This is a case-control study conducted to examine the risk factors for multidrug resistance (MDR) among patients with pulmonary tuberculosis (TB) in four centers in Burkina Faso, West Africa: Ouagadougou, Bobo-Dioulasso, Gorom-Gorom, and Dori. Fifty-six MDR-TB cases and 304 controls were enrolled of which 40 MDR-TB cases and 222 controls were from Ouagadougou. The majority of cases were male, with 39 among MDR-TB cases and 205 in controls. The MDR-TB cases were aged from 14 to 75 years versus 11 to 75 years in the controls. The total risk assessment battery score was 11. Living outside of Burkina Faso (adjusted odds ratio [OR] = 0.017; 95% confidence interval [95% CI]: 0.001-0.325), known TB contact (OR = 0.045; 95% CI: 0.004-0.543), and patients with previous history of TB treatment (OR = 0.004; 95% CI: 0.000-0.0.052) were significantly associated with MDR-TB. TB contact and mainly previous treatment were the strongest determinants of MDR-TB. Also, living outside Burkina was a risk factor.

Genetic mutations are responsible for the high rate of resistance observed in the treatment of tuberculosis. This study aimed at determining the occurrence of mutations associated with rifampicin (RIF) and isoniazid (INH) resistance of Mycobacterium tuberculosis complex (MTBC) isolates. MTBC strains isolated by culture from 110 TB patients diagnosed with resistant to rifampicin (RR-TB) by Xpert MTB/RIF were studied. The isolates were obtained from the National Tuberculosis Reference Laboratory in Ouagadougou. They were identified culturally using Antigenic method (SD Bioline TB Ag MPT64). Polymerase Chain Reaction, PCR (DRplus) was used to detect the occurrence of mutations in the genes associated with resistance katG and inhA promoter for INH, and rpoB for RIF. Out of 103 isolates with RIF resistant, mutations were detected in 87(84.5%) of gene rpoB while no mutation was found in 16(15.5%) of the gene of the isolates even though the wild probes had disappeared. Single mutations were found in the codons D516V (41.7%) and H526Y (17.5%) while combined mutations (single and double) were mostly detected in the codons D516 (51.5%), H526Y (20.4%), S531L (11.7%) and H526D (10.7%) respectively. Single mutations responsible for high-level isoniazid resistance, katG were observed in the codon S315T1 while the combined inhA and katG were detected in the codon C8T and S315T, 16 (14.5%) respectively. The highest mutation occurrence was observed with rpoB516, rpoB526 for RIF and katG315 for INH associated with resistance of MTBC isolates. There is a need to improve molecular assay kit diagnosis to curb the geographic specificity of the target genes needed to detect more possible mutations.

In previously treated patients, the level of resistance of M. tuberculosis complex to commonly used anti-tuberculosis drugs is very high in Ouagadougou. Our results showed that multidrug-resistant tuberculosis could be a public health problem in Burkina Faso.

Background: Underdeveloped and underused medical laboratories in sub-Saharan Africa negatively affect the diagnosis and appropriate treatment of ailments.Objective: We identified political, disease-related and socio-economic factors that have shaped the laboratory sector in Senegal, Mali and Burkina Faso to inform laboratory-strengthening programmes.Methods: We searched peer-reviewed and grey literature from February 2015 to December 2018 on laboratory and health systems development from colonial times to the present and conducted in-depth interviews with 73 key informants involved in (inter)national health or laboratory policy, organisation, practice or training. This article depended on the key informants’ accounts due to the paucity of literature on laboratory development in francophone West African countries. Literature and interview findings were triangulated and are presented chronologically.Results: Until around 1990 there were a few disease-specific research laboratories; only the larger hospitals and district health facilities housed a rudimentary laboratory. The 1990s brought the advent of donor-dictated, vertical, endemic and epidemic disease programmes and laboratories. Despite decentralising from the national level to the regional and district levels, these vertical laboratory programmes biased national health resource allocation deleteriously neglecting the development of the horizontal, general-health laboratory. After the year 2000, the general-health laboratory system received more attention when, influenced by the World Health Organization, national networks and (sub-)directorates of laboratories were installed.Conclusion: To advance national general healthcare, as opposed to disease-specific healthcare, national laboratory directors and experts in general laboratory development should be consulted when national policies are made with potential laboratory donors.

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