Fiches originales, livres libres et ressources de référence, triés par matière et résumés en français.
Tout est légal : contenus originaux, licences libres ou liens vers la source officielle.
9415 ressources
Michaela Müller-Trutwin, Nicolas Huot
No abstract available
E. Ruizendaal, H. D. F. H. Schallig, J. Bradley, M. Traore-Coulibaly, P. Lompo, U. d’Alessandro, S. Scott, F. Njie, S. H. Zango, O. Sawadogo, M. D. de Jong, H. Tinto, P. F. Mens
BackgroundDiagnosis of malaria in pregnancy is problematic due to the low sensitivity of conventional diagnostic tests (rapid diagnostic test and microscopy), which is exacerbated due to low peripheral parasite densities, and lack of clinical symptoms. In this study, six potential biomarkers to support malaria diagnosis in pregnancy were evaluated.MethodsBlood samples were collected from pregnant women at antenatal clinic visits and at delivery. Microscopy and real-time PCR were performed for malaria diagnosis and biomarker analyses were performed by ELISA (interleukin 10, IL-10; tumor necrosis factor-α, TNF-α; soluble tumor necrosis factor receptor II, sTNF-RII; soluble fms-like tyrosine kinase 1, sFlt-1; leptin and apolipoprotein B, Apo-B). A placental biopsy was collected at delivery to determine placental malaria.ResultsIL-10 and sTNF-RII were significantly higher at all time-points in malaria-infected women (p < 0.001). Both markers were also positively associated with parasite density (p < 0.001 and p = 0.003 for IL-10 and sTNF-RII respectively). IL-10 levels at delivery, but not during pregnancy, were negatively associated with birth weight. A prediction model was created using IL-10 and sTNF-RII cut-off points. For primigravidae the model had a sensitivity of 88.9% (95%CI 45.7–98.7%) and specificity of 83.3% (95% CI 57.1–94.9%) for diagnosing malaria during pregnancy. For secundi- and multigravidae the sensitivity (81.8% and 56.5% respectively) was lower, while specificity (100.0% and 94.3% respectively) was relatively high. Sub-microscopic infections were detected in 2 out of 3 secundi- and 5 out of 12 multigravidae.ConclusionsThe combination of biomarkers IL-10 and sTNF-RII have the potential to support malaria diagnosis in pregnancy. Additional markers may be needed to increase sensitivity and specificity, this is of particular importance in populations with sub-microscopic infections or in whom other inflammatory diseases are prevalent.Electronic supplem
Serge Ouoba, Ko Ko, Moussa Lingani, Shintaro Nagashima, Alice N. Guingané, E. Bunthen, Md Razeen Ashraf Hussain, Aya Sugiyama, Tomoyuki Akita, Masayuki Ohisa, Moussa Abdel Sanou, Ousmane Traore, Job Wilfried Nassa, Maimouna Sanou, Kazuaki Takahashi, Halidou Tinto, Junko Tanaka
In highly endemic countries for hepatitis B virus (HBV) infection, childhood infection, including mother-to-child transmission (MTCT), represents the primary transmission route. High maternal DNA level (viral load ≥ 200,000 IU/mL) is a significant factor for MTCT. We investigated the prevalence of HBsAg, HBeAg, and high HBV DNA among pregnant women in three hospitals in Burkina Faso and assessed the performance of HBeAg to predict high viral load. Consenting pregnant women were interviewed on their sociodemographic characteristics and tested for HBsAg by a rapid diagnostic test, and dried blood spot (DBS) samples were collected for laboratory analyses. Of the 1622 participants, HBsAg prevalence was 6.5% (95% CI, 5.4–7.8%). Among 102 HBsAg-positive pregnant women in DBS samples, HBeAg was positive in 22.6% (95% CI, 14.9–31.9%), and viral load was quantified in 94 cases, with 19.1% having HBV DNA ≥ 200,000 IU/mL. HBV genotypes were identified in 63 samples and predominant genotypes were E (58.7%) and A (36.5%). The sensitivity of HBeAg by using DBS samples to identify high viral load in the 94 cases was 55.6%, and the specificity was 86.8%. These findings highlight the need to implement routine HBV screening and effective MTCT risk assessment for all pregnant women in Burkina Faso to enable early interventions that can effectively reduce MTCT.
BackgroundIntermittent preventive treatment of malaria in children (IPTc) is a highly efficacious method of malaria control where malaria transmission is highly seasonal. However, no studies published to date have examined community perceptions of IPTc.MethodsA qualitative study was undertaken in parallel with a double-blind, placebo-controlled, randomized trial of IPTc conducted in Mali and Burkina Faso in 2008–2009 to assess community perceptions of and recommendations for IPTc. Caregivers and community health workers (CHWs) were purposively sampled. Seventy-two in-depth individual interviews and 23 focus group discussions were conducted.FindingsWidespread perceptions of health benefits for children led to enthusiasm for the trial and for IPTc specifically. Trust in and respect for those providing the tablets and a sense of obligation to the community to participate in sanctioned activities favoured initial adoption. IPTc fits in well with existing understandings of childhood illness. Participants did not express concerns about the specific drugs used for IPTc or about providing tablets to children without symptoms of malaria. There was no evidence that IPTc was perceived as a substitute for bed net usage, nor did it inhibit care seeking. Participants recommended that distribution be “closer to the population”, but expressed concern over caregivers' ability to administer tablets at home.ConclusionsThe trial context mediated perceptions of IPTc. Nonetheless, the results indicate that community perceptions of IPTc in the settings studied were largely favourable and that the delivery strategy rather than the tablets themselves presented the main areas of concern for caregivers and CHWs. The study identifies a number of key questions to consider in planning an IPTc distribution strategy. Single-dose formulations could increase the success of IPTc implementation, as could integration of IPTc within a package of activities, such as bed net distribution and free curative
A randomized trial reported by Diadier Diallo and colleagues shows that intermittent preventive treatment for malaria in children who are protected from mosquitoes using insecticide-treated bednets provides substantial protection from malaria. BackgroundIntermittent preventive treatment of malaria in children (IPTc) is a promising new approach to the control of malaria in areas of seasonal malaria transmission but it is not known if IPTc adds to the protection provided by an insecticide-treated net (ITN).Methods and FindingsAn individually randomised, double-blind, placebo-controlled trial of seasonal IPTc was conducted in Burkina Faso in children aged 3 to 59 months who were provided with a long-lasting insecticide-treated bednet (LLIN). Three rounds of treatment with sulphadoxine pyrimethamine plus amodiaquine or placebos were given at monthly intervals during the malaria transmission season. Passive surveillance for malaria episodes was established, a cross-sectional survey was conducted at the end of the malaria transmission season, and use of ITNs was monitored during the intervention period. Incidence rates of malaria were compared using a Cox regression model and generalized linear models were fitted to examine the effect of IPTc on the prevalence of malaria infection, anaemia, and on anthropometric indicators. 3,052 children were screened and 3,014 were enrolled in the trial; 1,505 in the control arm and 1,509 in the intervention arm. Similar proportions of children in the two treatment arms were reported to sleep under an LLIN during the intervention period (93%). The incidence of malaria, defined as fever or history of fever with parasitaemia ≥5,000/µl, was 2.88 (95% confidence interval [CI] 2.70–3.06) per child during the intervention period in the control arm versus 0.87 (95% CI 0.78–0.97) in the intervention arm, a protective efficacy (PE) of 70% (95% CI 66%–74%) (p<0.001). There was a 69% (95% CI 6%–90%) reduction in incidence of severe malaria (p = 0.
Innocent Valea, Halidou Tinto, Maxime K Drabo, Lieven Huybregts, Marie-Claire Henry, Dominique Roberfroid, Robert T Guiguemde, Patrick Kolsteren, Umberto D'Alessandro
BackgroundIntermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) is being implemented in most malaria endemic countries as a standard two-doses regimen as it reduces the risk of low birth weight (LBW) and the prevalence of maternal anaemia. Nevertheless, where the risk of infection close to delivery is high because of intense transmission, a third IPTp-SP dose may further reduce the negative effects of malaria on pregnancy outcome.MethodsPregnant women in the 2nd or 3rd trimester were randomized to receive either 2 (SP2) or 3 doses (SP3) of SP. Trained field workers paid home visits to the women for drug administration according to a predefined drug delivery schedule. Women were encouraged to attend their scheduled ANC visits and to deliver at the health facilities where the new-born was weighed. The prevalence of LBW (<2500 g), severe anaemia (Hb < 8 g/dL) and premature birth was analysed using intention-to-treat (ITT) and per-protocol (PP) analysis.ResultsData from 1274 singleton pregnancies were analysed (641 in the SP3 and 633 in the SP2 group). The uptake of the intervention appeared to be low. Though the prevalence of LBW in both intervention groups was similar (adjusted Incident Rate Ratio, AIRR = 0.92, 95%CI: 0.69-1.24) in the ITT analysis, the risk of severe anaemia was significantly lower in the SP3 group compared to the SP2 group (AIRR = 0.38, 95%CI: 0.16 - 0.90). The PP analysis showed a trend of reduced risk of LBW, severe anaemia and premature delivery in the SP3 group, albeit the difference between two and three IPTp-SP did not reach statistical significance.ConclusionThe risk of LBW and severe anaemia tended to be lower in the SP3 group, though this was not statistically significant, probably due to the low uptake of the intervention which reduced the power of the study. Further studies are needed for establishing whether a third SP dose has a real benefit in preventing the negative effects of malaria in pregnancy in settings whe
Julie R Gutman, Carole Khairallah, Kasia Stepniewska, Harry Tagbor, Mwayiwawo Madanitsa, Matthew Cairns, Anne Joan L'lanziva, Linda Kalilani, Kephas Otieno, Victor Mwapasa, Steve Meshnick, Simon Kariuki, Daniel Chandramohan, Meghna Desai, Steve M. Taylor, Brian Greenwood, Feiko O. ter Kuile
BackgroundIn sub-Saharan Africa, the efficacy of intermittent preventive therapy in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) for malaria in pregnancy is threatened by parasite resistance. We conducted an individual-participant data (IPD) meta-analysis to assess the efficacy of intermittent screening with malaria rapid diagnostic tests (RDTs) and treatment of RDT-positive women with artemisinin-based combination therapy (ISTp-ACT) compared to IPTp-SP, and understand the importance of subpatent infections.MethodsWe searched MEDLINE and the Malaria-in-Pregnancy Library on May 6, 2021 for trials comparing ISTp-ACT and IPTp-SP. Generalised linear regression was used to compare adverse pregnancy outcomes (composite of small-for-gestational-age, low birthweight (LBW), or preterm delivery) and peripheral or placental Plasmodium falciparum at delivery. The effects of subpatent (PCR-positive, RDT/microscopy-negative) infections were assessed in both arms pooled using multi-variable fixed-effect models adjusting for the number of patent infections. PROSPERO registration: CRD42016043789.FindingsFive trials conducted between 2007 and 2014 contributed (10,821 pregnancies), two from high SP-resistance areas where dhfr/dhps quintuple mutant parasites are saturated, but sextuple mutants are still rare (Kenya and Malawi), and three from low-resistance areas (West-Africa). Four trials contributed IPD data (N=10,362). At delivery, the prevalence of any malaria infection (relative risk [RR]=1.08, 95% CI 1.00-1.16, I2=67.0 %) and patent infection (RR=1.02, 0.61-1.16, I2=0.0%) were similar. Subpatent infections were more common in ISTp recipients (RR=1.31, 1.05-1.62, I2=0.0%). There was no difference in adverse pregnancy outcome (RR=1.00, 0.96-1.05; studies=4, N=9,191, I2=54.5%). Subpatent infections were associated with LBW (adjusted RR=1.13, 1.07-1.19), lower mean birthweight (adjusted mean difference=32g, 15-49), and preterm delivery (aRR=1.35, 1.15-1.57).InterpretationISTp-
Sarah Roux
La sex hormone binding globulin (SHBG) est une protéine de transport plasmatique des hormones stéroïdes sexuelles. Elle est maintenant considérée comme marqueur complémentaire au dosage de testostérone, au diagnostic de pathologies telles que le syndrome des ovaires polykystiques chez la femme ou l’hypogonadisme chez l’homme. Cela a contribué à une augmentation des demandes de dosage de cette protéine. C’est pourquoi le laboratoire d’hormonologie du centre hospitalier universitaire (CHU) de Bordeaux a décidé d’internaliser ce dosage, afin de répondre à une problématique de maîtrise de la qualité de rendu de résultats et d’optimisation budgétaire. Ce travail de mise en route du dosage au CHU s’inscrit de facto dans une démarche d’actualisation de connaissances concernant la SHBG et ses intérêts cliniques. À l’issu de cet exercice, des discussions clinico-biologiques à propos de l’intérêt du maintien de certaines autres analyses en lien avec la SHBG, telles que la testostérone libre et biodisponible, ont été initiées.
Raoul Karfo, Elie Kabré, Nadia Safir, Mounya Bouabdellah, Laila Benchekroun, Jean Sakandé, Layachi Chabraoui
L'immunofixation est actuellement très utilisée dans les laboratoires d'analyses médicales. L'interprétation des résultats est en général facile, mais il existe des cas qui posent des problèmes d'interprétation. Nous vous rapportons deux observations d'interprétation délicate. Dans la première observation, nous présentons un cas de précipitation non spécifique de la protéine sur toutes les pistes, dans la deuxième observation un cas présentant une double bande monoclonale à l'immunofixation. Pour ces deux observations, l'utilisation de la solution réductrice de β2-mercaptoéthanol nous a permis de résoudre le problème et de conclure à un diagnostic. La confrontation des données cliniques, radiologiques et biologiques est nécessaire avant de conclure à une immunoglobuline monoclonale.
Marie-Sophie Chérillat, Myriam Zafra, Yvonne Peyrache, Marie-Claude Roche
L’éducation thérapeutique du patient (ETP) mobilise une approche systémique avec des processus d’apprentissage centrée sur la personne. Cette pratique intégrée aux soins nécessite pour le professionnel d’adapter ses pratiques et de mobiliser une posture éducative, définie comme pierre angulaire de l’ETP. La notion de posture éducative peut s’avérer complexe à mettre en œuvre et demande à être explicitée au travers de ses différentes dimensions.
Anne Libessart
Introduction : l'IVG est un droit encore très controversé. De ce fait, diverses informations et mésinformations circulent à son sujet. Nous pouvions donc nous demander quelles sont les connaissances de la population sur l'IVG. Ainsi, l'objectif principal de l'étude était de réaliser un état des lieux des connaissances et idées reçues de la population au sujet de l'IVG. Méthode : l'enquête épidémiologique descriptive a été réalisée au travers d'un questionnaire anonyme noté sur 25. Celui-ci a été distribué à 535 personnes, hommes et femmes âgés de 18 ans et plus. Résultats : l'étude a révélé que 98% de la population connaissait l'IVG. Cependant, leurs connaissances à ce sujet sont insuffisantes avec 81% de la population ayant une note égale ou inférieure à 15. De plus, nous avons remarqué des différences de connaissances au sein de la population en fonction de l'âge, du sexe et de la catégorie socio-professionnelle. Discussion : bien que l'IVG soit connue de tous, la population connaît peu de choses à son sujet. De plus, les idées reçues sont encore fortement ancrées dans la population causant ainsi des craintes et une stigmatisation des femmes ayant recours à l'IVG. Conclusion : afin d'améliorer les connaissances de la population et d'enrayer les idées reçues, il est nécessaire de faciliter l'accès à des sources d'informations fiables et de supprimer celles qui le sont moins.
Shannon N Wood, Haley L Thomas, Mary Thiongo, Georges Guiella, Fiacre Bazié, Yentéma Onadja, Rosine Mosso, Raimi Fassassi, Peter Gichangi, Michele R Decker
ObjectivesAmong nationally representative cross-sections of women in need of contraception from Burkina Faso, Côte d'Ivoire and Kenya, we aimed to: (1) examine the intersection of past-year physical/sexual intimate partner violence (IPV), emotional IPV and reproductive coercion (RC) and (2) assess the impact of physical/sexual IPV, emotional IPV and RC on women’s contraceptive use outcomes, including current contraceptive use, method type and covert use.DesignThe present analysis uses cross-sectional female data collected in Burkina Faso (December 2020–March 2021), Côte d'Ivoire (October–November 2021) and Kenya (November–December 2020).SettingsBurkina Faso, Côte d'Ivoire and KenyaParticipantsAnalytical samples were restricted to partnered women with contraceptive need who completed a violence module (Burkina Faso n=1863; Côte d'Ivoire n=1105; Kenya n=3390).Primary and secondary outcome measuresThe exposures of interest—past-year emotional IPV, physical/sexual IPV and RC—were assessed using abridged versions of the Revised Conflict and Tactics Scale-2 and Reproductive Coercion Scale, respectively. Outcomes of interest included current contraceptive use, contraceptive method type (female controlled vs male compliant), and covert contraceptive use, and used standard assessments.ResultsAcross sites, 6.4% (Côte d'Ivoire) to 7.8% (Kenya) of women in need of contraception experienced RC; approximately one-third to one-half of women experiencing RC reported no other violence forms (31.7% in Burkina Faso to 45.8% in Côte d'Ivoire), whereas physical/sexual IPV largely occurred with emotional IPV. In multivariable models, RC was consistently associated with covert use (Burkina Faso: aOR 2.84 (95% CI 1.21 to 6.64); Côte d'Ivoire: aOR 4.45 (95% CI 1.76 to 11.25); Kenya: aOR 5.77 (95% CI 3.51 to 9.46)). Some IPV in some settings was also associated with covert use (emotional IPV, Burkina Faso: aOR 2.99 (95% CI 1.56 to 5.74); physical/sexual, Kenya: aOR 2.35 (95% CI 1.33 to 4.17)
Eric Breton, Elodie David
In the fight against malaria, transmission blocking interventions (TBIs) such as transmission blocking vaccines or drugs, are promising approaches to complement conventional tools. They aim to prevent the infection of vectors and thereby reduce the subsequent exposure of a human population to infectious mosquitoes. The effectiveness of these approaches has been shown to depend on the initial intensity of infection in mosquitoes, often measured as the mean number of oocysts resulting from an infectious blood meal in absence of intervention. In mosquitoes exposed to a high intensity of infection, current TBI candidates are expected to be ineffective at completely blocking infection but will decrease parasite load and therefore, potentially also affect key parameters of vector transmission. The present study investigated the consequences of changes in oocyst intensity on subsequent parasite development and mosquito survival. To address this, we experimentally produced different intensities of infection for Anopheles gambiae females from Burkina Faso by diluting gametocytes from three natural Plasmodium falciparum local isolates and used a newly developed non-destructive method based on the exploitation of mosquito sugar feeding to track parasite and mosquito life history traits throughout sporogonic development. Our results indicate the extrinsic incubation period (EIP) of P. falciparum and mosquito survival did not vary with parasite density but differed significantly between parasite isolates with estimated EIP50 of 16 (95% CI: 15–18), 14 (95% CI: 12–16) and 12 (95% CI: 12–13) days and median longevity of 25 (95% CI: 22–29), 15 (95% CI: 13–15) and 18 (95% CI: 17–19) days for the three isolates respectively. Our results here do not identify unintended consequences of the decrease of parasite loads in mosquitoes on the parasite incubation period or on mosquito survival, two key parameters of vectorial capacity, and hence support the use of transmission blocking strateg
Grégory Ninot, Mathilde Minet, Jérôme Larché, Jean Ribstein, Laurent Chiche
Le terme interventions non médicamenteuses (INM) est utilisé par les chercheurs du domaine de la santé depuis 1975. Il figure dans de nombreux rapports d’autorités françaises, européennes et internationales de santé, l’OMS depuis 2003 et la HAS depuis 2011 par exemple. La pandémie de COVID-19 ayant provoqué d’innombrables polémiques notamment dans les médias sur ces pratiques de prévention et de soin a été un révélateur du manque de définition précise et partagée. Une initiative collaborative française de consensus est venue pallier ce manque. Elle a répondu aux attendus scientifiques internationaux dans le domaine de la santé et aux spécificités de ces solutions immatérielles, personnalisées et ciblées de santé. Cet article de mise au point à destination des médecins internistes retrace dans une première partie le travail de consensus mené avec le pilotage d’un comité pluridisciplinaire d’experts, le soutien de l’Inserm et la logistique de la société savante internationale Non-Pharmacological Intervention Society. En trois ans, ce travail a permis d’établir avec plus de 1000 participants une définition, une caractérisation et un cadre évaluatif comportant 14 recommandations éthiques et 63 recommandations méthodologiques. Ce paradigme appelé NPIS Model a reçu à ce jour le soutien de 30 sociétés savantes françaises, deux sociétés savantes européennes et trois autorités de santé françaises. La seconde partie présente les outils collaboratifs qui en ont émergés. La troisième aborde les implications des INM susceptibles de contribuer à la recherche et à la pratique dans le champ de la médecine interne.
Diakourga Arthur Djibougou, Gloria Ivy Mensah, Mamoudou Cissé, Toé Inoussa, Leon Tinnoga Sawadogo, Adjima Combary, Adama Sanou, Bassirou Bonfoh, Kennedy Kwasi Addo, Adrien Marie Gaston Belem, Clément Ziemlé Meda, Roch Konbobr Dabiré, Achille Kaboré, Potiandi Serge Diagbouga
ABSTRACT.We report the frequency and associated factors of tuberculosis (TB) and parasite coinfection from newly diagnosed pulmonary TB patients (TB+) and non-TB participants (TB−) from the Regional Tuberculosis Control Center, households, and health facilities in Bobo-Dioulasso from 2019 to 2021. Biological samples were examined for parasite infection using direct microscopy, concentration techniques, and the immunochromatographic rapid test. Data were analyzed using STATA 14. Of a total of 192 participants involved, 95 were TB+ and 97 were non-TB. There was no statistically significant difference in parasitic infections between the two groups, although it was higher in TB+ than TB− (69.5% [66/95] versus 55.7% [54/97]; P = 0.07). Protozoal infection prevalence was significantly higher in patients with TB+ than in those TB− (61.1% versus 37.1%; P = 0.001). Specifically, Entamoeba spp. and Cryptosporidium spp. followed this pattern with 35.8% versus 19.6% (P = 0.01) and 22.1% versus 8.3% (P = 0.007), respectively. Although higher in TB+ patients, helminthiasis frequency was not significantly different between the two groups (23.2% versus 15.5%; P = 0.2). Helminth species were Schistosomia mansoni (17.9% versus 12.4%), Dicrocoelium dendriticum (3.2% versus 1.0%), Enterobius vermicularis (2.1% versus 2.1%), Wuchereria bancrofti (1.1% versus 0.0%), and Hymenolepis nana (1.1% versus 0.0%). Illiteracy (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.0–6.1), smoking (aOR: 2.4; 95% CI: 1.1–5.3), and handwashing after defecation (aOR: 2.4; 95% CI: 1.2–4.7) were associated with parasites. This study reported a high frequency of parasite coinfection in TB patients. These findings suggest the need for adequate health education for behavioral change and systematic diagnosing of parasites in TB patients for better coinfection management.
Bright Opoku Ahinkorah
Intimate partner violence has been associated with numerous consequences for women, including pregnancy termination. This study aimed to examine the association between intimate partner violence and pregnancy termination among adolescent girls and young women in 25 sub-Saharan African countries. Data for this study was obtained from the demographic and health surveys of 25 countries in sub-Saharan Africa, published between 2010 and 2019. A total of 60,563 adolescent girls and young women were included in this study. Binary logistic regression models were used in analyzing the data and the results were presented as crude odds ratios (CORs) and adjusted odds ratios (AORs) at 95% confidence interval (CI). The prevalence of intimate partner violence and pregnancy termination among adolescent girls and young women in the 25 countries in sub-Saharan Africa were 19% and 10.1% respectively. In all these countries, the odds of pregnancy termination was higher among adolescent girls and young women who had ever experienced intimate partner violence, compared to those who had never experienced intimate partner violence [COR = 1.60, 95% CI = 1.51–1.71], and this persisted after controlling for confounders [AOR = 1.58, 95% CI = 1.48–1.68]. However, across countries, intimate partner violence had significant association with pregnancy termination among adolescent girls and young women in Angola, Chad, Congo DR and Gabon (Central Africa); Benin, Burkina Faso, Cote D'lvoire, Gambia and Mali (West Africa); Comoros, Rwanda and Uganda (East Africa); and Malawi and Zambia (Southern Africa). The findings imply that reducing pregnancy termination among adolescent girls and young women in sub-Saharan Africa depends on the elimination of intimate partner violence. Thus, policies and programmes aimed at reducing pregnancy termination among adolescent girls and young women in sub-Saharan Africa, should pay particular attention to those who have history of intimate partner violence. Highlight
Simona Skandro, Till Bärnighausen, Michael Lowery Wilson
The aim of this cross-sectional study is to explore the prevalence of Intimate Partner Violence (IPV) and associated sociodemographic factors in Burkina Faso during the COVID-19 pandemic. We used the 2021 Burkina Faso Demographic and Health Survey (DHS). The total sample counted 9702 eligible women of reproductive age (15-49 years). A 2-stage probability sampling design was used. We compared the prevalence of IPV in 2021 with already published prevalence rates in Burkina Faso from 2010. We applied simple bivariate and multiple logistic regression analyzes to find significant predictors of IPV. A P-value < .05 was considered significant. The respondents had a mean age of 31 years, with 2/3 from a rural area and 2/3 from uneducated/illiterate background. The overall prevalence of IPV in Burkina Faso was higher in 2021 than in 2010 (29% vs 15%). The most prevalent form was emotional violence (25.6%), followed by physical (14%) and sexual abuse (3.7%). A respondent’s use of violence toward her partner, having seen her father beat her mother, her partner’s use of alcohol, disagreement about the number of children wanted, and being the first among co-wives were significantly associated with at least one form of IPV. Not working, having an educated partner, rural residence and a smaller household size were negatively associated with at least one type of IPV. This study reveals a high prevalence of IPV in Burkina Faso during the COVID-19-pandemic in 2021 and uncovers associated factors at that time. We recommend future research after the effects of the pandemic have subsided to evaluate whether the increased prevalence was a general or a COVID-19-related trend. Campaigns which aim to reduce IPV should focus on couples with socio-demographic characteristics that are associated with IPV.
Ali Derkaoui, Abderrahim Elbouazzaoui, Noufel Elhouari, Sanae Achour, Smael Labib, Hicham Sbai, Mustapha Harrandou, Mohammed Khatouf, Nabil Kanjaa
AbstractLes pesticides organophosphorés (POP) sont des pesticides organiques de synthèse, largement utilisés en agriculture essentiellement comme insecticide, nemacide ou acaricide. Ce sont les produits agricoles, les plus incriminés dans les intoxications dans notre contexte. L’objectif de ce travail était de déterminer les caractéristiques cliniques, paracliniques, et évolutives de cette intoxication en milieu de réanimation. Étude rétrospective portant sur les cas admis en réanimation (2003-2010). Les critères d’inclusion étaient d’ordre clinique, para clinique, thérapeutique et évolutif. 28 cas ont été recensés: 19 femmes et 9 hommes, âge moyen= 24,5±11 ans. La tentative de suicide était le principal motif d’intoxication (19cas). Le Glasgow coma score était en moyenne de 11±4. Le syndrome central, était présent chez 78 % de nos patients, suivi du syndrome muscarinique 71% et le syndrome nicotinique dans 53% des cas. La prise en charge thérapeutique a consisté à la ventilation mécanique dans 50% des cas, l’usage des drogues vasoactives dans 14% des cas et l’administration d’un traitement antidotique dans 64 % des cas. La mortalité globale était de 25%. Les pesticides organophosphorés sont les toxiques agricoles, le plus souvent incriminés dans notre contexte. Les symptômes résultent d’une importante accumulation d’Acétylcholine (Ach) dans l’organisme; responsable de l’apparition des trois syndromes caractéristiques. Le diagnostic biologique se fait par le dosage de l’activité cholinestérasique dans le plasma. Le traitement associe des mesures symptomatiques qui reposent essentiellement sur la réanimation respiratoire et neurologique au traitement antidotique. L’évolution clinique dans ce type d’intoxication, est généralement favorable sous traitement avec régression des signes en quelques jours. Le décès est essentiellement, le fait d’une insuffisance respiratoire de mécanismes multiples: encombrement bronchique réalisant une véritable “noyade interne”, bronchoco
Luc Pascal Christian Loulouga Badinga, Nour Mekaoui, Lamiae Karboubi, Badr Sououd Benjelloun Dakhama
Dysphania ambrosioides ou ansérine, appelée au Maroc M'Khinza est une plante appartenant à la famille des Chenopodiaceae. Utilisée au Maroc pour ses propriétés thérapeutiques notamment antipyrétique, elle peut être toxique si elle est mal dosée. Nous rapportons deux cas d'intoxications colligés au service des urgences médicales pédiatriques de Rabat: un nourrisson de 5 mois et une fille de 10 ans qui, suite à l'ingestion d'infusion de cette plante à des doses indéterminées dans un but antipyrétique avaient présenté respectivement une encéphalopathie toxique et une déshydratation sévère sur gastroentérite aiguë aboutissant aux décès en moins de 12 heures. Ces nouveaux cas de neurotoxicité et d'entérotoxicité au M'Khinza doivent interpeler sur la nécessité de savoir évoquer le diagnostic, d'informer, de lutter contre la banalisation de sa consommation, d'inciter à la recherche sur la pharmacopée traditionnelle permettant d'identifier leurs propriétés thérapeutiques afin de formaliser, rationaliser et codifier leurs prescriptions.
Ahmed Mougui, Imane El Bouchti
Ali Derkaoui, Smael Labib, Sanae Achour, Hicham Sbai, Mustapha Harrandou, Mohammed Khatouf, Nabil Kanjaa
La paraphénylène-diamine (PPD) est une amine aromatique dérivée de l’aniline, utilisée depuis 1863 par les femmes dans un but cosmétique comme teinture capillaire noire ou adjuvant de henné dans plusieurs pays d’Afrique et de Moyen Orient. Le but de notre travail était de décrire les caractéristiques cliniques, paracliniques et évolutives de nos patients et de les comparer avec les données de la littérature. Il s’agissait d’une étude rétrospective portant sur les cas admis en réanimation (2003-2010). Les critères d’inclusion étaient d’ordre clinique, paraclinique, thérapeutique et évolutif. Durant la période de l’étude 24 patients ont été inclus provenant de la région de Fés-Boulmane. L’intoxication à la (PPD) représentait 26% de l’ensemble des intoxications admises au cours de la même période. L’âge moyen était de 23,6 + /- 11,6 ans. Il existait une prédominance féminine avec un sex-ratio de 4,7. L’intoxication était volontaire dans 82,6 %, accidentelle dans 8,6 %, et criminelle dans 4,3%. Le syndrome de rhabdomyolyse caractéristique de cette intoxication était retrouvé chez 60% de nos patients, l’atteinte respiratoire chez 56,5%, l’atteinte cardiaque était présente dans 30% des cas et 17,4% des patients avaient présentés une insuffisance rénale. La prise en charge thérapeutique se basait sur l’apport volémique massif, alcalinisation des urines ainsi que l’administration de corticoïdes et de diurétiques. Le recours à une trachéotomie de sauvetage était nécessaire chez 7 patients. Trois de nos patients avaient bénéficié d’une épuration extra rénale. L’évolution était fatale chez 47,8% des cas. La PPD représente ainsi la principale cause de mortalité toxique dans notre contexte. L’intoxication à la PPD, représente la première cause de rhabdomyolyse toxique dans notre contexte. Elle est responsable d’une mortalité très élevée. Ce qui implique une réglementation du commerce de la PPD, une information du corps soignant et une prise en charge précoce.
Mohamed Hafed Barhoumi, Badra Bannour, Tarek Barhoumi, Rami Jouini, Nadia Marwene, Mohamed Ridha Fatnassi
Les intoxications aiguës par les pesticides organophosphorés (OP) au cours de la grossesse sont des événements rares, peu décrites dans la littérature. A travers cette étude rétrospective, nous rapportons les résultats de sept cas d’ingestion suicidaire d’OP chez des femmes enceintes. Cette intoxication était le plus souvent grave. En effet, cinq des sept parturientes avaient un Glasgow initial < 9 et le POP score était ≥ 3 chez toutes les parturientes. Cinq patientes avaient nécessité une ventilation mécanique de durée moyenne de 3,4 jours. L’évolution était favorable pour toutes les patientes mais dans plus de la moitié des cas elle était défavorable pour le fœtus (mort fœtal in utéro). Deux mécanismes peuvent expliquer ces complications fœtales. Le premier est l’hypoxie fœtale associée ou non à un état de choc qui peuvent se traduire au niveau du RCF par une tachycardie ou des décélérations et aboutir ainsi à un décès in utero. Le deuxième mécanisme est le passage de ces pesticides à travers la barrière placentaire, ce qui pose un risque potentiel pour le fœtus par altération des systèmes enzymatiques des microsomes.
Fadima Yaya Bocoum, Grissoum Tarnagda, Fabrice Bationo, Justin R. Savadogo, Sarata Nacro, Séni Kouanda, Christina Zarowsky
BackgroundAlthough the advantages of introducing point of care testing for syphilis in antenatal care (ANC) are well documented, there is little evidence on how to address structural issues within health systems. A better understanding of how these interventions work in a range of settings and contexts is needed in order to overcome bottlenecks at health system level. To better understand the relationships between implementation and context we developed and implemented an intervention focused on integrating a rapid screening test for syphilis in ANC services in rural primary health care facilities in Burkina Faso. This manuscript describes the intervention and reports on feasibility and acceptability of the intervention, the facilitators and barriers to the implementation of this intervention and the likelihood that point of care test for syphilis will become routinely incorporated in practice.MethodsIn Kaya Health and Demographic Surveillance System (Kaya HDSS), all 7 primary healthcare facilities were selected for intervention in 2013. A participatory approach was used to design and implement an antenatal syphilis screening intervention. The Normalization Process Model (NPM) proposed by May et al. was adapted in order to identify barriers and facilitators and to explore the likelihood to become routinely incorporated in practice. Registers, Observations (n = 14 ANC 1) of interactions between patients and health workers during ANC and interviews with health workers (n = 14) were our data sources.ResultsAn intervention that included onsite training, provision of supplies and medicines, quality control and supervision was implemented in 7 health facilities in 2013. Rapid syphilis test and treatment were delivered during ANC within the examination room with no specific additional mechanism regarding staff organization. The perceived barriers were lack of training of all staff, workload, stock-outs of consumables and lack of motivation of staff. Key facilitators includ