La bibliothèque des étudiants en santé

9415 ressources

• Lien vers la sourceArticle

  Éditorial

  Jimmy Armoogum, Philippe Cordazzo, Virginie Dejoux, Yara Makdessi, Nicolas Rebière

  Biostatistiques et épidémiologieSanté publiqueLicence : https://creativecommons.org/licenses/by/4.0/

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Editorial - Using death investigation data to better understand the overdose crisis

  Amanda VanSteelandt, Jenny Rotondo

  Licence : This work is licensed under a Creative Commons Attribution 4.0 International License

  Lire dans MyLaafi
• Lien vers la sourceMémoire

  Éducation de l'entourage d'un patient ayant une maladie chronique par le médecin généraliste

  Julie Cartelle

  Introduction : l’Éducation Thérapeutique du Patient (ETP) s’impose en médecine de ville. Les médecins généralistes, comme le recommandent les autorités publiques et professionnelles, y jouent un rôle important. En tant que médecins de « famille », ils reconnaissent une place majeure des relations que le patient peut avoir. L’entourage ou le proche a une influence essentielle. L’objectif de cette enquête est de percevoir la posture éducative des médecins généralistes formés face à l’entourage d’un patient atteint de maladie chronique. Méthode : une étude qualitative par entretiens semi-dirigés a été réalisée, interrogeant des médecins généralistes formés à l’ETP. Quatorze médecins ont été interviewés. Ils avaient bénéficié de la formation aux quarante heures par l’Union Régionale des Professionnels de Santé (URPS) ou par la COordination pour la Prévention et d’Éducation du Patient en PIcardie (COPEPPI). Résultats : les praticiens utilisaient les savoir-faire et les savoir-être acquis sur l’entourage comme sur le patient. Ils définissaient le proche selon son rôle, avec ses forces et ses limites, qu’ils intégraient ou non selon certains éléments. Ils étaient conscients de l’impact de cette posture sur tous, avec ses limites et freins, réalisant déjà des actions, ou forces de proposition pour augmenter l’intégration de cette population, afin d’améliorer la santé du patient et finalement la sienne. Conclusion : les médecins généralistes formés réalisent des actions éducatives sur les proches. En développant des actions à destination de l’entourage, cela améliorerait la santé et la qualité de vie du patient, ainsi que sa propre santé.

  Biostatistiques et épidémiologieSémiologieMaladies infectieuses et tropicalesLicence : https://creativecommons.org/licenses/by/4.0/

  Lire dans MyLaafi
• Lien vers la sourceArticle

  Éducation inclusive, réussite scolaire et passage à l’âge adulte

  Serge Ebersold

  Cet article analyse les conditions de scolarisation de lycéens danois, français, néerlandais et tchèques inscrits en 2007 en terminale et interroge l’aptitude des systèmes éducatifs à placer les élèves à besoins éducatifs particuliers (BEP) à égalité de chances avec les autres élèves en termes d’accès, de réussite et de devenir. Il suggère que les politiques inclusives développées ces dernières années peinent à réduire les inégalités entre ces élèves et l’ensemble de la population scolaire. Il révèle que les systèmes scolaires peinent à mettre en œuvre les principes censés régir la scolarisation des élèves à BEP. Ils s’en trouvent surexposés au risque d’échec scolaire et aux vulnérabilités qui entourent l’accès à l’enseignement supérieur et à l’emploi, notamment lorsque leur trouble réside dans la distance à la norme scolaire, comme c’est le cas des troubles de l’apprentissage. Il montre également qu’en déléguant aux familles l’accessibilisation de l’environnement éducatif, il tend à renforcer les effets inégalitaires des mécanismes visibles et invisibles de sélection qui traversent les systèmes éducatifs, notamment en France.

  Biostatistiques et épidémiologieSanté publiqueLicence : https://creativecommons.org/licenses/by/4.0/

  Lire dans MyLaafi
• Article libreArticle

  Éducation thérapeutique au Mali : un atelier de formation pour soignants et jeunes diabétiques de type 1

  A. Togo, M. Minkailou, P. Trebuchet, D. Sylla, A.T. Sidibé, S. Besançon, M. Nguemeni, T. Signe, B. Lab, M. Castellsague

  En mars 2021, dans le cadre d'un partenariat entre les Hôpitaux Universitaires de Genève (HUG), l'Organisation Santé Diabète et le ministère de la Santé du Mali, une formation de 4 jours sous forme d'ateliers a été organisée avec l'objectif de renforcer les compétences des soignants en matière d’éducation thérapeutique du patient (ETP) destinée aux enfants et jeunes diabétiques de type 1. Pour assurer l'interprofessionnalité, des binômes médico-infirmiers travaillant déjà ensemble au sein des structures de santé de 7 régions du Mali ont participé à la formation. Au-delà de la complémentarité entre les professionnels, il s'agit de s'adapter aux réalités du système de santé malien. Toutes les activités étaient co-animés par des binômes de professionnels médecin et infirmier spécialisés en diabétologie et en ETP. Au total 30 professionnels, ont participé à la formation qui s'est déroulée en 2 jours de cours et 2 jours de camp avec des enfants diabétiques de type 1 et leur entourage. Pour renforcer la capacité des soignants à pratiquer l'ETP, nous avons choisi des approches innovantes avec des activités permettant la mise en pratique immédiate des compétences apprises avec divers outils pédagogiques. Les bénéficiaires étant non seulement les professionnels, mais aussi les enfants et adolescents et leur entourage, sans oublier les formateurs.

  Médecine interne (cardiologie, endocrinologie, néphrologie…)PédiatrieLicence : https://creativecommons.org/licenses/by/4.0/ Cet article en libre accès est distribué selon les termes de la licence Creative Commons CC BY 4.0 ().

  Lire dans MyLaafi
• Lien vers la sourceLivre

  Éducation thérapeutique du patient. Modèles, pratiques et évaluation

  Jérôme Foucaud, Jacques A. Bury, Maryvette Balcou-Debussche, Chantal Eymard

  Issu d’une collaboration entre l’Inpes et des acteurs de l’éducation thérapeutique du patient, cet ouvrage rassemble des analyses d’interventions d’éducation thérapeutique mises en place en France et au Québec, dans le cadre de huit maladies chroniques : diabète, obésité, maladies cardio-vasculaires, VIH/sida, asthme, cancer, polyarthrite rhumatoïde et lombalgie. En rendant compte des modèles théoriques qui sous-tendent l’éducation thérapeutique et des démarches mises en œuvre, les contributions mettent au jour une large diversité de pratiques. Qu’il soit professionnel de santé, formateur ou chercheur, le lecteur trouvera ainsi des pistes pour démarrer, développer et évaluer ses actions éducatives. Il trouvera aussi matière à éprouver ses conceptions de la santé et de l’éducation, notamment à travers la découverte de pratiques qui produisent des résultats très encourageants alors qu’elles se réfèrent à des cadres théoriques diversifiés et à des voies différenciées pour penser l’action éducative. Parce qu’elles ne montrent pas l’excellence d’une voie plutôt qu’une autre, ces analyses invitent au développement de nouvelles perspectives d’action et de recherche. L’ouvrage offre ainsi une ouverture précieuse dans un contexte général où l’éducation thérapeutique s’inscrit dans le Code de santé publique, notamment à travers la loi Hôpital, patients, santé et territoires du 21 juillet 2009, qui en reconnaît l’importance pour l’amélioration de l’état de santé des personnes, en particulier de celles atteintes d’une maladie chronique.

  ImmunologieSémiologieMaladies infectieuses et tropicalesLicence : https://creativecommons.org/publicdomain/zero/1.0/

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Efavirenz-based simplification after successful early lopinavir-boosted-ritonavir-based therapy in HIV-infected children in Burkina Faso and Côte d’Ivoire: the MONOD ANRS 12206 non-inferiority randomised trial

  Désiré Lucien Dahourou, Madeleine Amorissani-Folquet, Karen Malateste, Clarisse Amani-Bosse, Malik Coulibaly, Carole Seguin-Devaux, Thomas Toni, Rasmata Ouédraogo, Stéphane Blanche, Caroline Yonaba, François Eboua, Philippe Lepage, Divine Avit, Sylvie Ouédraogo, Philippe Van de Perre, Sylvie N’Gbeche, Angèle Kalmogho, Roger Salamon, Nicolas Meda, Marguerite Timité-Konan, Valériane Leroy

  BackgroundThe 2016 World Health Organization guidelines recommend all children <3 years start antiretroviral therapy (ART) on protease inhibitor-based regimens. But lopinavir/ritonavir (LPV/r) syrup has many challenges in low-income countries, including limited availability, requires refrigeration, interactions with anti-tuberculous drugs, twice-daily dosing, poor palatability in young children, and higher cost than non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs. Successfully initiating LPV/r-based ART in HIV-infected children aged <2 years raises operational challenges that could be simplified by switching to a protease inhibitor-sparing therapy based on efavirenz (EFV), although, to date, EFV is not recommended in children <3 years.MethodsThe MONOD ANRS 12026 study is a phase 3 non-inferiority open-label randomised clinical trial conducted in Abidjan, Côte d’Ivoire, and Ouagadougou, Burkina Faso (ClinicalTrial.gov registry: NCT01127204). HIV-1-infected children who were tuberculosis-free and treated before the age of 2 years with 12–15 months of suppressive twice-daily LPV/r-based ART (HIV-1 RNA viral load (VL) <500 copies/mL, confirmed) were randomised to two arms: once-daily combination of abacavir (ABC) + lamivudine (3TC) + EFV (referred to as EFV) versus continuation of the twice-daily combination zidovudine ( ZDV) or ABC + 3TC + LPV/r (referred to as LPV). The primary endpoint was the difference in the proportion of children with virological suppression by 12 months post-randomisation between arms (14% non-inferiority bound, Chi-squared test).ResultsBetween May 2011 and January 2013, 156 children (median age 13.7 months) were initiated on ART. After 12–15 months on ART, 106 (68%) were randomised to one of the two treatment arms (54 LPV, 52 EFV); 97 (91%) were aged <3 years. At 12 months post-randomisation, 46 children (85.2%) from LPV versus 43 (82.7%) from EFV showed virological suppression (defined as a VL <500 copies/mL; difference, 2.5%; 95%

  Microbiologie (bactériologie, virologie)ImmunologiePharmacologieLicence : 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

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of a mass radio campaign on family behaviours and child survival in Burkina Faso: a repeated cross-sectional, cluster-randomised trial

  Sophie Sarrassat, Nicolas Meda, Hermann Badolo, Moctar Ouedraogo, Henri Some, Robert Bambara, Joanna Murray, Pieter Remes, Matthiew Lavoie, Simon Cousens, Roy Head

  SummaryBackgroundMedia campaigns can potentially reach a large audience at relatively low cost but, to our knowledge, no randomised controlled trials have assessed their effect on a health outcome in a low-income country. We aimed to assess the effect of a radio campaign addressing family behaviours on all-cause post-neonatal under-5 child mortality in rural Burkina Faso.MethodsIn this repeated cross-sectional, cluster randomised trial, clusters (distinct geographical areas in rural Burkina Faso with at least 40 000 inhabitants) were selected by Development Media International based on their high radio listenership (>60% of women listening to the radio in the past week) and minimum distances between radio stations to exclude population-level contamination. Clusters were randomly allocated to receive the intervention (a comprehensive radio campaign) or control group (no radio media campaign). Household surveys were performed at baseline (from December, 2011, to February, 2012), midline (in November, 2013, and after 20 months of campaigning), and endline (from November, 2014, to March, 2015, after 32 months of campaigning). Primary analyses were done on an intention-to-treat basis, based on cluster-level summaries and adjusted for imbalances between groups at baseline. The primary outcome was all-cause post-neonatal under-5 child mortality. The trial was designed to detect a 20% reduction in the primary outcome with a power of 80%. Routine data from health facilities were also analysed for evidence of changes in use and these data had high statistical power. The indicators measured were new antenatal care attendances, facility deliveries, and under-5 consultations. This trial is registered with ClinicalTrial.gov, number NCT01517230.FindingsThe intervention ran from March, 2012, to January, 2015. 14 clusters were selected and randomly assigned to the intervention group (n=7) or the control group (n=7). The average number of villages included per cluster was 34 in the c

  Biostatistiques et épidémiologiePédiatrieSanté publiqueLicence : This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of a prospective payment method for health facilities on direct medical expenditures in a low-resource setting: a paired pre-post study

  Ivlabèhiré Bertrand Meda, Seni Kouanda, Alexandre Dumont, Valéry Ridde

  AbstractAlmost all sub-Saharan countries have adopted cost-reduction policies to facilitate access to health care. However, several studies underline the reimbursement delays experienced by health facilities, which lead to deficient implementation of these policies. In April 2016, for its free care policy, Burkina Faso shifted from fee-for-service (FFS) paid retrospectively to FFS paid prospectively. This study tested the hypothesis that this new method of payment would be associated with an increase in direct medical expenditures (expenses covered by the policies) associated with deliveries. This paired pre-post study used data from two cross-sectional national surveys. Observations were paired according to the health facility and the type of delivery. We used a combined approach (state and household perspectives) to capture all direct medical expenses (delivery fees, drugs and supplies costs, paraclinical exam costs and hospitalization fees). A Wilcoxon signed-rank test was used to test the hypothesis that the 2016 distribution of direct medical expenditures was greater than that for 2014. A total of 279 pairs of normal deliveries, 66 dystocia deliveries and 48 caesareans were analysed. The direct medical expenditure medians were USD 4.97 [interquartile range (IQR): 4.30–6.02], 22.10 [IQR: 15.59–29.32] and 103.58 [IQR: 85.13–113.88] in 2014 vs USD 5.55 [IQR: 4.55–6.88], 23.90 [IQR: 17.55–48.81] and 141.54 [IQR: 104.10–172.02] in 2016 for normal, dystocia and caesarean deliveries, respectively. Except for dystocia (P = 0.128) and medical centres (P = 0.240), the 2016 direct medical expenditures were higher than the 2014 expenses, regardless of the type of delivery and level of care. The 2016 expenditures were higher than the 2014 expenditures, regardless of the components considered. In the context of cost-reduction policies in sub-Saharan countries, greater attention must be paid to the provider payment method and cost-control measures because these elements may g

  Biostatistiques et épidémiologiePharmacologieSanté publiqueLicence : http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of a serogroup A meningococcal conjugate vaccine (PsA–TT) on serogroup A meningococcal meningitis and carriage in Chad: a community study

  DM Daugla, JP Gami, K Gamougam, N Naibei, L Mbainadji, M Narbé, J Toralta, B Kodbesse, C Ngadoua, ME Coldiron, F Fermon, A-L Page, MH Djingarey, S Hugonnet, OB Harrison, LS Rebbetts, Y Tekletsion, ER Watkins, D Hill, DA Caugant, D Chandramohan, M Hassan-King, O Manigart, M Nascimento, A Woukeu, C Trotter, JM Stuart, MCJ Maiden, BM Greenwood

  SummaryBackgroundA serogroup A meningococcal polysaccharide–tetanus toxoid conjugate vaccine (PsA–TT, MenAfriVac) was licensed in India in 2009, and pre-qualified by WHO in 2010, on the basis of its safety and immunogenicity. This vaccine is now being deployed across the African meningitis belt. We studied the effect of PsA–TT on meningococcal meningitis and carriage in Chad during a serogroup A meningococcal meningitis epidemic.MethodsWe obtained data for the incidence of meningitis before and after vaccination from national records between January, 2009, and June, 2012. In 2012, surveillance was enhanced in regions where vaccination with PsA–TT had been undertaken in 2011, and in one district where a reactive vaccination campaign in response to an outbreak of meningitis was undertaken. Meningococcal carriage was studied in an age-stratified sample of residents aged 1–29 years of a rural area roughly 13–15 and 2–4 months before and 4–6 months after vaccination. Meningococci obtained from cerebrospinal fluid or oropharyngeal swabs were characterised by conventional microbiological and molecular methods.FindingsRoughly 1·8 million individuals aged 1–29 years received one dose of PsA–TT during a vaccination campaign in three regions of Chad in and around the capital N'Djamena during 10 days in December, 2011. The incidence of meningitis during the 2012 meningitis season in these three regions was 2·48 per 100 000 (57 cases in the 2·3 million population), whereas in regions without mass vaccination, incidence was 43·8 per 100 000 (3809 cases per 8·7 million population), a 94% difference in crude incidence (p<0·0001), and an incidence rate ratio of 0·096 (95% CI 0·046–0·198). Despite enhanced surveillance, no case of serogroup A meningococcal meningitis was reported in the three vaccinated regions. 32 serogroup A carriers were identified in 4278 age-stratified individuals (0·75%) living in a rural area near the capital 2–4 months before vaccination, whereas only one ser

  Microbiologie (bactériologie, virologie)ImmunologieMaladies infectieuses et tropicalesLicence : https://creativecommons.org/licenses/by/3.0/ This is an open access article under the CC BY license ().

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of age and sex on the associations between potential modifiable risk factors and both type 2 diabetes and impaired fasting glycaemia among West African adults

  Ayuba Issaka, Adrian J. Cameron, Yin Paradies, William K. Bosu, Yèssito Corine N. Houehanou, Jean B. Kiwallo, Chea S. Wesseh, Dismand S. Houinato, Diarra J. P. Nazoum, Christopher Stevenson

  BackgroundType 2 diabetes mellitus (T2DM) is becoming one of the leading causes of morbidity and mortality worldwide, including among Africans. Knowledge of the association between traditional risk factors and both diabetes and pre-diabetes, and whether these differ by age and sex, is important for designing targeted interventions. However, little is known about these associations for African populations.MethodsThe study used data from WHO STEPS surveys, comprising 15,520 participants (6,774 men and 8,746 women) aged 25–64 years, from 5 different West African countries, namely Burkina Faso (4,711), Benin (3,816), Mali (1,772), Liberia (2,594), and Ghana (2,662). T-test and chi-square tests were used to compare differences in the prevalence of traditional risk factors for both sexes. Multinomial logistic regression was conducted to ascertain the relative risks (RR) and 95% confidence intervals (CI) for both T2DM and impaired fasting glucose (IFG) relating to each risk factor, including obesity [defined by BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)], high blood pressure (HBP), fruit and vegetable consumption, physical inactivity, alcohol consumption, and smoking. Models for each of these traditional risk factors and interactions with age and sex were fitted.ResultsFactors associated with T2DM and IFG were age, obesity [defined by BMI, WC, WHtR, and WHR], HBP, smoking, physical inactivity, and fruit and vegetable consumption (p < 0.05). Analysis of interaction effects showed few significant differences in associations between risk factors and T2DM according to age or sex. Significant interaction with age was observed for HBPage and T2DM [RR; 1.20, 95% CI: (1.01, 1.42)) (p = 0.04)], WHtRage and T2DM [RR; 1.23, 95% CI: (1.06, 1.44) (p = 0.007)] and WHR*age and IFG [RR: 0.79, 95% CI: (0.67, 0.94) (p = 0.006)]. Some interactions with age and sex were observed for the association of alcohol consumption and both IFG and T2DM,

  Biostatistiques et épidémiologieMédecine interne (cardiologie, endocrinologie, néphrologie…)Santé publiqueLicence : 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

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of balanced energy-protein supplementation during pregnancy and lactation on birth outcomes and infant growth in rural Burkina Faso: study protocol for a randomised controlled trial

  Katrien Vanslambrouck, Brenda de Kok, Laeticia Celine Toe, Nathalie De Cock, Moctar Ouedraogo, Trenton Dailey-Chwalibóg, Giles Hanley-Cook, Rasmané Ganaba, Carl Lachat, Lieven Huybregts, Patrick Kolsteren

  IntroductionAdequate nutrition during pregnancy is crucial to both mother and child. Maternal malnutrition can be the cause of stillbirth or lead to poor birth outcomes such as preterm delivery and small-for-gestational-age newborns. There is a probable positive effect of providing pregnant women a balanced energy-protein (BEP) food supplement, but more evidence is needed. The MIcronutriments pour la SAnté de la Mère et de l’Enfant (MISAME) III project aims to improve birth outcomes and infant growth by testing a BEP supplement during pregnancy and lactation in rural Burkina Faso. This paper describes the study protocol.Methods and analysisMISAME-III is a four-arm individually randomised efficacy trial implemented in six rural health centre catchments areas in the district of Houndé. Eligible pregnant women, aged between 15 and 40 years old and living in the study areas, will be enrolled. Women will be randomly assigned to one of the four study groups: (1) prenatal intervention only, (2) postnatal intervention only, (3) prenatal and postnatal intervention or (4) no prenatal or postnatal intervention. The intervention group will receive the BEP supplement and iron/folic acid (IFA) tablets, while the control group will only receive the IFA tablets following the national health protocol. Consumption will be supervised by trained village women on a daily basis by means of home visits. The primary outcomes are small-for-gestational age at birth and length-for-age z-score at 6 months of age. Secondary outcomes will be measured at birth and during the first 6 months of the infants’ life. Women will be enrolled from October 2019 until the total sample size is reached.Ethics and disseminationMISAME-III has been reviewed and approved by the University Hospital of Ghent and the ethics committee of Centre Muraz, Burkina Faso. Informed consent will be obtained. Results will be published in relevant journals and shared with other researchers and public health institutions.Trial r

  PédiatrieGynécologie-obstétriqueSanté publiqueLicence : https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original w

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of Biannual Azithromycin Distribution to Infants on Community Gut Resistome and Microbiome: A Cluster-Randomized, Controlled Trial

  Boubacar Coulibaly, Daisy Yan, Ali Sié, Kiemdé Dramane, Mamadou Bountogo, Dah Clarisse, Ouermi Lucienne, Fanny Yago-Wienne, Djeinam Touré, Georges Dimithé, Regina Khassanov, Souleymane Sidibé, Noel Pouorinibé Somé, Lina Zhong, Cindi Chen, Danny Yu, YuHeng Liu, Thomas Abraham, Brittany Peterson, Armin Hinterwirth, Benjamin F. Arnold, Kieran O’Brien, Catherine E. Oldenburg, Elodie Lebas, Thomas M. Lietman, Thuy Doan

  ABSTRACT.Biannual azithromycin administration to preschool children in sub-Saharan Africa improved childhood mortality but selected for antibiotic resistance (AMR). WHO guidelines recommended focusing treatment on infants ages 1–11 months old to reduce mortality while minimizing selection of AMR. The Infant Mortality Reduction by the Mass Administration of Azithromycin study was a double-masked, placebo-controlled, cluster-randomized trial that investigated these WHO guidelines. Health centers from three regions of Burkina Faso were randomized in a 2:1 ratio to receive either biannual azithromycin (67%) or placebo (33%) distribution to children 1–11 months old. A total of 3,524 rectal samples from children ages 1–59 months old from 60 randomly selected communities were included in the analysis. The prespecified primary outcome was the community-level fold change in macrolide resistance determinants between arms at the 24-month time point. Macrolide resistance determinants in the gut of children in communities whose infants received azithromycin did not increase compared with those in communities treated with placebo (1.05-fold change). Similarly, the fold changes for resistance determinants for beta-lactams, metronidazole, sulfonamides, tetracycline, and trimethoprim were 0.99-fold, 1.00-fold, 1.22-fold, 0.96-fold, and 0.96-fold, respectively. At 6 months after the fourth treatment, there were no detectable differences in the microbiome structure (Euclidean permutational multivariate analysis of variance) and Shannon diversity index between treatment arms. These results suggest that biannual azithromycin administration to children 1–11 months old did not lead to a significant long-lasting increase in gut AMR or alterations of the gut microbiomes of children 1–59 months old in the community.

  Microbiologie (bactériologie, virologie)PharmacologiePédiatrieLicence : Creative Commons Attribution (CC-BY) 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.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of Commonly Used Pediatric Antibiotics on Gut Microbial Diversity in Preschool Children in Burkina Faso: A Randomized Clinical Trial

  Catherine E Oldenburg, Ali Sié, Boubacar Coulibaly, Lucienne Ouermi, Clarisse Dah, Charlemagne Tapsoba, Till Bärnighausen, Kathryn J Ray, Lina Zhong, Susie Cummings, Elodie Lebas, Thomas M Lietman, Jeremy D Keenan, Thuy Doan

  AbstractBackgroundExposure to antibiotics may result in alterations to the composition of intestinal microbiota. However, few trials have been conducted, and observational studies are subject to confounding by indication. We conducted a randomized controlled trial to determine the effect of 3 commonly used pediatric antibiotics on the intestinal microbiome in healthy preschool children.MethodsChildren aged 6–59 months were randomized (1:1:1:1) to a 5-day course of 1 of 3 antibiotics, including amoxicillin (25 mg/kg/d twice-daily doses), azithromycin (10 mg/kg dose on day 1 and then 5 mg/kg once daily for 4 days), cotrimoxazole (240 mg once daily), or placebo. Rectal swabs were obtained at baseline and 5 days after the last dose and were processed using 16S rRNA gene sequencing. The prespecified primary outcome was inverse Simpson’s α-diversity index.ResultsPost-treatment Simpson’s diversity was significantly different across the 4 arms (P = .003). The mean Simpson’s α-diversity among azithromycin-treated children was significantly lower than in placebo-treated children (6.6; 95% confidence interval [CI], 5.5–7.8; vs 9.8; 95% CI, 8.7–10.9; P = .0001). Diversity in children treated with amoxicillin (8.3; 95% CI, 7.0–9.6; P = .09) or cotrimoxazole (8.3; 95% CI, 8.2–9.7; P = .08) was not significantly different than placebo.ConclusionsAzithromycin affects the composition of the pediatric intestinal microbiome. The effect of amoxicillin and cotrimoxazole on microbiome composition was less clear.Clinical Trials Registrationclinicaltrials.gov NCT03187834.

  Biologie cellulaire et moléculaireGénétiqueMicrobiologie (bactériologie, virologie)Licence : http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of cost-reduction interventions on facility-based deliveries in Burkina Faso: a controlled interrupted time-series study with multiple non-equivalent dependent variables

  Ivlabèhiré Bertrand Meda, Seni Kouanda, Valéry Ridde

  BackgroundEvaluating health intervention effectiveness in low-income countries involves many methodological challenges to be addressed. The objective of this study was to estimate the sustained effects of two interventions to improve financial access to facility-based deliveries.MethodsIn an innovative controlled interrupted time-series study with primary data, we used four non-equivalent dependent variables (antenatal care) as control outcomes to estimate the effects of a national subsidy for deliveries (January 2007–December 2013) and a local ‘free delivery’ intervention (June 2007–December 2010) on facility-based deliveries. The statistical analysis used spline linear regressions with random intercepts and slopes.ResultsThe analysis involved 20 877 observations for the national subsidy and 8842 for the ‘free delivery’ intervention. The two interventions did not have immediate effects. However, both were associated with positive trend changes varying from 0.21 to 0.52 deliveries per month during the first 12 months and from 0.78 to 2.39 deliveries per month during the first 6 months. The absolute effects, evaluated 84 and 42 months after introduction, ranged from 2.64 (95% CI 0.51 to 4.77) to 10.78 (95% CI 8.52 to 13.03) and from 9.57 (95% CI 5.97 to 13.18) to 14.47 (95% CI 10.47 to 18.47) deliveries per month for the national subsidy and the ‘free delivery’ intervention, respectively, depending on the type of antenatal care used as a control outcome.ConclusionThe results suggest that both interventions were associated with sustained non-linear increases in facility-based deliveries. The use of multiple control groups strengthens the credibility of the results, making them useful for policy makers seeking solutions for universal health coverage.

  Biostatistiques et épidémiologieSanté publiqueLicence : https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original w

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of egg consumption on early childhood development: evidence from Un Oeuf study

  Helen Ernyey, Chhavi Tiwari, Heather Stark, Emma Hunniford, Aissata Wereme N’Diaye, Yacouba Zare, Anteneh Omer, Sarah Lindley McKune

  Objective:Recent studies have shown that inclusion of eggs in young children’s diet can help meet nutritional requirements associated with cognitive development. This study aims to investigate the effect of egg consumption on early childhood development using Ages and Stages Questionnaire-3 in Burkina Faso.Design:The study presented here uses data collected during a follow-up of the Un Oeuf-a three-arm clustered randomised controlled trial (RCT), conducted roughly 4 months after the end of the RCT.Setting:This research was conducted in eighteen rural villages within the Kaya Department of the Sanmatenga Province in Burkina Faso.Participants:Participants of this study include a total of 244 children aged between 18 and 33 months, with seventy-eight children in the full intervention group, eighty-three in the partial group, and eighty-three in the control group.Results:Results show that children with consistent egg consumption (in all months) had a lower odd of falling below the cut-off scores in gross motor ( ) and personal social skills ( ). And a dose–response was established; for each additional egg/week, a 1·9 % increase in scores for problem-solving skills was observed.Conclusions:Findings from this study contribute to a growing body of evidence that increasing egg consumption among children in low- and middle-income countries (LMIC) can improve growth and development. The study highlights the need for additional research in LMIC to better understand the multifactorial relationship between diet and childhood development.

  PédiatrieSanté publiqueLicence : https://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, provided the original article is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of eligibility for referral following mass screening for severe acute malnutrition using mid-upper arm circumference: A prospective regression discontinuity design

  BackgroundSevere Acute Malnutrition (SAM) is a major cause of morbidity and mortality in children under five. Mid-upper arm circumference (MUAC) is widely used for community screening, but the effect of referral eligibility on subsequent outcomes is uncertain.ObjectiveThis study assesses the intention-to-treat effect of eligibility for referral to a nutritional program, triggered by MUAC below 11.5 cm, on subsequent nutritional status and all-cause mortality among children in Burkina Faso.MethodsA prospective regression discontinuity (RD) analysis was nested within the Community Health with Azithromycin Treatment (CHAT) trial, a cluster-randomized controlled trial in Nouna District, Burkina Faso (ClinicalTrials.gov NCT03676764). Children aged 6–59 months were screened during twice-yearly censuses; MUAC <11.5 cm triggered a referral recommendation. Because treatment uptake was unmeasured, the estimand was referral eligibility, not treatment receipt. Outcomes were MUAC at the next census and death before that census. Primary analyses used outcome-specific Imbens–Kalyanaraman bandwidths and mixed-effects models with a child random intercept.ResultsAmong 65,554 children, 226 (0.34%) met the referral threshold at least once. The selected bandwidth included 2,901 observations for the MUAC outcome (158 below and 2,743 above the cutoff) and 2,628 observations for mortality (148 below and 2,480 above). The estimated mean difference in MUAC at the cutoff was 0.21 cm (95% CI, −0.22 to 0.65), and the mortality odds ratio was 0.95 (95% CI, 0.03 to 31.37). Most sensitivity analyses were similar, although the widest fixed bandwidth produced discordant and unstable estimates.ConclusionsNear the 11.5-cm cutoff, we found no evidence that referral eligibility changed next-census MUAC or all-cause mortality. These findings do not evaluate SAM treatment receipt or effectiveness, and the mortality estimate was highly imprecise. Stronger mechanisms may be needed to complete referral and l

  PédiatrieSanté 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.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of Free Healthcare Policy for Children under Five Years Old on the Incidence of Reported Malaria Cases in Burkina Faso by Bayesian Modelling: “Not only the Ears but also the Head of the Hippopotamus”

  Mady Ouédraogo, Toussaint Rouamba, Sékou Samadoulougou, Fati Kirakoya-Samadoulougou

  Burkina Faso has recently implemented an additional strategy, the free healthcare policy, to further improve maternal and child health. This policy targets children under five who bear the brunt of the malaria scourge. The effects of the free-of-charge healthcare were previously assessed in women but not in children. The present study aims at filling this gap by assessing the effect of this policy in children under five with a focus on the induced spatial and temporal changes in malaria morbidity. We used a Bayesian spatiotemporal negative binomial model to investigate the space–time variation in malaria incidence in relation to the implementation of the policy. The analysis relied on malaria routine surveillance data extracted from the national health data repository and spanning the period from January 2013 to December 2018. The model was adjusted for meteorological and contextual confounders. We found that the number of presumed and confirmed malaria cases per 1000 children per month increased between 2013 and 2018. We further found that the implementation of the free healthcare policy was significantly associated with a two-fold increase in the number of tested and confirmed malaria cases compared with the period before the policy rollout. This effect was, however, heterogeneous across the health districts. We attributed the rise in malaria incidence following the policy rollout to an increased use of health services combined with an increased availability of rapid tests and a higher compliance to the “test and treat” policy. The observed heterogeneity in the policy effect was attributed to parallel control interventions, some of which were rolled out at different paces and scales. Our findings call for a sustained and reinforced effort to test all suspected cases so that, alongside an improved case treatment, the true picture of the malaria scourge in children under five emerges clearly (see the hippopotamus almost entirely).

  Parasitologie et mycologieMaladies infectieuses et tropicalesPédiatrieLicence : 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 ().

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of integrating maternal and child health services, nutrition and family planning services on postpartum family planning uptake at 6 months post-partum in Burkina Faso, Cote d’Ivoire and Niger: a quasi-experimental study protocol

  Denise Kpebo, Abou Coulibaly, Wambi Maurice Evariste Yameogo, Sujata Bijou, Ramatoulaye Hamidou Lazoumar, Halima Tougri, Marguerite N’dour, Seni Kouanda

  BackgroundAlthough several interventions integrating maternal, neonatal, child health and nutrition with family planning have been implemented and tested, there is still limited evidence on their effectiveness to guide program efforts and policy action on health services integration. This study aims to assess the effectiveness of a service delivery model integrating maternal and child health services, nutrition and family planning services, compared with the general standard of care in Burkina Faso, Cote d'Ivoire, and Niger.MethodsThis is a quasi experimental study with one intervention group and one control group of 3 to 4 health facilities in each country. Each facility was matched to a control facility of the same level of care that had similar coverage on selected reproductive health indicators such as family planning and post-partum family planning. The study participants are pregnant women (up to 28 weeks of gestational age) coming for their first antenatal care visit. They will be followed up to 6 months after childbirth, and will be interviewed at each antenatal visit and also during visits for infant vaccines. The analyzes will be carried out by intention to treat, using generalized linear models (binomial log or log Poisson) to assess the effect of the intervention on the ratio of contraceptive use prevalence between the two groups of the study at a significance level of 5%, while taking into account the cluster effect and adjusting for potential confounding factors (socio-demographic characteristics of women unevenly distributed at inclusion).DiscussionThis longitudinal study, with the provision of family planning services integrated into the whole maternal care continuum, a sufficiently long observation time and repeated measurements, will make it possible to better understand the timeline and the factors influencing women’s decision-making on the use of post-partum family planning services. The results will help to increase the body of knowledge regardi

  Biostatistiques et épidémiologieImmunologiePédiatrieLicence : 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

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of Neonatal Azithromycin on All-Cause and Cause-Specific Infant Mortality: A Randomized Controlled Trial

  ABSTRACT.Mass azithromycin distribution reduces all-cause childhood mortality in some high-mortality settings in sub-Saharan Africa. Although the greatest benefits have been shown in children 1 to 5 months old living in areas with high mortality rates, no evidence of a benefit was found of neonatal azithromycin in a low-mortality setting on mortality at 6 months. We conducted a 1:1 randomized, placebo-controlled trial evaluating the effect of a single oral 20-mg/kg dose of azithromycin or matching placebo administered during the neonatal period on all-cause and cause-specific infant mortality at 12 months of age in five regions of Burkina Faso. Neonates were eligible if they were between the ages of 8 and 27 days and weighed at least 2,500 g at enrollment. Cause of death was determined via the WHO 2016 verbal autopsy tool. We compared all-cause and cause-specific mortality using binomial regression. Of 21,832 infants enrolled in the study, 116 died by 12 months of age. There was no significant difference in all-cause mortality between the azithromycin and placebo groups (azithromycin: 52 deaths, 0.5%; placebo, 64 deaths, 0.7%; hazard ratio, 0.81; 95% CI, 0.56–1.17; P = 0.30). There was no evidence of a difference in the distribution of causes of death (P = 0.40) and no significant difference in any specific cause of death between groups. Mortality rates were low at 12 months of age, and there was no evidence of an effect of neonatal azithromycin on all-cause or cause-specific mortality.

  PédiatrieSanté publiqueLicence : Creative Commons Attribution (CC-BY) 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.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of pedo-climatic conditions on physicochemical characteristics and agro-industrial potential of three native oilseeds fruits from Burkina Faso

  Hemayoro Sama, Dieudonné Kimbié Traoré, Samson Guenné, Adama Hilou, Mamoudou H. Dicko

  BackgroundPlants are greatly affected by pedoclimatic conditions. They can alter the physiology of plants and affect seeds agro-morphological and physicochemical characteristics. It is therefore conceivable that tree species which have a potential as oil/fat producing plants are affected by pedoclimatic conditions variability. This study aims to evaluate the effect of pedoclimatic conditions variation on the physicochemical characteristics and the agro-industrial potential of three oilseeds fruits from Burkina Faso: Balanites aegyptiaca, Sclerocarya birrea and Lannea microcarpa.ResultsA characterization of the size, chemical composition and weight of 100 seeds of the three native oilseeds from Banfora (Sudanian zone), Ouagadougou (Sudano-Sahelian zone) and Ouahigouya (Sahelian zone) was carried out. Results showed that seed size, seed weight and chemical composition varied significantly according to the pedoclimatic zone of the collection significant correlations between seed size, 100-seed weight, total ash and also for seed oil content and moisture have also been revealed. Principal component analysis (PCA) associated increases in seed size and total ash content with high annual rainfall and low temperature areas, while increases in seed oil content were associated with low rainfall and high annual temperature areas.ConclusionSeed size and seed weight were associated with high rainfall and low temperature, while high temperature and low rainfall were associated with oil accumulation in the seeds. However, the limit number of replications of physicochemical characteristics analyses, a limitation of the study, does not allow an exhaustive conclusion to be drawn from the study.

  Santé publiqueLicence : 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

  Lire dans MyLaafi
• Lien vers la sourceMémoire

  Effect of pregnancy planning on maternal and neonatal outcomes in type 1 diabetic women with type 1 diabetes treated by continuous subcutaneous insulin infusion

  Lucie Mourou

  Objectif : le diabète de type 1 reste un facteur de risque de complications de la grossesse. L’objectif était d'évaluer l'effet de la programmation de la grossesse sur la survenue de complications obstétricales et néonatales chez les femmes diabétiques de type 1 traitée par CSII avant la grossesse. Méthode : nous avons étudié rétrospectivement le déroulement et l’issue des grossesses des femmes diabétiques de type 1 traitées par CSII avant la grossesse suivie par les départements de diabétologie des hôpitaux universitaires de Montpellier (France) et Padoue (Italie) et ayant accouché consécutivement entre 2002 et 2017. Les dossiers médicaux de 99 femmes ont été étudiés. Résultats : 73 grossesses (73,7%) étaient programmées. Les taux d'HbA1c étaient significativement plus bas avant et pendant toute la grossesse quand celle-ci était programmée (tous p <0,01). La programmation réduit le risque de prématurité (RR = 0,69 IC95 [0,5 ; 0,98] p <0,05). Ce résultat persistait après ajustement sur l'âge de la mère de plus de 40 ans, l’HTA gravidique ou la prééclampsie. L'augmentation de l’Hba1c au premier, deuxième et troisième trimestre était significativement associé au risque de prématurité (respectivement RR = 2,5 IC95 [1,13 ; 5,6], RR = 3,63 IC95 [1,30 ; 10,1] et RR = 3,96 IC95 [1,61 ; 9,756] p <0,05). Les nouveau-nés prématurés étaient significativement plus souvent admis en unité de soins intensifs (40% vs 13,2% p <0,05). Conclusion : la programmation de la grossesse chez les femmes traitées par CSII est associée à un meilleur contrôle glycémique pendant la grossesse et à une réduction significative du risque de prématurité.

  SémiologieMaladies infectieuses et tropicalesMédecine interne (cardiologie, endocrinologie, néphrologie…)Licence : https://creativecommons.org/licenses/by-sa/4.0/

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of prenatal micronutrient-fortified balanced energy-protein supplementation on maternal and newborn body composition: A sub-study from the MISAME-III randomized controlled efficacy trial in rural Burkina Faso

  Alemayehu Argaw, Laeticia Celine Toe, Giles Hanley-Cook, Trenton Dailey-Chwalibóg, Brenda de Kok, Lionel Ouédraogo, Anderson Compaoré, Moctar Ouédraogo, Amadi Sawadogo, Rasmané Ganaba, Katrien Vanslambrouck, Patrick Kolsteren, Carl Lachat, Lieven Huybregts

  BackgroundMicronutrient-fortified balanced energy-protein (BEP) supplements are promising interventions to prevent intrauterine growth retardation in low- and middle-income countries. On the other hand, one concern with blanket prenatal supplementation programs using energy-dense supplements is that they could lead to more maternal and/or infant overweight. However, evidence is lacking on the potential effect of BEP on maternal and offspring body composition. This study evaluates the effects of micronutrient-fortified BEP supplementation during pregnancy on body composition of mothers and their newborns in rural Burkina Faso.Methods and findingsThe MISAME-III study is an open label individually randomized controlled trial where pregnant women (n = 1,897) of gestational age <21 weeks received either a combination of micronutrient-fortified BEP and iron-folic acid (IFA) tablets (i.e., intervention) or IFA alone (i.e., control). The prenatal phase of the MISAME-III study was conducted between the first enrollment in October 2019 and the last delivery in August 2021. In a sub-study nested under the MISAME-III trial, we evaluated anthropometry and body composition in newborns who were born starting from 17 November 2020 (n: control = 368 and intervention = 352) and their mothers (n: control = 185 and intervention = 186). Primary study outcomes were newborn and maternal fat-free mass (FFMI) and fat-mass (FMI) indices. We used the deuterium dilution method to determine FFMI and FMI and %FFM and %FM of total body weight within 1 month postpartum. Our main analysis followed a modified intention-to-treat approach by analyzing all subjects with body composition data available. Univariable and multivariable linear regression models were fitted to compare the intervention and control arms, with adjusted models included baseline maternal age, height, arm fat index, hemoglobin concentration and primiparity, household size, wealth and food security indices, and newborn age (days).

  HématologiePédiatrieGynécologie-obstétriqueLicence : 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.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Effect of the free healthcare policy on socioeconomic inequalities in care seeking for fever in children under five years in Burkina Faso: a population-based surveys analysis

  Sekou Samadoulougou, Mariamawit Negatou, Calypse Ngawisiri, Valery Ridde, Fati Kirakoya-Samadoulougou

  BackgroundIn 2016, Burkina Faso implemented a free healthcare policy as an initiative to remove user fees for women and under-5 children to improve access to healthcare. Socioeconomic inequalities create disparities in the use of health services which can be reduced by removing user fees. This study aimed to assess the effect of the free healthcare policy (FHCP) on the reduction of socioeconomic inequalities in the use of health services in Burkina Faso.MethodsData were obtained from three nationally representative population based surveys of 2958, 2617, and 1220 under-5 children with febrile illness in 2010, 2014, and 2017–18 respectively. Concentration curves were constructed for the periods before and after policy implementation to assess socioeconomic inequalities in healthcare seeking. In addition, Erreyger’s corrected concentration indices were computed to determine the magnitude of these inequalities.ResultsPrior to the implementation of the FHCP, inequalities in healthcare seeking for febrile illnesses in under-5 children favoured wealthier households [Erreyger’s concentration index = 0.196 (SE = 0.039, p = 0.039) and 0.178 (SE = 0.039, p < 0.001) in 2010 and 2014, respectively]. These inequalities decreased after policy implementation in 2017–18 [Concentration Index (CI) = 0.091, SE = 0.041; p = 0.026]. Furthermore, existing pro-rich disparities in healthcare seeking between regions before the implementation of the FHCP diminished after its implementation, with five regions having a high CI in 2010 (0.093–0.208), four regions in 2014, and no region in 2017 with such high CI. In 2017–18, pro-rich inequalities were observed in ten regions (CI:0.007–0.091),whereas in three regions (Plateau Central, Centre, and Cascades), the CI was negative indicating that healthcare seeking was in favour of poorest households.ConclusionThis study demonstrated that socioeconomic inequalities for under-5 children with febrile illness seeking healthcare in Burkina Faso reduced c

  Biostatistiques et épidémiologiePédiatrieSanté publiqueLicence : 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

  Lire dans MyLaafi