INTRODUCTION:Mother-to-child transmission (MTCT) of HIV, syphilis, and hepatitis B virus (HBV) commonly observed in the WHO African region is associated with excess morbidity and mortality. Despite some progress, the coverage of interventions to prevent MTCT of these infections remains insufficient, particularly for syphilis and HBV. To fulfil these gaps and achieve the triple elimination of MTCT of these infections by 2030, the World Health Organization (WHO) advocates for integration of prevention of MTCT (PMTCT) activities for HBV with HIV and syphilis antenatal services. In partnership with the local governments, the TRI-MOM project, conducted in 2 phases, aims to evaluate a simplified (based on inexpensive rapid diagnostic tests), integrated (in maternal and child health services) and coordinated (between the various programs and health care workers) strategy for the triple elimination of HIV, syphilis and HBV MTCT in Burkina Faso and The Gambia. METHODS AND ANALYSIS:The strategy will be implemented in 5 rural and urban health facilities in each country and will include four activities: i) training sessions for healthcare workers working in maternal and child health services, ii) screening of pregnant women of the three infections using rapid diagnostic tests at the first antenatal visit, iii) clinical assessment and treatment of women tested positive for any of the 3 infections, and iv) raising awareness on HIV, Syphilis and HBV PMTCT among pregnant women and empowering those screened positive. 17,000 pregnant women are expected to be screened. The strategy will be evaluated through an interdisciplinary, mixed-methods approach comprising three studies: i) a quantitative and qualitative cross-sectional study conducted both before and after the implementation of the strategy to assess its impact on triple screening coverage in pregnant women; ii) a an intervention study with longitudinal follow-up of pregnant women positive for any of the three infections to assess the coverage of PMTCT measures; and iii) a cost and cost-effectiveness analysis of the project compared to the reference situation in each country, which will rely on a micro costing study to estimate the incremental cost of the strategy per mother/child couple compared with the reference situation in each country, and compare it to the number of avoided infections. ETHICS AND DISSEMINATION:The study protocol has been approved by the competent authorities of the countries participating to the research (the LSHTM/MRCUG Scientific Coordinating Committee, the Gambia Government/MRC Joint Ethics Committee, the LSHTM ethics committee, the Burkinabe National Ethical Committee for Research in Health and the French Commission on Information Technology and Liberties). Results on the feasibility and acceptability of the triple elimination strategy will be disseminated using different media including policy briefs, posters and articles. TRIAL REGISTRATION NUMBER:ClinicalTrials.gov NCT05951751.
Background Otitis externa is a common condition in oto-rhino-laryngology practice, particularly in tropical settings. This study aimed to describe the clinical characteristics and management of otitis externa in a tertiary hospital in Burkina Faso. Methods We conducted a retrospective descriptive study over a 10-year period, from January 2008 to December 2017 in the ENT department of a tertiary referral hospital in Burkina Faso. Patients diagnosed with otitis externa and complete medical records were included. Results A total of 318 cases of otitis externa were collected, representing 4.89% of all otitis cases and 0.7% of ENT consultations. The mean age was 27 years, ranging from 6 months to 90 years, with a female predominance (male-to-female ratio = 0.86). The 15–30-year age group was most affected (39.6%). Otalgia was the main presenting symptom (70.1%). The mean consultation delay was 18 days. Diffuse otitis externa was the most frequent clinical form (50.0%), followed by external auditory canal furunculosis (27.0%) and otomycosis (19.1%). Bacteriological examinations were performed on 3.7% of cases, predominantly isolating Pseudomonas aeruginosa and Staphylococcus aureus . Management was predominantly medical, based on topical antibiotics (76.0%). Favorable clinical outcomes were observed in 99.0% of patients. Conclusion Otitis externa is a frequent condition in ENT practice. Diagnosis is straightforward based on otoscopy. Management is primarily medical with excellent outcomes. Preventive strategies should focus on reducing predisposing factors and improving safe ear hygiene practices.
Introduction: Neonatal mortality remains a major public health issue in resource-limited countries. In 2022, approximately 2.3 million newborns died, mainly in sub-Saharan Africa. Auditing neonatal deaths is an essential strategy recommended by the World Health Organization to improve the quality of care and reduce preventable deaths. The objective of the study was to analyze the causes of neonatal deaths and identify modifiable factors in the Neonatology Department of the Yalgado Ouédraogo University Hospital Center. Methodology: It was a descriptive cross-sectional study of neonatal deaths that occurred between January 1 and December 31, 2024, in the department, excluding those that occurred before any treatment was provided. Medical records were used as data sources. The analysis was conducted in accordance with World Health Organization recommendations for auditing neonatal deaths. Results: Intra-hospital neonatal mortality was 17.8%. It affected premature and low birth weight newborns (63% and 71.1%, respectively) during the first week of life. The main causes of death were prematurity, perinatal asphyxia, and neonatal infections. The modifiable factors identified were delayed consultation, delayed referral, and inadequate initial care. Conclusion: A significant proportion of neonatal deaths observed were potentially preventable. Strengthening the referral system and improving early neonatal care could significantly reduce neonatal mortality in Burkina Faso.
Introduction Hamman syndrome corresponds to spontaneous pneumomediastinum associated with subcutaneous emphysema. It is a rare condition, often underdiagnosed in our setting due to the nonspecific nature of its symptoms, particularly in the obstetric setting. Case report We report a case of Hamman syndrome in a patient managed in the pneumology department of Yalgado Ouédraogo University Hospital. The patient was a 19-year-old woman, on day 11 after cesarean section, admitted for grade IV dyspnea on the mMRC scale, with oxygen desaturation to 85% on room air, no signs of respiratory distress, and cervicothoracic subcutaneous emphysema. Thoracic CT angiography showed pneumomediastinum associated with alveolar syndrome. Management combined oxygen therapy, nefopam, and amoxicillin-clavulanic acid, with a favorable outcome. Conclusion Hamman syndrome is a rare condition. Clinically, it should be considered in any case of acute dyspnea and/or acute chest pain associated with subcutaneous emphysema. Contrast-enhanced chest CT is the reference examination for confirming the diagnosis and should be performed early to avoid unnecessary invasive investigations. Management is most often symptomatic, with a favorable outcome.
RÉSUMÉ Le phéochromocytome est une tumeur sécrétant des catécholamines dont l’exérèse chirurgicale comporte un risque élevé d’instabilité hémodynamique potentiellement mortelle. Nous rapportons la prise en charge périopératoire réussie d’un volumineux phéochromocytome chez une femme de 26 ans avec une hypertension ancienne, dans un contexte de ressources limitées. La patiente présentait des symptômes paroxystiques classiques et une volumineuse masse surrénalienne droite. L’optimisation préopératoire a inclus un blocage alpha et bêta (nicardipine et labétalol) pendant 13 jours. En peropératoire, la gestion a anticipé les variations tensionnelles grâce à un monitorage invasif. Les crises hypertensives lors de la manipulation tumorale ont été contrôlées par des bolus d’esmolol et de nicardipine, suivis d’une vasoplégie profonde après résection, nécessitant une perfusion de noradrénaline. La patiente a été extubée à H6, sevrée des vasopresseurs et sortie de réanimation à H48. Ce cas démontre qu’une médecine périopératoire structurée et protocolisée permet de mener à bien la chirurgie complexe du phéochromocytome, même dans des environnements difficiles. ABSTRACT Pheochromocytoma is a rare catecholamine-secreting tumor whose surgical resection carries high risk of life-threatening hemodynamic instability. We report the successful perioperative management of a large pheochromocytoma in a 26-year-old woman with long-standing hypertension in a resource-limited setting. The patient presented with classic paroxysmal symptoms and a large right adrenal mass. Preoperative optimization included a 13-day regimen of calcium and beta-blockers (nicardipine and labetalol). Intraoperatively, management focused on anticipating hemodynamic swings using invasive monitoring. Hypertensive crises during tumor manipulation were controlled with esmolol and nicardipine boluses, followed by profound vasoplegia upon resection, requiring noradrenaline infusion. The patient was extubated at 6 hours, weaned from vasopressors, and discharged from intensive care at 48 hours. This case demonstrates that a structured, protocolized perioperative medicine can safely navigate the complexities of pheochromocytoma surgery, even in challenging environments.
