Faten Fedhila, Sarra Ben Ahmed, Elhem Jbebli, Fatma Mezghani, Samir Haddad, Samar Rhayem, Monia Khemiri
La localisation mammaire isolée d´un lymphome de Hodgkin est rare. Elle peut prêter à confusion avec les autres néoplasies et affections inflammatoires mammaires. Nous rapportons le cas d´une patiente âgée de 18 ans traitée pour lymphome de Hodgkin à cellularité mixte, qui s´est présenté 6 mois après la rémission complète pour un nodule mammaire inflammatoire gauche. Le bilan anatomopathologique initial a été en faveur d´un abcès mammaire. Les investigations face à l´évolution défavorable malgré une antibiothérapie adaptée ont été en faveur d´une rechute du LH avec une localisation mammaire isolée. La patiente est actuellement sous 4e ligne thérapeutique (polychimiothérapie). Les lymphomes Hodgkiniens mammaires sont connus par leur pronostic défavorable. Les progrès thérapeutiques (thérapie ciblée) peuvent améliorer le devenir des patientes.
Microbiologie (bactériologie, virologie)PharmacologiePédiatrieLicence : https://creativecommons.org/licenses/by/4.0/ The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (), which permits unrestricted use, distribution, and reproduction in any medium, p
BackgroundIn 2020, an estimated 287 000 women died globally from pregnancy‐related causes and 2 million babies were stillborn. Many of these outcomes can be prevented by quality healthcare during pregnancy and childbirth. Within the continuum of maternal health, antenatal care (ANC) is a key moment in terms of contact with the health system, yet it remains an underutilized platform. This paper describes the protocol for a study conducted in collaboration with Ministries of Health and country research partners that aims to employ implementation science to systematically introduce and test the applicability of the adapted WHO ANC package in selected sites across four countries.MethodsStudy design is a mixed methods stepped-wedge cluster randomized implementation trial with a nested cohort component (in India and Burkina Faso). The intervention is composed of two layers: (i) the country- (or state)-specific ANC package, including evidence-based interventions to improve maternal and newborn health outcomes, and (ii) the co-interventions (or implementation strategies) to help delivery and uptake of the adapted ANC package. Using COM-B model, co-interventions support behaviour change among health workers and pregnant women by (1) training health workers on the adapted ANC package and ultrasound (except in India), (2) providing supplies, (3) conducting mentoring and supervision and (4) implementing community mobilization strategies. In Rwanda and Zambia, a fifth strategy includes a digital health intervention. Qualitative data will be gathered from health workers, women and their families, to gauge acceptability of the adapted ANC package and its components, as well as experience of care. The implementation of the adapted ANC package of interventions, and their related costs, will be documented to understand to what extent the co-interventions were performed as intended, allowing for iteration.DiscussionResults from this study aim to build the global evidence base on how t
Biostatistiques et épidémiologiePédiatrieGynécologie-obstétriqueLicence : Open Access Creative Commons Attribution licence CC BY 3.0 IGO https://creativecommons.org/licenses/by/3.0/igo : The Article is licensed under the terms of the Creative Commons Attribution 3.0 IGO Licence (), which permits use, sharing, adaptation, distribution, and reproduction in any medium or for
Maguy Daures, Kevin Phelan, Mariama Issoufou, Séni Kouanda, Ousmane Sawadogo, Kader Issaley, Cecile Cazes, Benjamin Séri, Bertine Ouaro, Bruno Akpakpo, Vincent Mendiboure, Susan Shepherd, Renaud Becquet
The Optimising treatment for acute MAlnutrition (OptiMA) strategy trains mothers to use mid upper arm circumference (MUAC) bracelets for screening and targets treatment to children with MUAC < 125 mm or oedema with one therapeutic food at a gradually reduced dose. This study seeks to determine whether OptiMA conforms to SPHERE standards (recovery rate > 75 %). A single-arm proof-of-concept trial was conducted in 2017 in Yako district, Burkina Faso including children aged 6–59 months in outpatient health centres with MUAC < 125 mm or oedema. Outcomes were stratified by MUAC category at admission. Multivariate survival analysis was carried out to identify variables predictive of recovery. Among 4958 children included, 824 (16·6 %) were admitted with MUAC < 115 mm or oedema, 1070 (21·6 %) with MUAC 115–119 mm and 3064 (61·8 %) with MUAC 120–124 mm. The new dosage was correctly implemented at all visits for 75·9 % of children. Global recovery was 86·3 (95 % CI 85·4, 87·2) % and 70·5 (95 % CI 67·5, 73·5) % for children admitted with MUAC < 115 mm or oedema. Average therapeutic food consumption was 60·8 sachets per child treated. Recovery was positively associated with mothers trained to use MUAC prior to child’s admission (adjusted hazard ratio 1·09; 95 % CI 1·01, 1·19). OptiMA was successfully implemented at the scale of an entire district under ‘real-life’ conditions. Programme outcomes exceeded SPHERE standards, but further study is needed to determine if increasing therapeutic food dosages for the most severely malnourished will improve recovery.
PédiatrieSanté publiqueLicence : http://creativecommons.org/licenses/by/4.0/ This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Molly Cliff, Sally Jahn, Andre Bita Fouda, Anderson Latt, Clement Lingani, Caroline Trotter
BackgroundPrevious analytical work, defining the distribution of meningitis epidemics in Africa is over 20 years old, with climate change representing an ongoing issue. We aim to update this analysis and determine if the meningitis belt geography and associated environmental risk factors have changed in the last two decades.MethodsEpidemic bacterial meningitis data from 2003–2022 were provided by WHO-AFRO. Districts across Africa were coded 1 if they experienced a meningitis outbreak and 0 if not. Monthly means of windspeed, rainfall, dust, and humidity were processed into climatic profiles using k-means clustering. We undertook logistic regression with meningitis epidemic history as the dependent variable and k-means clusters of rainfall, dust, humidity, and windspeed, alongside land-cover type as independent variables. A sensitivity analysis was conducted, excluding the Democratic Republic of Congo (DRC), due to limited laboratory confirmation of cases.ResultsRainfall, dust, windspeed and humidity demonstrated the strongest statistical association with outbreaks and were included in our final model. With a probability cut-off >0.4, our model had specificity and sensitivity of 82.07% and 82.22%, respectively, in identifying districts having experienced a meningitis epidemic. The Sahelian region had the highest risk of meningitis outbreaks (probability >0.8), consistent with previous findings. The inclusion/exclusion of the DRC had a significant impact on our model. In the full model the Republic of the Congo, Gabon, and Angola had a moderate risk of meningitis (probability >0.4), suggesting a possible expansion of the belt. However, when the DRC was excluded, no countries surrounding the meningitis belt were at risk for outbreaks, highlighting the importance of laboratory testing and case confirmation.ConclusionsThe apparent extension of risk beyond the belt possibly reflects surveillance limitations rather than alterations in disease ecology. Where possible, labor
Biostatistiques et épidémiologieMicrobiologie (bactériologie, virologie)Maladies infectieuses et tropicalesLicence : This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Brahim El Hasbaoui, Lamia Karboubi, Badr Sououd Benjelloun
The haemorrhagic disorders are particularly frequent in neonatal period. Their causes are varied and their knowledge is capital for their good management. Our purpose was to describe the epidemiological, diagnostic, and common causes of new-bornhaemorrhagic syndrome in paediatric emergency medical department of the Rabat Children's Hospital. We conducted a descriptive study from December 2015 to April 2016, about new-borns admitted to medical emergencies for haemorrhagic syndrome defined by bleeding, exteriorized or not, whatever its importance, severity, causes and the associated clinical and biological disorders. Between December 2015 and April 2016, we identified 30 cases of newborn haemorrhagic syndromes on 594 hospitalizations (5.05%). The sex-ratio (M/F) was 1.5. None of them received vitamin K after birth and all were breastfed. Preterm infants accounted for 10%. The presentation of haemorrhage encountered was dominated by visceral bleeding especially digestive (80%), followed by epistaxis (10%), Haematuria (7%), and skin haemorrhage (3%). Physical examination was normal in most of cases with exception (nine babies had pallor with hypotonia, three babies suffered from hypovolemic shock, respiratory distress(10%), drowsiness, poor sucking and fever. The most common cause of bleeding disorder was haemorrhagic disease of the new-born (80%), disseminated intravascular coagulation (DIC) (10%), esophagitis (6.67%) and isolated thrombocytopenia (3.33%). At the end of our study, given the high frequency of vitamin k deficiency bleeding disease despite the prophylaxis received, a strengthening of the prevention system is necessary.
Biostatistiques et épidémiologiePédiatrieSanté publiqueLicence : The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Andreas Kuznik, Abdulrazaq G. Habib, Deogratias Munube, Mohammed Lamorde
BackgroundSickle cell disease (SCD) constitutes a major public health problem in sub-Saharan Africa (SSA). Newborn screening and early subsequent clinical intervention can reduce early mortality and increase life expectancy, but have not been widely implemented in SSA. This analysis assesses the cost-effectiveness of a newborn screening and prophylactic intervention (NSPI) package for SCD in 47 SSA countries.MethodsA lifetime Markov model with annual cycles was built with infants either being screened using isoelectric focusing (IEF) or not screened. Confirmed positive cases received interventions including insecticide-treated mosquito bed nets, folic acid supplementation, prophylactic antimalarial and penicillin therapy, and vaccinations against bacterial infections. Estimates for the local incidence of SCD, the life expectancy of untreated children, the SCD disability weight, and the cost of screening laboratory tests were based on published sources. Among treated infants, the annual probability of mortality until 30 years of age was derived from a pediatric hospital-based cohort. The outcome of interest included a country-specific cost per Disability Adjusted Life Year (DALY) averted.ResultsOf 47 modeled countries in SSA, NSPI is almost certainly highly cost-effective in 24 countries (average cost per DALY averted: US$184); in 10 countries, it is cost-effective in the base case (average cost per DALY averted: US$285), but the results are subject to uncertainty; in the remaining 13, it is most likely not cost-effective. We observe a strong inverse relationship between the incidence rate of SCD and the cost per DALY averted. Newborn screening is estimated to be cost-effective as long as the incidence rate exceeds 0.2–0.3 %, although in some countries NSPI is cost-effective at incidence rates below this range. In total, NSPI could avert over 2.4 million disability adjusted life years (DALYs) annually across SSA.ConclusionsUsing IEF to screen all newborns for SCD plu
Biostatistiques et épidémiologieParasitologie et mycologieImmunologieLicence : Open Access http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/publicdomain/zero/1.0/ This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (), which permits unrestricted use, distribution, and reproduction in any medium, provid
The region surrounding the Caribbean Sea is predominantly composed of island nations for its Eastern part and the American continental coast on its Western part. A large proportion of the population, particularly in the Caribbean islands, traces its ancestry to Africa as a consequence of the Atlantic slave trade during the XVI–XVIII centuries. As a result, sickle cell disease has been largely introduced in the region. Some Caribbean countries and/or territories, such as Jamaica and the French territories, initiated newborn screening (NBS) programs for sickle cell disease more than 20 years ago. They have demonstrated the major beneficial impact on mortality and morbidity resulting from early childhood care. However, similar programs have not been implemented in much of the region. This paper presents an update of the existing NBS programs and the prevalence of sickle cell disease in the Caribbean. It demonstrates the impact of the Caribbean Network of Researchers on Sickle Cell Disease and Thalassemia (CAREST) on the extension of these programs. The presented data illustrate the importance of advocacy in convincing policy makers of the feasibility and benefit of NBS for sickle cell disease when coupled to early care.
Biologie cellulaire et moléculaireGénétiqueBiostatistiques et épidémiologieLicence : http://creativecommons.org/licenses/by/4.0/ Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ().
Staphylococcus aureus is a pathogen with high epidemic potential frequently involved in nosocomials and communities infections. The pathogenicity of Staphylococcus aureus is due to both its ability to resist antibiotics and to Produce toxins. This work aims at studying the resistance and Molecular Epidemiology of Staphylococcus aureus. Antibiotic susceptibility of the 70 strains isolates of Staphylococcus aureus was determined by agar diffusion while Multiplex PCR and MLST were used to search toxin-coding genes and MRSA typing, respectively. 14.28% of isolates were multidrug resistant. Staphylococcus aureus showed high susceptibility to aminoglycoside and Macrolides familly. lukS-PV/lukF-PV and sea genes were detected in 45% and 3% of Staphylococcus aureus respectively. Ten (10) sequence types including ST5710, ST2430, ST5289, ST5786, ST6942, ST6943, ST6944, ST6945, ST6946, ST6947 have been reported. The study showed a diversity of antibiotic resistance phenotypes and a great diversity of MRSA clones causing infections.
Biologie cellulaire et moléculaireGénétiqueBiostatistiques et épidémiologieLicence : Open Access http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/publicdomain/zero/1.0/ This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as
Until 2010, Burkina Faso was an exception to the international trend of abolishing user fees for antiretroviral treatment (ART). Patients were still expected to pay 1,500F CFA (2 Euros) per month for ART. Nevertheless, many non-governmental organizations (NGOs) exempted patients from payment. The objective of this study was to investigate how NGOs selected the beneficiaries of payment exemptions for government-provided ART and rationed out complementary medical and psychosocial services.For this qualitative study, we conducted 13 individual interviews and three focus group discussions (n = 13 persons) with program staff in nine NGOs (4,000 patients), two NGO coordinating structures and one national program. These encounters were recorded and transcribed, and their content was thematically analyzed. The results were presented to the NGOs for feedback.Results indicate that there are no concrete guidelines for identifying patients warranting payment exemptions. Formerly, ART was scarce in Burkina Faso and the primary criterion for treatment selection was clinical. Our results suggest that this scarcity, mediated by an approach we call sociotherapeutic rationality (i.e. maximization of clinical success), may have led to inequities in the provision of free ART. This approach may be detrimental to assuring equity since the most impoverished lack resources to pay for services that maximize clinical success (e.g. viral load) that would increase their chances of being selected for treatment. However, once selected into treatment, attempts were made to ration-out complementary services more equitably.This study demonstrates the risks entailed by medication scarcity, which presents NGOs and health professionals with impossible choices that run counter to the philosophy of equity in access to treatment. Amid growing concerns of an international funding retreat for ART, it is important to learn from the past in order to better manage the potentially inequitable consequences of A
Biologie cellulaire et moléculaireGénétiqueImmunologieLicence : http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Malgré une amélioration globale de l’état bucco-dentaire des enfants en France, la maladie carieuse reste fréquente et fortement influencée par des facteurs comportementaux, éducatifs et sociaux. Dans ce contexte, un programme de promotion de la santé bucco-dentaire a été mis en place en 2025 auprès des élèves de cours élémentaire 1 (CE1) de la ville de Pessac, en partenariat avec l’association Humadentaire et l’unité de formation et de recherche (UFR) d’Odontologie de l’Université de Bordeaux. L’objectif de cette étude était d’estimer la prévalence et le niveau de carie chez les enfants participants, de décrire leurs connaissances et habitudes en santé bucco-dentaire, et d’étudier le lien entre ces connaissances, les comportements déclarés et l’état clinique observé. Une étude observationnelle transversale a été réalisée à partir des données recueillies lors du programme, incluant un questionnaire éducatif portant sur les habitudes d’hygiène, l’alimentation et les connaissances relatives à la carie, ainsi que d’un dépistage bucco-dentaire.
Biostatistiques et épidémiologieSémiologieMaladies infectieuses et tropicalesLicence : https://creativecommons.org/licenses/by/4.0/
Ahmed Yaogo, Alain Sommer, Pierre Moulaï, Saïd Chebili, Agnès Abaoub-Germain
IntroductionLe Burkina Faso a connu une amélioration constante depuis deux décennies de l'offre de soins en psychiatrie. De même, le taux d'alphabétisation sans cesse croissant s'accompagne d'une profonde modification des conceptions et des comportements. La présente étude visait à déterminer l′impact des déterminants socioéconomiques sur le processus du recours aux soins par les familles.MéthodesIl s'est agi d'une enquête transversale portant sur 200 familles, menée dans le service de psychiatrie du Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou. Variable à expliquer: premier recours aux soins par les familles (guérisseur traditionnel ou prières religieuses vs. consultations psychiatrique ou médicale). Variable explicative: catégorie socioprofessionnelle classée en suivant la nomenclature des professions et catégories socioprofessionnelles; niveau d’études. L'analyse statistique a été effectuée à l'aide du logiciel SAS version 9.2. Le test du Khi deux a été utilisé.RésultatsIl existait une association entre le choix du premier recours et la Profession et la catégorie socioprofessionnelledu « décideur » (p = 0.0006) ainsi que leniveau d’études du « décideur » (p = 0.0001).ConclusionLa Profession et Catégorie Sociale et le niveau d'instruction scolaire pourraient être un marqueur important dans les politiques visant à optimiser les processus de recours aux soins des patients dans le circuit de soins.
Biostatistiques et épidémiologieSanté publiqueLicence : The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aline Philibert, Valéry Ridde, Aristide Bado, Pierre Fournier
BackgroundAlthough many developing countries have developed user fee exemption policies to move towards universal health coverage as a priority, very few studies have attempted to measure the quality of care. The present paper aims at assessing whether women’s satisfaction with delivery care is maintained with a total fee exemption in Burkina Faso.MethodsA quasi-experimental design with both intervention and control groups was carried out. Six health centres were selected in rural health districts with limited resources. In the intervention group, delivery care is free of charge at health centres while in the control district women have to pay 900 West African CFA francs (U$2). A total of 870 women who delivered at the health centre were interviewed at home after their visit over a 60-day range. A series of principal component analyses (PCA) were carried out to identify the dimension of patients’ satisfaction.ResultsWomen’s satisfaction loaded satisfactorily on a three-dimension principal component analysis (PCA): 1-provider-patient interaction; 2-nursing care services; 3-environment. Women in both the intervention and control groups were satisfied or very satisfied in 90% of cases (in 31 of 34 items). For each dimension, average satisfaction was similar between the two groups, even after controlling for socio-demographic factors (p = 0.436, p = 0.506, p = 0.310, respectively). The effects of total fee exemption on satisfaction were similar for any women without reinforcing inequalities between very poor and wealthy women (p ≥ 0.05). Although the wealthiest women were more dissatisfied with the delivery environment (p = 0.017), the poorest were more highly satisfied with nursing care services (p = 0.009).ConclusionContrary to our expectations, total fee exemption at the point of service did not seem to have a negative impact on quality of care, and women’s perceptions remained very positive. This paper shows that the policy of completely abolishing user fees with or
Santé publiqueLicence : http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
BackgroundThe geographic overlap between HIV-1 and malaria has generated much interest in their potential interactions. A variety of studies have evidenced a complex HIV-malaria interaction within individuals and populations that may have dramatic effects, but the causes and implications of this co-infection at the population level are still unclear. In a previous publication, we showed that the prevalence of malaria caused by the parasite Plasmodium falciparum is associated with HIV infection in eastern sub-Saharan Africa. To complement our knowledge of the HIV-malaria co-infection, the objective of this work was to assess the relationship between malaria and HIV prevalence in the western region of sub-Saharan Africa.Methodology/Principal FindingsPopulation-based cross-sectional data were obtained from the HIV/AIDS Demographic and Health Surveys conducted in Burkina Faso, Ghana, Guinea, Mali, Liberia and Cameroon, and the malaria atlas project. Using generalized linear mixed models, we assessed the relationship between HIV-1 and Plasmodium falciparum parasite rate (PfPR) adjusting for important socio-economic and biological cofactors. We found no evidence that individuals living in areas with stable malaria transmission (PfPR>0.46) have higher odds of being HIV-positive than individuals who live in areas with PfPR≤0.46 in western sub-Saharan Africa (estimated odds ratio 1.14, 95% confidence interval 0.86–1.50). In contrast, the results suggested that PfPR was associated with being infected with HIV in Cameroon (estimated odds ratio 1.56, 95% confidence interval 1.23–2.00).Conclusion/SignificanceContrary to our previous research on eastern sub-Saharan Africa, this study did not identify an association between PfPR and infection with HIV in western sub-Saharan Africa, which suggests that malaria might not play an important role in the spread of HIV in populations where the HIV prevalence is low. Our work highlights the importance of understanding the epidemiologic ef
Biostatistiques et épidémiologieParasitologie et mycologieImmunologieLicence : This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
Achille Sindimbasba Nikièma, Lassane Koala, Rabila Bamogo, Simon P. Sawadogo, Arielle Bettina Sandra Badiel, Ali Ouari, Abdoul-Aziz Millogo, Clarisse Bougouma, Mamadou Sermé, Soungalo Traoré, Babacar Faye, Roch Kounbobr Dabiré
BackgroundThe Lymphatic Filariasis Elimination Programme was launched in Burkina Faso in 2001 aiming to eliminate the disease as a public health concern through mass drug administration (MDA). After eight years of MDA, the Hauts-Bassins region successfully passed the Transmission Assessment Survey (TAS), which led to the MDA being stopped. This study aims to assess whether parasite transmission has resurfaced in areas where MDA was stopped more than ten years ago.MethodsA cross-sectional entomological survey was conducted in the villages of Tiebalogo and Tondogosso, in the Hauts-Bassins region. From August to December 2022, adult mosquitoes were collected using Human Landing Collection (HLC) indoor and outdoor, Window Exit Trap (WET) and Pyrethrum Spray Collection (PSC). Mosquitoes were identified morphologically. Genomic DNAs extracted from An. gambiae s.l., An. funestus, An. nili were amplified by PCR for Wuchereria bancrofti parasite detection.ResultsA total of 2688 mosquitoes were collected in both study sites, with 630 being collected in Tondogosso and 2058 in Tiebalogo. The An. gambiae s.l. was the predominant mosquitoes, with high numbers being collected in both sites. Of those collected in Tiebalogo, 1786 (86.78%) were identified as An. gambiae s.l., while 373 (59.21%) were identified in Tondogosso. The HLC method collected the greatest number of mosquitoes, followed by the PSC and WET methods. No Wuchereria bancrofti DNA was detected in any of the mosquito pools analyzed in both sites.ConclusionsThese findings provide further evidence that there is no Lymphatic Filariasis transmission occurring in Hauts-Bassin’s post-TAS area. Molecular xenomonitoring of the filarial parasite which is a sensitive tool, could also serve as a complementary tool for monitoring transmission in post-MDA area and help national neglected tropical disease control program with surveillance in these areas.
Biologie cellulaire et moléculaireGénétiqueBiostatistiques et épidémiologieLicence : Open Access http://creativecommons.org/licenses/by/4.0/ This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original autho
Access to safe, effective, and affordable essential medicines (EM) is critical to quality health services and as such has played a key role in innovative health system strengthening approaches such as Performance-based Financing (PBF). Available literature indicates that PBF can improve EM availability, but has not done so consistently in the past. Qualitative explorations of the reasons are yet scarce. We contribute to expanding the literature by estimating the impact of PBF on EM availability and stockout in Burkina Faso and investigating mechanisms of and barriers to change. The study used an explanatory mixed methods design. The quantitative study component followed a quasi-experimental design (difference-in-differences), comparing how EM availability and stockout had changed three years after implementation in 12 PBF and in 12 control districts. Qualitative data was collected from purposely selected policy and implementation stakeholders at all levels of the health system and community, using in-depth interviews and focus group discussions, and explored using deductive coding and thematic analysis. We found no impact of PBF on EM availability and stockouts in the quantitative data. Qualitative narratives converge in that EM supply had increased as a result of PBF, albeit not fully satisfactorily and sustainably so. Reasons include persisting contextual challenges, most importantly a public medicine procurement monopoly; design challenges, specifically a disconnect and disbalance in incentive levels between service provision and service quality indicators; implementation challenges including payment delays, issues around performance verification, and insufficient implementation of activities to strengthen stock management skills; and concurrently implemented policies, most importantly a national user fee exemption for children and pregnant women half way through the impact evaluation period. The case of PBF and EM availability in Burkina Faso illustrates the dif
PédiatrieGynécologie-obstétriqueSanté publiqueLicence : Creative Commons Attribution License This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
La nocardiose est une infection rare, mais sévère, causée par des bactéries du genre nocardia, qui appartiennent à l'ordre des actinomycétales. Si elles peuvent toucher l'adulte immunocompétent, les nocardioses restent des pathologies de l'individu fragilisé sur le plan immunitaire. L'atteinte pulmonaire reste la plus fréquente, sa prise en charge correcte est liée au diagnostic qui est souvent retardé par des présentations non spécifiques et des prélèvements non concluants. Nous rapportons ici deux cas de nocardiose chez des patients immunocompétents. Le premier cas est celui d'un homme de 24 ans, avec notion de tabagisme et d'éthylisme, hospitalisé pour des douleurs thoraciques et des hémoptysies de faible abondance, évoluant depuis deux mois, avec apparition d'abcès sous cutanés dorsaux fistulisés. L'exploration radiologique découvre une masse tissulaire médiastino-pulmonaire droite avec lyse costale adjacente et diffusion aux tissus para vertébraux droits. Les prélèvements bactériologiques restent négatifs motivant une biopsie scannoguidée de la lésion qui est revenue en faveur d'infection à nocardiose. Le second cas concerne un homme de 22 ans, aux antécédents de tuberculose pleurale traitée il y a 8 ans puis une rechute de tuberculose en 2011 (abcès médiastinal). Admis pour suspicion de rechute de tuberculose devant une toux chronique avec altération de l'état général et une hépatosplénomégalie. Le scanner thoracique montre des condensations alvéolaires avec pleurésie. Au cours de son hospitalisation, apparition de tuméfactions sous cutanées purulentes dont l'étude bactériologique du pus est revenue en faveur de nocardiose avec une souche résistante à tous les antibiotiques sauf colistine et bactrim. Les auteurs illustrent à travers ces deux observations, les aspects cliniques et radiologiques de nocardiose pulmonaire en mettant le point sur les difficultés diagnostiques et thérapeutiques surtout dans un pays à forte prévalence de tuberculose et très faible in
Biostatistiques et épidémiologieMicrobiologie (bactériologie, virologie)ImmunologieLicence : The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
VS L'Esperance, T Ekong, SE Cox, J Makani, CR Newton, D Soka, A Komba, FJ Kirkham, CM Hill
Low haemoglobin oxygen saturation (SpO2) predicts complications in children with sickle cell anaemia (SCA) in the North but there are few data from Africa, where the majority of the patients reside. We measured daytime and overnight SpO2 in children with SCA in routine follow-up clinic, and controls without symptoms of SCA, comparing rural (Kilifi, Kenya) and urban (Dar-es-Salaam, Tanzania) cohorts. Daytime SpO2 was lower in 65 Tanzanian children with SCA (TS; median 97 (IQR 94–100)%); p<0.0001) than in 113 Kenyan children with SCA (KS; 99 (98–100)%) and 20 Tanzanian controls (TC; 100 (98–100)%). Compared with 95 Kenyan children with SCA, in 54 Tanzanian children with SCA and 19 TC who returned for overnight oximetry, mean (KS 99.0 (96.7–99.8)%; TS 97.9 (95.4–99.3)%; TC 98.4 (97.5–99.1)%; p=0.01) and minimum nocturnal SpO2 (92 (86–95)%; 87 (78.5–91)%; 90 (83.5–93)% p=0.0001) were lower. The difference between children with SCA persisted after adjustment for haemoglobin (p=0.004). Urban Tanzanian children, with and without SCA, experience greater exposure to low daytime and night-time SpO2 compared with rural Kenyan children with SCA. Possible explanations include differences in the prevalence of obstructive sleep apnoea or asthma, alterations in the oxyhaemoglobin desaturation curve or cardiovascular compromise, for example, to shunting at atrial or pulmonary level secondary to increased pulmonary artery pressure. The fact that non-SCA siblings in the urban area are also affected suggests that environmental exposures, for example, air pollution, nutrition or physical exercise, may play a role. Further studies should determine aetiology and clinical relevance for the SCA phenotype in children resident in Africa.
Biostatistiques et épidémiologieHématologieMédecine interne (cardiologie, endocrinologie, néphrologie…)Licence : http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is pr
Licence : The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Licence : The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Papa Souleymane Touré, Cheikh Tidiane Tall, Pauline Dioussé, Adama Berthé, Madoky Maguatte Diop, Mamadou Moustapha Sarr, Balla Diop, Yakham Mohamed Léye, Bernard Marcel Diop, Mamadou Mourtalla Ka
Le nodule de Sœur Marie-Josèphe est une métastase ombilicale d'une tumeur le plus souvent intra-abdominale. C'est un signe clinique rare dont l'incidence est de 1-3% de toutes les néoplasies abdomino-pelviennes, avec un pronostic péjoratif du fait de son retard diagnostique. Nous rapportons quatre observations d'une métastase cutanée ombilicale révélatrice d'un adénocarcinome dont deux pancréatiques, un gastrique et un d'origine ovarienne. Le but de notre travail est de montrer à travers ces quatre cas cliniques, l'intérêt de l'imagerie (tomodensitométrie, échographie) et de la biopsie dans la démarche diagnostique. A travers ces quatre observations nous insistons aussi sur les difficultés diagnostiques et thérapeutiques que pose cette tumeur dans nos pays à ressources limitées.
Licence : The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Licence : The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Licence : The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Licence : The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Licence : The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.