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The frequency of sickle cell disease varies from 5% to 20% in Africa. This retrospective study investigated 173 patients in an ambulatory setting from August 2000 to July 2006. The study included 98 women and 75 men, aged 15-62 years,... more
The frequency of sickle cell disease varies from 5% to 20% in Africa. This retrospective study investigated 173 patients in an ambulatory setting from August 2000 to July 2006. The study included 98 women and 75 men, aged 15-62 years, with a mean age of 26.7 years. Only 89 patients (71 SC and 18 SS) were seen in ophthalmology, 44 (49%) had sickle cell retinopathy with 26 (29%) cases nonproliferative and 18 cases proliferative (20%). Among the 71 SC patients, 35 (50%) had sickle cell retinopathy, with 40% the proliferative form. Of the 18 SS patients, nine had a retinopathy (50%), with four cases proliferative. Retinopathy is a frequent complication of sickle cell disease, which can lead to blindness, and its management better accessibility to the ophthalmologic examination and preventive treatment by laser photo coagulation.
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ABSTRACT
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There is an urgent need to assess the accuracy/feasibility of using dried blood spots (DBS) for monitoring of HIV-1 viral load in resource-limited settings. A total of 892 DBS from HIV-1-positive pregnant women and their neonates enrolled... more
There is an urgent need to assess the accuracy/feasibility of using dried blood spots (DBS) for monitoring of HIV-1 viral load in resource-limited settings. A total of 892 DBS from HIV-1-positive pregnant women and their neonates enrolled in the Kesho Bora prevention of mother-to-child transmission trial conducted in Durban (South Africa) and Bobo-Dioulasso (Burkina Faso) between May 2005 and July 2008 were tested for HIV-1 RNA. The combination Nuclisens extraction method (BioMérieux)/Generic HIV Viral Load assay (Biocentric) was performed using one DBS (in Durban) versus 2 DBS (in Bobo-Dioulasso) on 2 distinct open real-time polymerase chain reaction instruments. DBS HIV-1 RNA results were compared with plasma HIV-1 RNA and HIV serology results used as the gold standards. The limits of detection of assays on DBS were 3100 and 1550 copies per milliliter in Durban and Bobo-Dioulasso, respectively. DBS HIV-1 RNA values correlated significantly with plasma levels (n = 327; R = 0.7351) and were uniformly distributed according to duration of DBS storage at -20°C (median duration, 280 days). For early infant diagnosis, the sensitivity and specificity were 100% (95% confidence interval: 97.2 to 100.0 and 96.5 to 100.0, respectively). HIV-1 viral load kinetics in DNase-pretreated DBS were similar to those obtained in plasma specimens among 13 patients receiving antiretroviral treatment. HIV-1 RNA findings from serial infant DBS collected prospectively (n = 164) showed 100% concordance with HIV serology at 18 months of life. Our findings strongly advocate the implementation of DBS HIV-1 RNA testing in remote areas from low-income and middle-income countries.
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To determine the prevalence of HIV infection among pregnant women in Burkina Faso and to identify factors associated with HIV infection in this population, we performed in 4 antenatal clinics in 4 urban centres located in the centre, the... more
To determine the prevalence of HIV infection among pregnant women in Burkina Faso and to identify factors associated with HIV infection in this population, we performed in 4 antenatal clinics in 4 urban centres located in the centre, the north, the east and the south-west of the country cross-sectional serological surveys between 7 October 1994 and 7 February 1995 using unlinked anonymous HIV screening method. In the towns included in the study more than 94% of pregnant women attend at least 2 antenatal consultations. In each centre all pregnant women attending an antenatal consultation during a 2-week period were invited to take part in a study to measure the prevalence of syphilis. Women with positive syphilis serology were offered treatment free of charge. A total of 1294 pregnant women were recruited into the study. There were no refusals. Thirty-two women (2.5%) had positive syphilis serology. The overall seroprevalence of HIV infection was 8% (95% confidence interval [CI]: 6.6-9.6). There was no evidence that the prevalence of syphilis or HIV infection varied between the 4 towns (P=0.12 and 0.52 respectively). In logistic regression analyses only the presence of syphilis infection was associated with risk of HIV (odds ratio=3.4; 95% CI: 1.4-7.9). The prevalence of syphilis among pregnant women in Burkina Faso is relatively low compared with that of HIV infection. These results suggest that HIV epidemic in Burkina Faso is important and that there is an urgent need to intensify HIV-prevention activities. The need for HIV surveillance in this sentinel population is urgent to follow the course of the epidemic and to measure the impact of interventions. One of the consequences of the high prevalence of HIV infection among pregnant women which requires greater attention in Burkina Faso is the increasing number of children who will be infected with HIV by vertical transmission.
Research Interests: Medical Microbiology, Adolescent, Urban Health, Syphilis, Pregnancy, and 14 moreHumans, Burkina Faso, Female, Hiv Infection, Risk factors, Clinical Sciences, Middle Aged, Adult, Public health systems and services research, Odds ratio, Pregnant Women, Risk Factors, Cross Sectional Studies, and Logistic Models
We conducted a cross-sectional study of sexually transmitted disease and HIV infections among a random sample of the 2364 adult population in 2000 in Bobo-Dioulasso, the second largest town in Burkina Faso. The prevalence of HIV infection... more
We conducted a cross-sectional study of sexually transmitted disease and HIV infections among a random sample of the 2364 adult population in 2000 in Bobo-Dioulasso, the second largest town in Burkina Faso. The prevalence of HIV infection was 5.2%. Risk factor analysis was conducted among sexually active men 20 to 34 years old and women 15 to 24 years old. Factors independently associated with HIV infection among men were having been married (adjusted odds ratio (aOR)=8.19 [1.70-39]), reporting more than two non-marital partners in the last 12 months (aOR=6.07 [1.14-32.4]), reporting a past urban residence other than Bobo-Dioulasso (aOR =6.37 [1.96-20.7] and having a positive serology for HSV-2 infection (aOR=12.0 [3.49-40.9]). Among women the factors were being Christian (aOR=3.73 [1.20-11.6]), having had a first sexual partner more than 24 years old (aOR =4.30 [1.35-13.6]) and having a positive serology for HSV-2 infection (aOR =4.40 [1.32-14.6]). HIV infection in Bobo-Dioulasso therefore depends on both exposure factors (sexual behaviours) and transmissibility cofactors (HSV-2).
Research Interests: Christianity, Epidemiology, Medical Microbiology, Adolescent, Medicine, and 15 moreMultivariate Analysis, Humans, Burkina Faso, Female, Male, Hiv Infection, Clinical Sciences, Prevalence, Adult, Public health systems and services research, Age Factors, Cross sectional Study, Condoms, Cross Sectional Studies, and Marital Status
Little information is available regarding human immunodeficiency virus (HIV) infection among female sex workers (FSW) in Burkina Faso, West Africa. A cross-sectional study was conducted in Ouagadougou and Bobo-Dioulasso, the 2 largest... more
Little information is available regarding human immunodeficiency virus (HIV) infection among female sex workers (FSW) in Burkina Faso, West Africa. A cross-sectional study was conducted in Ouagadougou and Bobo-Dioulasso, the 2 largest cities of the country, to determine the prevalence of HIV infection and other sexually transmitted diseases (STDs) among FSWs, and to investigate the factors which were associated with HIV infection in this population. From October to November 1994, 426 FSWs were recruited. The method of anonymous and unlinked HIV screening recommended by the World Health Organization (WHO) was used. The overall HIV seroprevalence was 58.2% (95% confidence interval: 53.4-62.9) and 52.6% of FSWs had at least one STD agent. The most common STDs were trichomoniasis (23%), syphilis (15%) and gonorrhoea (13%). In a logistic regression analysis, risk factors for HIV infection were high gravidity (> or = 2 pregnancies), low perception of personal risk of HIV infection, syphilis and the presence of genital warts. These results suggest that FSWs in Burkina Faso need better information about HIV transmission and prevention and then need better access to STD detection and management services.
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The objective of our study was to estimate the prevalence of HIV infection among pregnant women in Bobo-Dioulasso (Burkina Faso) according to 2 survey methods. Unlinked anonymous HIV screening was performed among women attending 2... more
The objective of our study was to estimate the prevalence of HIV infection among pregnant women in Bobo-Dioulasso (Burkina Faso) according to 2 survey methods. Unlinked anonymous HIV screening was performed among women attending 2 antenatal clinics. Voluntary and confidential HIV counselling and testing were offered to women attending 2 other antenatal clinics in the same time period, September-October 1996. Voluntary HIV testing was performed in the context of a clinical trial on mother-to-child transmission of HIV (ANRS 049 clinical trial) with an acceptance rate of HIV testing of 93%. The first survey recruited 200 women and the second, 424. The mean age (24.6 years vs 24.8 years) and the mean number of pregnancies (3.1 vs 3.3) of women were comparable, in the 2 studies (P=0.69 and P=0.26, respectively). Prevalence of HIV infection in the blinded survey was estimated at 10.0% (95% confidence interval (CI): 6.4-15.2), while it was 9.4% (95% CI: 6.9-12.7) in the voluntary HIV screening programme. These 2 estimates were not statistically different (P=0.82). In the voluntary screening study, the prevalence of HIV infection was significantly different between age groups 15-24 years and 25-49 years (13.9% vs 4.5%, P < 0.001). In the age group 25-49 years, the prevalence of HIV infection estimated in the blinded study and in the voluntary screening study were significantly different (10.5% vs 4.5%, P=0.04) suggesting a potential participation bias among pregnant women of older age in the voluntary, confidential HIV screening group. In conclusion, for the purpose of HIV surveillance, the most reliable method for HIV prevalence remains the unlinked, anonymous testing.
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Research Interests: Bioinformatics, Behavior, Life Sciences, Developing Countries, Health, and 15 moreMedicine, Counseling, Emotions, Population, Humans, Biomedical Research, Burkina Faso, Female, Male, Prevalence, Questionnaires, Adult, Occupational Exposure, Public health systems and services research, and Health Personnel
Research Interests: Microbiology, Medical Microbiology, Treatment Outcome, France, HIV, and 12 moreHumans, Female, Drug Resistance, Male, Clinical Sciences, Human immunodeficiency virus, Highly Active Antiretroviral Therapy, Retrospective Studies, Antimicrobial agents, Species Specificity, Cohort Studies, and Viral Load
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The study aimed to estimate costs of provision and access to highly active antiretroviral therapy (HAART) in order to assist in planning and resource allocation regarding scaling up and sustainable access to HAART in Benin. A prospective... more
The study aimed to estimate costs of provision and access to highly active antiretroviral therapy (HAART) in order to assist in planning and resource allocation regarding scaling up and sustainable access to HAART in Benin. A prospective study was carried out to collect data on costs of provision of care at the Outpatient Treatment Centre (OTC) of the National University hospital in Cotonou, Benin and on costs borne by people living with HIV/AIDS (PLWHA) and their families in accessing care. We used an Excel model, a macro costing approach and WHO guidelines for costing health services. Annual costs were subsequently extrapolated from a societal perspective over a 10-year time horizon. Sensitivity analysis was conducted on major cost categories. The study population was mostly of middle age (median age of 38, IQR 34-42), married (65%), working class (60%) with low literacy (70% primary education level or less). The main drivers of costs of HAART service provision were drugs (73%), biological monitoring (15%) and personnel (8%). Annual costs of provision of HAART and household costs borne by PLWHA and families in seeking care amounted to 1160 USD and 111 USD per PLWHA respectively. These household costs are respectively 40% and 14% of household health and education related costs and may represent catastrophic health expenditures for patients and families. The provision of drugs and biological monitoring, and household costs in accessing care, remain by far the main barriers to ensuring universal access to HAART.
Research Interests: Psychology, Demography, Resource Allocation, Prospective studies, Humans, and 15 moreBenin, Health Services, Primary Education, Female, Male, Adult, Public health systems and services research, Economic Models, Cost Benefit Analysis, Highly Active Antiretroviral Therapy, Biological Monitoring, Prospective Study, AIDS care, Health Expenditure, and Health Services Accessibility
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People screened for human immunodeficiency virus (HIV) using rapid diagnostic tests (RDTs) in Africa remain generally unaware of their status for hepatitis B (HBV) and hepatitis C (HCV) infections. We evaluated a two-step screening... more
People screened for human immunodeficiency virus (HIV) using rapid diagnostic tests (RDTs) in Africa remain generally unaware of their status for hepatitis B (HBV) and hepatitis C (HCV) infections. We evaluated a two-step screening strategy in Burkina Faso, using both HIV RDTs and Dried Blood Spot (DBS) assays to confirm an HIV-positive test, and to test for HBV and HCV infections. HIV counselling and point-of-care testing were performed at a voluntary counselling and testing centre with HBV, HCV status and HIV confirmation using DBS specimens, being assessed at a central laboratory. Serological testing on plasma was used as the reference standard assay to control for the performance of DBS assays. Nineteen out of 218 participants included in the study were positive for HIV using RDTs. A fourth-generation HIV ELISA and immunoblot assays on DBS confirmed HIV status. Twenty-four out of 25 participants infected with HBV were found positive for hepatitis B surface antigen (HBsAg) using DBS. One sample with a low HBsAg concentration on plasma was not detected on DBS. Five participants tested positive for HCV antibodies were confirmed positive with an immunoblot assay using DBS specimens. Laboratory results were communicated within 7 days to participants with no loss to follow up of participants between the first and second post-test counselling sessions. In conclusion, DBS collection during HIV point-of-care testing enables screening and confirmation of HBV, HCV and HIV infections. Diagnosis using DBS may assist with implementation of national programmes for HBV, HCV and HIV screening and clinical care in middle- to low-income countries.
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It is important for HIV/AIDS control programmes to determine population knowledge on AIDS in order to develop appropriate Information, Education and Communication (IEC) messages. The objectives of our study were to determine the... more
It is important for HIV/AIDS control programmes to determine population knowledge on AIDS in order to develop appropriate Information, Education and Communication (IEC) messages. The objectives of our study were to determine the seroprevalence of HIV and syphilis among pregnant women, female prostitutes and long-distance truck drivers and to evaluate knowledge, attitudes, beliefs, and practice (KABP) with respect to the HIV/AIDS epidemic in these three groups in Burkina Faso. We performed three cross-sectional serosurveys including face-to-face interviews on KABP between October 1994 and February 1995 in three population groups. Overall, 1,294 pregnant women, 236 long-distance truck drivers and 426 female prostitutes were recruited. HIV seroprevalence was 8% (95% Confidence Interval (CI): 6.6-9.6) among pregnant women, 18.6% (95% CI: 13.9-24.2) among long-distance truck drivers and 58.2% (95% CI: 53.4-62.9) in female prostitutes. The prevalence of syphilis was 2.5%, 9.3% and 15%, respectively. Most pregnant women (98%), long-distance truck drivers (96%) and female prostitutes (98%) had already heard of AIDS. However, the level of knowledge of HIV transmission routes, of risk factors for HIV transmission and of available preventive measures was very low. Consequently, 41% of pregnant women, 40% of long-distance truck drivers and an alarming 61% of female prostitutes reported that they did not feel themselves at risk for HIV. In each group, high levels of knowledge on AIDS were associated with increased awareness of AIDS risk and the adoption of preventive behaviours. Level of education was associated with knowledge of AIDS and condom use. However, in the 12 months preceding the surveys, condom use was very low among pregnant women (0.1%), long-distance truck drivers (18%) and among female prostitutes (42%). These results indicate that HIV is widespread in Burkina Faso and that there is an urgent need to develop and evaluate HIV prevention strategies in the general population and among core groups such as female prostitutes and long-distance truck drivers. Interventions must include information campaigns, condom promotion and distribution, and sexually transmitted diseases control.
Research Interests: Health Promotion, Health Behavior, Health Education, Disease Outbreaks, Pregnancy, and 15 moreHumans, Burkina Faso, Prostitution, Female, Male, Confidence intervals, Risk factors, Intervention Studies, Adult, Educational Status, Risk Factors, Condoms, Cross Sectional Studies, Acquired immunodeficiency syndrome, and Interviews as topic
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The impact of antiretroviral therapy (ART) on herpes simplex virus type-2 (HSV-2) replication is unclear. The aim of this study was to assess factors associated with cervico-vaginal HSV-2 DNA shedding and genital ulcer disease (GUD) in a... more
The impact of antiretroviral therapy (ART) on herpes simplex virus type-2 (HSV-2) replication is unclear. The aim of this study was to assess factors associated with cervico-vaginal HSV-2 DNA shedding and genital ulcer disease (GUD) in a cohort of women living with HIV-1 in Burkina Faso. Participants were screened for cervico-vaginal HSV-2 DNA, GUD, cervico-vaginal and systemic HIV-1 RNA and reproductive tract infections every 3-6 months over 8 years. Associations with HSV-2 shedding and quantity were examined using random effects logistic and linear regression, respectively. Of the 236 women with data on HSV-2 shedding, 151 took ART during the study period. Cervico-vaginal HSV-2 DNA was detected in 42% (99/236) of women in 8.2% of visits (151/1848). ART was associated with a reduction in HSV-2 shedding which declined for each year on ART (odds ratio [OR]=0.74; 95%CI, 0.59-0.92). In the multivariable model, the impact of ART was primarily associated with suppression of systemic HIV-1 RNA (aOR=0.32; 95%CI, 0.15-0.67). A reduction in GUD was also observed while on ART, mainly in those with HIV-1 viral suppression (aOR=0.53; 95%CI, 0.25-1.11). ART is strongly associated with a decrease in cervico-vaginal HSV-2 shedding, and the impact was sustained over several years.
Research Interests:
Although interventions to control HIV among high-risk groups such as female sex workers (FSW) are highly recommended in Africa, the contents and efficacy of these interventions are unclear. We therefore designed a comprehensive dedicated... more
Although interventions to control HIV among high-risk groups such as female sex workers (FSW) are highly recommended in Africa, the contents and efficacy of these interventions are unclear. We therefore designed a comprehensive dedicated intervention targeting young FSW and assessed its impact on HIV incidence in Burkina Faso. Between September 2009 and September 2011 we conducted a prospective, interventional cohort study of FSW aged 18 to 25 years in Ouagadougou, with quarterly follow-up for a maximum of 21 months. The intervention combined prevention and care within the same setting, consisting of peer-led education sessions, psychological support, sexually transmitted infections and HIV care, general routine health care and reproductive health services. At each visit, behavioural characteristics were collected and HIV, HSV-2 and pregnancy were tested. We compared the cohort HIV incidence with a modelled expected incidence in the study population in the absence of intervention, using data collected at the same time from FSW clients. The 321 HIV-uninfected FSW enrolled in the cohort completed 409 person-years of follow-up. No participant seroconverted for HIV during the study (0/409 person-years), whereas the expected modelled number of HIV infections were 5.05/409 person-years (95% CI, 5.01-5.08) or 1.23 infections per 100 person-years (p=0.005). This null incidence was related to a reduction in the number of regular partners and regular clients, and by an increase in consistent condom use with casual clients (adjusted odds ratio (aOR)=2.19; 95% CI, 1.16-4.14, p=0.01) and with regular clients (aOR=2.18; 95% CI, 1.26-3.76, p=0.005). Combining peer-based prevention and care within the same setting markedly reduced the HIV incidence among young FSW in Burkina Faso, through reduced risky behaviours.