IgE antibodies to Plasmodium falciparum and severity of malaria in children of one ethnic group living in Burkina Faso.
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Plasmodium falciparum malaria infection induces elevated blood levels of both total immunoglobulin and anti-plasmodial antibodies belonging to different isotypes. We have previously shown that donors living in areas of malaria transmission develop malaria-specific IgE antibodies that are present at highest concentrations in patients with severe disease, suggesting a role for this isotype in malaria pathogenesis. To establish the possible importance of IgE in the course and severity of this disease, we have analyzed a large and homogenous group of African children (age range = 6 months to 15 years) belonging to one ethnic group (Mossi) living in identical epidemiologic conditions in the same urban area (Ougadougo) of Burkina Faso. While IgG antibodies to P. falciparum increased to high concentrations in very young children and then remained at these levels in older patients, IgE antibodies increased with age, becoming most significantly elevated in children more than four years of age. In older children, those with severe malaria had significantly higher IgE antibody levels than those with non-severe disease. No significant differences between the patient groups were seen for IgG antibodies to P. falciparum. However, when the patients with severe malaria were divided into two groups distinguished by the presence of absence of coma, both IgG and IgE antibodies against malaria were lower in the comatous patients than in the non-comatous patients. The results support the conclusion that IgE antibodies against malaria, regardless of their possible protectivity, also contribute to disease severity in this large and homogenous group of African children. (+info)
Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative.
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OBJECTIVE: To gauge the effects of operating the Bamako Initiative in Kongoussi district, Burkina Faso. METHODS: Qualitative and quasi-experimental quantitative methodologies were used. FINDINGS: Following the introduction of fees-for-services in July 1997, the number of consultations for curative care fell over a period of three years by an average of 15.4% at "case" health centres but increased by 30.5% at "control" health centres. Moreover, although the operational results for essential drugs depots were not known, expenditure increased on average 2.7 times more than income and did not keep pace with the decline in the utilization of services. Persons in charge of the management committees had difficulties in releasing funds to ensure access to care for the poor. CONCLUSION: The introduction of fees-for-services had an adverse effect on service utilization. The study district is in a position to bear the financial cost of taking care of the poor and the community is able to identify such people. Incentives must be introduced by the state and be swiftly applied so that the communities agree to a more equitable system and thereby allow access to care for those excluded from services because they are unable to pay. (+info)
Hemoglobin C is associated with reduced Plasmodium falciparum parasitemia and low risk of mild malaria attack.
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Genetic predisposition to malaria has been shown by epidemiological, case-control and linkage studies. In particular, case-control studies have recently shown association between hemoglobin C and resistance to severe malaria in Mali and to clinical malaria in Burkina Faso. In a longitudinal study of families living in an endemic area, we investigated whether hemoglobin C is associated with reduced Plasmodium falciparum parasitemia and low risk of mild malaria attack. We surveyed 256 individuals (71 parents and 185 sibs) from 53 families during 2 years. Hemoglobin C carriers had less frequent malaria attacks than AA individuals within the same age group (P=0.01). Since age correlated with malaria attack and parasitemia (P<0.0001), we took age into account in association analyses. We performed combined linkage and association analyses, which avoid biases due to population structure. Using multi-allelic tests, we evidenced association between hemoglobin genotype and phenotypes related to malarial infection and disease (P<0.001). We further analyzed individual hemoglobin alleles and detected negative association between hemoglobin C and malaria attack (P=0.00013). Analyses that took into account confounding factors confirmed the negative association of hemoglobin C with malaria attack (P=0.0074) and evidenced a negative correlation between hemoglobin C and parasitemia (P=0.0009). These associations indicate that hemoglobin C reduces parasitemia and confers protection against mild malaria attack. (+info)
Community-based evaluation survey of immunizations in Burkina Faso.
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A cluster sample survey was conducted in January 1989 in 3 provinces of Burkina Faso to evaluate an immunization programme (based on two contacts, providing inactivated poliomyelitis vaccine plus DPT) that had been launched in 1982-84. The objectives were to estimate neonatal tetanus (NNT) mortality and poliomyelitis prevalence in the study area. The target population (using the same sample of households comprised 2107 live infants born during the preceding year for the NNT survey, and 17,154 children aged 0-9 years for the poliomyelitis survey. The NNT mortality rate was 3.3 per 1000 live births, and the poliomyelitis prevalence rate was 2.8 per 1000 children aged 5-9 years. Dates of onset of poliomyelitis cases among children aged 0-9 years and the numbers of children at risk during the 10-year recall period, reconstituted with demographic indicators taken from standardized life-tables, were used to calculate the incidence rates of poliomyelitis. These rates could be compared in the 5-year period preceding the survey, and showed a decreasing trend consistent with routine surveillance data. (+info)
Effect of zinc supplementation on growth in West African children: a randomized double-blind placebo-controlled trial in rural Burkina Faso.
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OBJECTIVE: To analyse the effects of zinc supplementation on growth parameters in a representative sample of young children in rural Burkina Faso. Design Randomized, double-blind, placebo-controlled efficacy trial. Setting Eighteen villages in rural northwestern Burkina Faso. Subjects In all, 709 children aged 6-31 months were enrolled; 685 completed the trial. Intervention Supplementation with zinc (12.5 mg zinc sulphate) or placebo daily for 6 days a week for 6 months. Outcomes Weight, length/height, mid-arm circumference, and serum zinc. RESULTS: In a representative subsample of study children, 72% were zinc-deficient at baseline. After supplementation, serum zinc increased in zinc-supplemented but not in control children of the subsample. No significant differences between groups were observed during follow-up regarding length/height, weight, mid-arm circumference, and z scores for height-for-age, weight-for-age, and weight-for-height. CONCLUSIONS: We conclude that zinc supplementation does not have an effect of public health importance on growth in West African populations of young children with a high prevalence of malnutrition. Multinutrient interventions are likely to be more effective. (+info)
Patterns of adult and old-age mortality in rural Burkina Faso.
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Based on a demographic surveillance population from 39 villages in rural Burkina Faso, we describe mortality patterns in adults (15-59 years) and older people (> or = 60 years), and discuss seasonal trends in mortality. During the study period 1993-1998, 589 deaths in adults and 593 deaths in older people were recorded from an average adult and older people population of 13 550. The crude all-cause mortality rate per 1000 for adults was 7.3 (95 per cent confidence interval (CI) 6.7-7.8) and for older people 55.8 (95 percent CI 51.3-60.3). The probability of dying before age 60 after reaching age 15 was 34 percent for males and 32 percent for females. Malaria and diarrhoea, recorded through verbal autopsy, accounted for 21 percent of total deaths in adults and 22 per cent in older people. A seasonal trend in mortality for older people with a peak in February was identified. The study shows that malaria is an important cause of death in adulthood. (+info)
Differential willingness of household heads to pay community-based health insurance premia for themselves and other household members.
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OBJECTIVE: This study compares household heads' willingness-to-pay (WTP) for community-based health insurance (CBI) for themselves with their WTP for other household members, in order to provide information for policy makers on setting the premium and choosing the enrollment unit. METHOD: A random sample of 698 heads of households was interviewed in the northwest of Burkina Faso and a bidding game approach was used to elicit WTP. Factors associated with differences in WTP were identified, including characteristics of the household head and of the household. RESULTS: Mean WTP by the heads of households for insurance for themselves (3575 CFA) was twice their mean WTP per capita for the household as a whole (1759 CFA). The old have a lower WTP than the young, females have lower WTP than males, the poor have a lower WTP than the rich, and that those with less schooling have a lower WTP than those with more years of schooling. CONCLUSION: The differences in household heads' WTP for insurance for themselves and their WTP to insure their households as a whole need to be considered when setting the insurance premium. WTP information can assist decision makers with the complex problem of choosing the enrollment unit and setting the premium. (+info)
Child mortality in a West African population protected with insecticide-treated curtains for a period of up to 6 years.
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OBJECTIVES: To determine the impact of insecticide-treated curtains (ITC) on all-cause child mortality (6-59 months) over a period of six years. To determine whether initial reductions in child mortality following the implementation of ITC are sustained over the longer term or whether "delayed" mortality occurs. METHODS: A rural population of ca 100 000 living in an area with high, seasonal Plasmodium falciparum transmission was studied in Burkina Faso. Annual censuses were conducted from 1993 to 2000 to measure child mortality. ITC to cover doors, windows, and eaves were provided to half the population in 1994 with the remainder receiving ITC in 1996. Curtains were re-treated or, if necessary, replaced annually. FINDINGS: Over six years of implementation of ITC, no evidence of the shift in child mortality from younger to older children was observed. Estimates of the reduction in child mortality associated with ITC ranged from 19% to 24%. CONCLUSIONS: In our population there was no evidence to suggest that initial reduction in child mortality associated with the introduction of insecticide-treated materials was subsequently compromised by a shift in child mortality to older-aged children. Estimates of the impact of ITC on child mortality in this population range from 19% to 24%. (+info)