Dracunculiasis in Burkina Faso: results of a national survey

National surveys using active reporting are essential steps in the global dracunculiasis eradication programme. All the known villages of Burkina Faso were visited at the end of 1990 by teams of field-workers who organized meetings with local informants in order to enquire about all cases of the emergence of Guinea worms during the past twelve months. The annual incidence for 1990 was then calculated using recent demographic data. Data collected were validated by a second survey of a random sample of 221 villages. The national coverage rate was 99.3% of villages; 42,227 cases were reported. The annual incidence for 1990 was 46.4 cases per 10,000. There was a pronounced heterogeneity in the spatial distribution of endemic foci, with a concentration of cases in the north and centre of the country. In Burkina Faso, dracunculiasis has a heterogeneous distribution with a pronounced concentration of cases in the North and Centre that reach mesoendemic incidence rates.

A three-state Markov model of Plasmodium falciparum parasitemia

A three-state Markov model taking into account clinical signs of malaria infections by P. falciparum is described. The three states considered are the noninfected (state 0), the infected exhibiting no clinical signs (state 1), and the infected with clinical signs (state 2). Methods for estimating the transition rates from longitudinal data are indicated. This model was used to assess the effect on children of an intervention trial on the use of mosquito nets impregnated with insecticide. The trial was conducted in West Africa (Burkina Faso) between 1985 and 1987. The analysis showed that the intervention was most effective on transition rates between state 1 and state 2.

Risk factors for preterm delivery in Burkina Faso (west Africa)

The environmental and socioeconomic risk factors for preterm delivery were assessed in a West African urban population (Bobo-Dioulasso, Burkina Faso). The study population were 102 cases of preterm delivery matched with 102 controls obtained from 4124 sequential deliveries which occurred between May and October 1989 in the three maternity centres in the city. The univariate analysis identified the risk factors as age (< 20 years), primiparity, marital status (single), low frequency of antenatal visits, death of a previous child and level of education of the mother. The following risk factors identified by multivariate analysis (logistic regression) are consistent with those identified in previous studies: youth of the mother, primiparity (P = 0.01) and death of a previous child (P < 0.05). On the other hand, in this study, the level of education of the parent was identified as an independent risk factor (P < 0.001). This finding could be used to determine a target population for prevention programmes.

A national survey of the prevalence of chloroquine resistant Plasmodium falciparum in Burkina Faso

Plasmodium falciparum susceptibility to chloroquine was investigated in 10 areas of Burkina Faso in the rainy seasons in 1990-1991. The 7-days in-vivo test was carried out from August to November on children aged 2-8 years with monospecific P. falciparum infection (asexual parasitaemia > 800 microliters-1 of blood), axillary temperature < 37.5 degrees C, and a negative Bergqvist urine test for 4-aminoquinolines. Among 2190 children screened, 366 were selected. Blood samples were collected on days 0, 2, 4 and 7 by finger-prick, and 100 microscopic fields of thick and thin smears were examined for parasite density and species identification. Chloroquine was given under supervision at the standard dose of 25 mg kg-1 over three days (days 0, 1 and 2) with an observation period of one hour after treatment. Parasitaemia did not clear in 63 cases (17.2%) with a 13.4% RII response and 3.8% RIII response. The results do not seem to indicate a decline in the sensitivity of P. falciparum to chloroquine in Burkina Faso during the past two years.

Pathogenesis and pathology of African trypanosomosis in Baoulé, N'Dama/Baoulé cross bred and Zebu cattle in Burkina Faso. 1. Clinical performance under high natural tsetse challenge

The pathogenesis and pathology of African animal trypanosomosis (AAT) in Baoulé, N'Dama/Baoulé-cross-bred and Zebu cattle was studied from 1987 to 1991 in a series of experiments conducted under natural and artificial conditions of challenge at the Centre de Recherches sur les Trypanosomoses Animales (CRTA) in Burkina Faso. This first paper reports on the clinical performance of 64 Baoulé, 10 N'Dama/Baoulé-cross-bred and 20 Zebu cattle, which were transferred to the pastoral zone of Satiri, 50 km northeast of Bobo-Dioulasso, a zone infested with Glossina palpalis gambiensis, G. morsitans submorsitans and G. tachinoides. Prior to the experiment, the cattle had been raised in a fly proof stable and at the CRTA breeding station, an area of extremely low incidence of trypanosomosis or had been exposed at least once to natural trypanosome challenge in an area of high Glossina density. The cattle were monitored daily for clinical performance. Blood samples were collected twice weekly and examined on the spot for packed red cell volume (PCV) and parasitaemia. In the blood of 98% of the cattle trypanosomes (Trypanosoma vivax, T. congolense) were detected. Significant inter- and intrabreed differences with respect to the clinical performance were recorded. Regarding general health, the humpless Baoulé and N'Dama/Baoulé cross-bred cattle (Bos taurus) proved to be superior to the humped Zebu cattle (B. indicus) under this high challenge. Previous exposure to natural challenge had a positive effect on survival for both Baoulé and Zebu cattle. The phenotypic variation in response to trypanosomosis was small in Baoulé previously exposed and large in Baoulé previously not exposed.(ABSTRACT TRUNCATED AT 250 WORDS)

Teenage pregnancy and child health in the urban Sahel

Longitudinal data for more than 20,000 live births in the cities of Bamako (Mali) and Bobo-Dioulasso (Burkina Faso) are used to study the effects of young maternal age (less than 18 years and 18-19) on birth weight, child health care and feeding behavior, and child mortality, after controlling for other socioeconomic and demographic factors. Teenage pregnancies are associated with significantly worse prenatal health care and vaccination behavior, lower birth weights, earlier weaning, and, especially during the second year of life, higher mortality. A proxy for mother's school enrollment at the time of pregnancy is strongly linked to worse prenatal health behavior and weakly associated with other poor behaviors and health outcomes. Overall, the results highlight the importance of behavioral factors relative to strictly biological factors for explaining child health differentials.

Possible role of specific immunoglobulin M antibodies to Plasmodium falciparum antigens in immunoprotection of humans living in a hyperendemic area, Burkina Faso

Two seroepidemiological studies were performed in an area of Burkina Faso hyperendemic for malaria to estimate the protective role of immunoglobulin M (IgM) antibodies. Six cross-sectional surveys were carried out on children (ages, < 16 years) in the village of Karankasso. The evolution of antibodies to crude extracts of Plasmodium falciparum (IgG or IgM antisomatic and IgG antiexoantigens) were tested by IFI or enzyme-linked immunosorbent assay and were followed up according to the fluctuations of the parasite densities. Specific IgG antibodies had the same evolution as parasite densities. By contrast, specific IgM antibodies increased when IgG and parasite densities began to decrease (despite a high inoculation rate). A longitudinal survey of 77 children and adults was conducted in another village (Dafinso). In that study, clinical follow-up of the selected individuals allowed us to define three groups in the population. Children in group 1 were considered nonimmune (children with one or more malaria attacks). Group 2 was composed of semiimmune children who did not present with any malarial attack during the survey but who had high levels of parasitemia during the transmission period. Group 3 was composed of immunoprotected adults. Specific IgM and IgG antibodies to crude extracts or a recombinant antigen (glutamate-rich protein) of P. falciparum were tested. Specific IgM antibodies were lower in group 1 (nonimmune) than in groups 2 (semiimmune) and 3 (immunoprotected). Furthermore, there was a negative correlation between parasite densities and the levels of specific IgM antibodies. We discuss the possible role of IgM antibodies in the acquisition of immunity to malaria.

HIV infection and severe malnutrition: a clinical and epidemiological study in Burkina Faso

OBJECTIVE

To define a clinical profile indicative of HIV infection in a population of severely malnourished children in Burkina Faso. A total of 433 children (average age, 19 months) were recruited at the Sanou Souro National Hospital, Bobo Dioulasso, Burkina Faso.

RESULTS

Sixty-three per cent presented with marasmus, 13% with kwashiorkor and 24% with both forms of malnutrition. The prevalence of HIV infection in children aged over 12 months was 13.8%, with a marked predominance of HIV-1 (95.8%). Mother-to-child transmission was proven in 77% of the cases; in 10% of the observed paediatric AIDS cases, transmission may have occurred through multi-injections with contaminated equipment. Marasmus was the form of malnutrition most frequently associated with HIV (P < 0.001); its severity was exacerbated by HIV infection. Adenopathy (P < 0.0001), oral candidiasis (P < 0.0006), skin disorders (P < 0.01) and hepatomegaly (P = 0.01) appeared to be significantly related to HIV infection. Discriminant analysis revealed that the presence of adenopathies was the strongest indicator symptom of HIV infection. Multivariate analysis revealed that a clinical profile of marasmus, adenopathies and oral candidiasis (specificity, 82%) was indicative of HIV infection in this population. The short-term clinical prognosis was poor and usually led to the death of the child when seropositive (P < 0.001).

CONCLUSIONS

Among children exhibiting severe malnutrition, HIV-positive children are distinguished by a high horizontal transmission rate, a high specific clinical profile and a very poor prognosis.

Serological evaluation of a simplified immunization schedule using quadruple DPT-polio vaccine in Burkina Faso

The immunogenicity of quadruple DPT-polio vaccine used in a two-dose regimen was investigated in a cross-sectional serological survey involving 355 children under 5 years of age. This schedule is currently applied in the EPI programme in three provinces in Burkina Faso, West Africa. It was found that two doses of quadruple DPT-polio vaccine induced antibodies at protective levels to diphtheria and tetanus toxin, and to the three types of polioviruses in over 90% of 179 children. The persistence of antibodies to tetanus and polioviruses is good, since over 90% of the children studied still had antibodies more than 2 years after their last vaccination. The antibodies to diphtheria toxin tend to decline in the first 6 months after vaccination, which is not uncommon. However, our data indicate clearly that a very high percentage (98%) of children have been primed to diphtheria toxin. Of 176 non-vaccinated children, up to 25% of the older ones had antibodies to polioviruses, most of them only to one type. This appears to be a sensitive parameter for the circulation of wild polioviruses in the environment. As the vaccination coverage in the study area was low (< 60%), it was to be expected that the circulation of polioviruses in the community could not be interrupted. The present study demonstrates the applicability of a two-dose strategy for primary immunization with a quadruple DPT-polio vaccine especially for poliovirus components and the toxoids. To induce pertussis immunity, however, a third vaccination is recommended.

Prolonged breast-feeding: no association with increased risk of clinical malnutrition in young children in Burkina Faso

Reported are our findings from a case-control study of the association between prolonged breast-feeding and clinical malnutrition in an urban setting in West Africa. The cases were children aged 12-36 months who had been hospitalized with a diagnosis of clinical malnutrition. Children of a similar age who lived in neighbouring courtyards were recruited as controls. For 152 case-control pairs in which both children were receiving solid foods, non-breast-feeding was associated with an increased risk of clinical malnutrition (crude odds ratio = 2.37; 95% confidence interval = 1.24, 4.55). This association remained statistically significant after controlling for various potentially confounding variables (P = 0.03). Our findings suggest that either prolonged breast-feeding may offer substantial protection against clinical malnutrition in the study population or malnutrition leads mothers to stop breast-feeding. These results are inconsistent with those of a number of workers who have reported that prolonged breast-feeding is associated with an increased risk of malnutrition. This inconsistency might have arisen because of differences in the definition of malnutrition used or because of variations in the quantity and quality of weaning foods available in different settings. We found no evidence to support the hypothesis that prolonged breast-feeding may be detrimental to children.

Development of multiple drug resistance of Trypanosoma congolense in Zebu cattle under high natural tsetse fly challenge in the pastoral zone of Samorogouan, Burkina Faso

Preliminary data from an ongoing epidemiological survey in the pastoral zone of Samorogouan (Kénédougou) indicate the occurrence of multiple-drug-resistant Trypanosoma congolense. Despite frequent trypanocidal drug treatments with diminazene aceturate (Berenil, Hoechst) at 7 mg/kg body weight (bw) at intervals of 2 to 4 weeks, no significant drop in the prevalence of African animal trypanosomosis (AAT) was observed. To examine a suspected drug resistance, 20 Zebu cattle, naturally infected with T. congolense and/or T. vivax, were transferred in December 1989 from Samorogouan into a fly-proof stable. Diminazene aceturate at 7 mg/kg bw cured infections of T. vivax, but was ineffective against T. congolense. Likewise, treatments with homidium bromide (Ethidium, FBC) at 1 mg/kg bw and isometamidium chloride (Trypamidium, Rhône Mérieux) at 1 mg/kg bw, respectively, proved to be ineffective. Corresponding chemotherapeutic trials in previously unexposed Zebu bulls and Sahelian goats infected with one primary T. congolense isolate from Samorogouan demonstrated a high level of resistance to diminazene aceturate (7 mg/kg bw in cattle and 17.5 mg/kg bw in goats), isometamidium chloride (1 and 2 mg/kg bw i.v. in goats) and quinapyramine sulphate (Trypacide'S', Rhône Mérieux) at 5 mg/kg bw in goats. The appearance of a multiple-drug-resistant strain of T. congolense emphasizes the urgent need for new chemical substances as trypanocidal drugs and the increasing importance of efficient vector control.

[In vivo chemosensitivity of Plasmodium falciparum to chloroquine in Burkina Faso: development of resistance 1988-1990]

A study of Plasmodium falciparum sensitivity to chloroquine was carried out in 1988 and 1990 in 5 localities, representatives of different climatic areas of Burkina Faso. The 7-day in vivo standard test performed in 1988 showed a total clearance failure of 25%. No significant difference with 1990 data was found, except for an increase of the resistance in the area of Fada N'Gourma, close to the border with Benin, Niger and Togo.

Serological evidence in sheep suggesting phlebovirus circulation in a Rift Valley fever enzootic area in Burkina Faso

Within the Phlebovirus serogroup, Rift Valley fever (RVF) virus is endemo-enzootic in the African sahelian zone. Recently an RVF epizootic in West Africa prompted a serosurvey in the major sheep and cattle raising areas. Because of the close antigenic relationship between the phleboviruses it appeared of interest to evaluate the prevalence of the other phleboviruses also. In 1987, 482 sheep serum samples were collected in 2 different ecological zones of Burkina Faso and tested for the presence of phlebovirus antibodies. A sensitive but non-specific immunofluorescent antibody test and a specific enzyme-linked immunosorbent assay (ELISA) were used, with the following African phlebovirus antigens: Rift Valley fever (RVF), Arumowot, Gabek Forest, Gordil, Saint Floris and Odrenisrou. A total of 15.8% of the sera sampled had anti-RVF antibody in the ELISA. RVF virus appeared to be more active in drier areas such as the sahelian region, known to be an enzootic area for the disease. Antibodies to other phleboviruses were found in 11.8% of the samples, independent of RVF virus activity. It is assumed that sheep can be infected by different phleboviruses.

Relationships between circulating S-antigens, naturally acquired antibodies to Plasmodium falciparum exoantigens and malaria attack in a mesoendemic area

A survey involving 77 individuals living in two savannah villages near Bobo Dioulasso (Burkina Faso, West Africa), was performed in June 1987 (before), August-September (during) and January 1988 after the seasonal transmission. The clinical longitudinal study during the seasonal period permitted us to define three different groups in terms of both age and occurrence of malaria attack (MA; greater than or equal to 5000 parasites/mm3 of blood and axillary fever greater than or equal to 37.8 degrees C). The presence of circulating stable antigen (S-Ag) and the antibody responses against exoantigens (E-Ag) of Plasmodium falciparum were also evaluated at three observations periods: beginning, during and after the transmission season. The adult group (III) had the highest rates of IgG Ab to E-Ag although, IgM prevalence to E-Ag was maximal in the group II (individuals with no malaria attack and age less than or equal to 15 years old). Group I (persons with less than or equal to 15 years old and who contracted at least one MA) did not have any S-Ag at the first observation period and showed the lowest rate of antibodies to E-Ag. The probability of occurrence of an MA calculated from these parameters at the beginning of the transmission period were correct in 78.9% of the cases in children (Groups I & II) and in 71.8% of adults during the subsequent transmission period. Therefore these values could be used for evaluating the probability of occurrence of a clinical MA during the transmission period in a mesoendemic area. S-Ag and antibodies to E-Ag could participate positively in the mechanisms involved in the development of the immune status.

In vitro immune recognition of synthetic peptides from the Plasmodium falciparum CS protein by individuals naturally exposed to different sporozoite challenge

The impact of duration and intensity of sporozoite challenge on the in vitro cell immune response to synthetic peptides of the circumsporozoite (CS) protein of Plasmodium falciparum was investigated in residents of a malaria endemic area in Burkina Faso (West Africa). Lymphocyte proliferation and interferon-gamma (IFN-gamma) production were used to assess immune recognition of synthetic peptides corresponding to the polymorphic Th2R and Th3R regions, to the conserved CS.T3 sequence and to NANP and degenerate NVDP repeats. Immune responses were measured in adults and children from a village where they received more than 100 sporozoite inoculations per year and in adults living in a town, exposed to a 10-100 times lower challenge. A lifetime intense exposure apparently increased the ability to proliferate in response to most peptides in the rural adults, who all produced antibodies to NANP repeats. Surprisingly, cell cultures from these subjects seldom contained appreciable levels of IFN-gamma. In the urban adults, possibly due to the moderate challenge they are exposed to, significant differences in the proliferative potentials of the peptides could be detected. The highest stimulation indices were obtained with the genetically unrestricted CS.T3 peptide. Remarkably, proliferative responses to Th2R and Th3R appeared to be correlated with the humoral response to the CS protein, indicating a T helper significance of the epitopes. The differing proliferative potential of the polymorphic epitopes in the urban adults suggests that polymorphism might delay the development of immune responsiveness under conditions of sporadic transmission. The children from the highly malarious village displayed the lowest proliferative scores, accompanied by a high prevalence of antibodies to NANP repeats. On the basis of these findings, the hypothesis is proposed that a pure B cell reactivity to NANP repeats could ontogenetically precede the mounting of a conventional T-B cooperative immune response.

[Variation of the parasite density of Plasmodium falciparum in asymptomatic carriers: consequences for malaria chemoresistance studies]

During the studies on malaria chemoresistance, we noted great variations in parasite density of Plasmodium falciparum between screening in the morning and final selection in the afternoon, in asymptomatic people. To better understand this phenomenon, we conducted a study in october 1987 on primary school children in a village near the city of Bobo-Dioulasso, at the peak malaria prevalence. We performed 3 blood-smears at 8 a.m., 2 p.m. and 8 p.m., on Day 0 and Day 4, to an initial number of 86 children, aged from 6 to 9 years. By the end of the study 44 children remained who fulfilled the inclusion criteria Among them 35 showed a parasitaemia on Day 0 and 9 remained negative. On Day 4, 28 were positive and 16 remained negative. Of the 35 children positive at entry to the study 16 remained continuously positive, the others were negative on at least one occasion. Of the 28 children positive on Day 4, 14 remained continuously positive. For the 16 people with a parasitaemia continuously positive on Day 0.7 (43.7 p. cent) became spontaneously negative on Day 4. But considering the small size of our sample, the analysis of the nycthemeral variation and of the variation between the two days did not show a significant difference. Further studies involving a greater number of blood-smears during a longer period and concerning more people, should be conducted. The possibility of spontaneous negativation of the parasitaemia without drug absorption shows that there are some cases of false malaria chemosensitivity that are declared when the in vivo tests are not coupled with in vitro tests.

[Preliminary data on dermatomycoses in Ouagadougou (Burkina Faso)]

This study is a contribution to a best knowledge of mycosis in Burkina Faso where the data concerning these diseases are very old. It has been focused on the clinical and mycological features of the dermoskeloton mycosis through the consultations at the two offices of dermatology in the city of Ouagadougou. From April to October, 1990, 216 patients have been taken census of, and they have shown 265 lesions among which 143 mycosis of the skinfolds (54 p. cent), 45 onychomycosis (17 p. cent), 29 palmoplantar mycosis (11 p. cent), 24 mycosis of the glabrous skin (9 p. cent) and 24 mycosis of the scalp (9 p. cent). From these 265 lesions we have isolated 156 strains of dermatophytes and 108 strains of candida. The species which have been seen more frequently are Candida albicans (30 p. cent), Trichophyton rubrum (19 p. cent), Trichophyton soudanense (13 p. cent) and Trichophyton tonsurans (8 p. cent). This study has enabled the identification of some clinical features and some responsible agents of the dermatoskeloton mycosis in Ouagadougou. It will lay the foundation for further specific studies in the country.

Detection of meningitis epidemics in Africa: a population-based analysis

Portions of sub-Saharan Africa are subject to major epidemics of meningococcal meningitis that require early detection and rapid control. We evaluated the usefulness of weekly meningitis rates derived from active surveillance data in Burkina Faso for detecting a meningitis epidemic. By analysing the rates of disease in 40 x 40km2 areas within a study region of Burkina Faso, we found that a threshold of 15 cases/100,000/week averaged over 2 weeks was 72-93% sensitive and 92-100% specific in detecting epidemics exceeding 100 cases/100,000/year. During epidemic periods, the positive predictive value of this threshold approached 100% for detecting local epidemics. Additionally, meningitis incidence was proportional to village size, with villages greater than 8000 having the highest disease rates during a major group A meningococcal epidemic in 1983-1984. Despite the rudimentary nature of surveillance data available in many developing countries, these data can be used to detect the early emergence of meningitis epidemics. Additional studies are needed to determine the relevance of this approach for detecting epidemics.

Community-based evaluation survey of immunizations in Burkina Faso

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.

[Perinatal mortality in Burkina Faso: risk factors in an urban environment of Bobo-Dioulasso]

A total of 96 mothers of stillborn babies (cases) and 402 mothers of live-born babies (controls) were studied between the 1st November 1988 and the 31st July 1989 in an attempt to identify the risk factors for the high number of stillbirths in the Maternity wing of the Hôpital National Sourô SANON in Bobo-Dioulasso, Burkina Faso. From a stratified analysis, eight risk factors emerged as significant predictors of mortality: mother older than 35 years, high parity (five or more), previous history of stillbirth, lack of medical supervision of pregnancy, interval between last consultation and birth longer than 30 days, complications during delivery and birth weight less than 2,500 g. Polygamy was associated with a 51% reduction in the risk of stillbirth. The problem of selection bias which affects the validity of hospital based case-control studies is discussed. Techniques for reducing selection bias in hospital based case-control studies are proposed. Improvements in antenatal care in Bobo-Dioulasso are suggested.

[Dracunculosis control by three techniques in the south-west of Burkina Faso. Compared efficacy of the techniques]

A study on the effectiveness of health education, chemical treatment of water sources and the two combined measures was carried out in ten dracunculiasis endemic villages in South-Western Burkina Faso from 1985 to 1989. Data on cases were collected by active case-finding. Dracunculiasis was eliminated from four villages through health education and from four other through combined measures after four years. Endemy was reduced by 67 p. 100 in two villages through chemical treatment. Difficulties encountered in the setting up of the measures and place of each of them in control programs are discussed.

Estimating the direct and indirect economic costs of malaria in a rural district of Burkina Faso

Comprehensive estimates of the direct economic costs of malaria should include not only the costs of care at established health facilities, but also other expenditures, such as travel and out-of-pocket costs of drugs. They should include all episodes of illness, whether or not the patient attended a health facility. Also, the indirect economic costs, which are based on the value of time lost due to illness, consider seasonal variations in the marginal product of labor according to the agricultural season. A 1985 representative survey of 626 households in Solenzo medical district, Burkina Faso, provided household data on health service utilization, expenditures, and agricultural production with which to implement these refinements. Numbers of malaria deaths and cases were estimated by adjusting survey totals according to monthly patterns of reported malaria deaths. The marginal product of labor was valued according to typical activities in each of three agricultural seasons: brewing millet beer during the maintenance period (January-February), growing cotton during the cash crop season (March-April), and growing millet and sorghum during the food crop season (May-December). The resulting values were $0.28, $1.09, and $0.55 per day, respectively. Cost per case averaged $5.96 and cost per capita $1.15. Indirect cost due to mortality was the largest cost component ($0.79 per capita), followed by direct costs incurred by the user (e.g. transportation costs and drug purchases, $0.22 per capita). Direct costs paid by providers were small, only $0.04 per capita. A household survey provides the necessary data for more comprehensive population-based estimates of costs of malaria.

[Preliminary epidemiological study of dracunculosis in the southwest of Burkina Faso]

An epidemiologic survey was carried out before the setting up of an applied research project on dracunculiasis control through three strategies. The data were collected by house-to-house visits and from family cards. The overall incidence rate was 10.3 per cent + 0.9 with variations from 1.7 to 35 per cent according to the villages. The incidence rates were significantly higher in the 5-14 and 15-59 years age groups. On the opposite, there was no significant difference between the rates according to sex. The disease presented a family feature and cases were concentrated in 35 per cent of families. The proportion of polyparasitism was important more than half of patients had two or more worms. The measurement of the same indicators at the end of project will allow the assessment of the project results.

Rising trend of reported primary genital syphilis and genital ulcer disease in Burkina Faso

Recent trends in reported primary genital syphilis and genital ulcer disease (GUD) were assessed in Burkina Faso using incidence data reported to the Ministry of Health. From 1978 to 1983 the yearly reports of genital syphilis and GUD rose by 42%. A single period moving average was calculated for each consecutive 13-week period from 1978 to 1983, documenting an average 7% rise per year. Severe limitations in the Ministry of Health of personnel and other resources for surveillance were noted and no improvements in surveillance methods were evident during this study. The rising trend suggests a growing problem of ulcerative sexually transmitted diseases, which may, in turn, facilitate infection with sexually acquired human immunodeficiency virus, coincident with the expansion of this epidemic in Africa. Syphilis complications are also almost certain to include adverse pregnancy outcome due to maternal syphilis. The rising trend in genital syphilis and GUD, and the probable increase in associated adverse sequellae, require that prevention and control of sexually transmitted diseases should be made a high priority.