Arnaud Iradukunda

Background Arterial hypertension is a major global public health concern. It coexists with other non-communicable and communicable diseases in Burundi, creating complex health challenges difficult to address. We aimed to assess the burden of newly diagnosed hypertension, identify associated risk factors, and assess 10-year cardiovascular risk among hypertensive and non-hypertensive patients. Knowing at-risk populations and level of risk could guide evidence-based interventions. Methods We conducted a modelling study on 714 patients admitted at Kamenge Teaching Hospital between January 2018 and December 2022. Retrospective data were obtained from medical records. Bayesian belief update methods, Bayesian logistic regression with bootstrapping, and Bayesian linear models were used to respectively estimate prevalence, risk factors, and associations between diastolic blood pressure (DBP) and cardiovascular risk. The 10-year cardiovascular risk was evaluated using the Canadian Framingham Risk Score. Findings: The prevalence of newly diagnosed hypertension was 16.9% (95% CrI: 14.2–19.7). Higher rates were observed among women (18%), patients aged 40–59 (21.3%) and ≥ 60 years (33.9%), those with higher education (up to 28.9%), and individuals with obesity, overweight, or family history of hypertension. Significant predictors included age ≥ 40, tobacco use, higher education, and excess weight. Moderate or severe 10-year cardiovascular risk was found in 24.9% of patients, with more than 60% of hypertensive patients classified as high risk. DBP showed a positive correlation with cardiovascular risk in both hypertensive and non-hypertensive groups. Interpretation: Newly detected hypertension and its strong association with elevated cardiovascular risk highlight missed opportunities for early diagnosis and prevention. Targeted screening and management of modifiable risk factors could reduce cardiovascular risk in this population and support national efforts to curb the growing burden of non-communicable diseases in Burundi. Conclusion The burden of newly diagnosed hypertension and its association with increased cardiovascular risk underscore the need for systematic screening, early diagnosis, and preventive strategies in Burundi. Interventions addressing modifiable risk factors could support national policies and resource allocation to reduce cardiovascular disease burden in line with the 2030 agenda.

Despite the implementation of a free healthcare policy for pregnant women and children under five since 2006, neonatal mortality remains high in Burundi. I

The coronavirus SARS-CoV-2 (COVID-19) experience has underscored the consequences of inequalities in health and access to health services across and within countries. Vulnerable population groups have been disproportionately exposed to certain diseases such as tuberculosis (TB) due to service interruptions. The current study aimed to assess TB related mortality and risk of drug resistance during the COVID-19 Pandemic in Burundi. We conducted an incident case–control study on 362 TB patients, with 181 multidrug resistant TB (MDR-TB) patients and 181 drug susceptible TB (DS-TB) patients. These patients under TB treatment between July 11, 2018, and November 11,2022 (18 months before and 18 months during COVID-19). Baseline and drug susceptibility status data were captured at treatment initiation. Mortality during treatment follow-up TB mortality was compared between categories of drug susceptibility, period (before vs during COVID-19) and regimen phase. A multivariate logistic regression was used to show the predictive risk factors. K-Fold cross-validation was used to evaluate the final model. A half of TB patients was under 40 years old, with majority of them being unemployed, malnourished and lacking food support during TB treatment. Most of them lived in precarious conditions with limited access to healthcare services. The overall TB-related mortality was 16.0% (95% CI: 12.5%- 20.3%) with 15.5% (95%CI: 10.7%-21.8%) in MDR-TB patients and 16.6% (95% CI: 11.6%-22.9%) in DS-TB patients. Stratified by the period, TB related mortality was 15.3% (95%CI: 11.7%-20.9%) before the COVID-19 pandemic and 17.1% (95%C 11.5%-24.6%) during the COVID-19 pandemic. More than a half of deaths in TB patients occurred during intensive phase of treatment. The risk of MDR-TB was significantly higher (p < 0.05) among patients undergoing treatment during the pandemic, those with a low education level, living in rural areas, unemployed, using public transportation, or living in overcrowded households (big family size,a small number of rooms). Additionally, patients with history of TB, previous treatment failure, and close contact with MDR-TB patients were more likely to have MDR-TB. The likelihood of MDR-TB further increased with the cumulative presence of these risk factors on the same TB patient. TB mortality increased during the COVID-19 pandemic, particularly among MDR-TB patients. The odds of MDR-TB encompass a range of socio demographic and clinical factors particularly among economically disadvantaged patients. These findings underscore the need for targeted equity-driven interventions in high-risked populations, especially in the context of emerging outbreaks, in order accelerate TB elimination goals. Additional investigation on TB related mortality should focus on the intensive phase of treatment, which aligns with the 2025 World Health Organization consolidated guidelines on TB diagnosis and control.

The COVID-19 pandemic, caused by SARS-CoV-2, disrupted work and life patterns worldwide, underscoring the urgency of addressing climate change. Despite contributing minimally to global greenhouse gas (GHG) emissions, Africa faces disproportionate vulnerability to the impacts of climate change. This commentary explores the benefits of blended work models (remote and in-office work) and the readiness of African cities to adopt them. Notably, the shift to working from home (WFH) during the pandemic improved individual well-being and reduced office energy consumption and commuting-related emissions. Robust digital infrastructure and organizational and sustainable policies are essential to fully leverage blended work for urban sustainability. The unexpected opportunities that arose during the pandemic could help African cities address climate change through careful planning and investment.

Background: Integrated national programme for the control of neglected tropical diseases and blindness aims to achieve a paradigm shift from control of morbidity to interruption of transmission and ultimately elimination.Objective: The aim of this study was to understand onchocerciasis epidemiology and control strategies in the context of Burundi. Specifically, the study sought to understand the coverage of Ivermectin treatment in onchocerciasis endemic zones, to assess the impact of African Programme for Onchocerciasis Control (APOC) approach on treatment coverage and forecast the therapeutic coverage to 2030 horizon in Burundi.Methods: We used retrospective data collected from 2005 to 2019 in four onchocerciasis endemic provinces in Burundi. For mapping and ivermectin coverage rates comparison, we respectively used a spatial analysis and welch testing methods. After, we forecasted the therapeutic coverage using the Autoregressive Integrated Moving Average (ARIMA) model, a statistical analysis model which uses time series data to predict future trends. All analysis were done using Quantum Geographic Information System (QGIS) and the R 3.5.3 software.Results: During study period, a mean population of 1,536, 392 (95% CI: 1,114 ,870 -1,932 ,403) has been targeted by ivermectin treatment in all the four provinces. The ivermectin coverage rate was 77.8% (95% CI: 67.8% to 81.6%). Specifically, ivermectin coverage rates were 76.4%, 76.6% and 78.7% in Rutana, Bururi and Cibitoke - Bubanza respectively. After six years of massive drug administration under World Health Organization community guidelines launched in 2011, the coverage rates were, except the 2016 year, above 80%. Forecasts for 2030 showed that the coverage rate for treatment could increase.Conclusion: This study showed that the ivermectin coverage rate significantly increased during the community-directed treatment approach period. The coverage rate should remain over 80% until 2030 in endemic regions, a strategy which should contribute to decrease the onchocerciasis prevalence and lead to onchocerciasis elimination.

The use of antenatal care by pregnant women enables them to receive good pregnancy monitoring. This monitoring includes counseling, health instructions, examinations and tests to avoid pregnancy-related complications or death during childbirth. To avoid these complications, the World Health Organization (WHO) recommends at least four antenatal visits. Therefore, this study was conducted to identify predictive factors of antenatal care (ANC) among women aged 15 to 49 years and its spatial distribution in Burundi. We used data from the Second Burundi Demographic and Health Survey (DHS). A Spatial analysis of ANC prevalence and Mulitlevel logistic regressions of determinants factors of ANC with a medical doctor were done. The ANC prevalence was mapped by region and by province. In unsampled data points, a cluster based interpolation of ANC prevalence was done using the kernel method with an adaptive window. Predictive factors of ANC were assessed using Mulitlevel logistic regressions. The dependent variable was antenatal care with a medical doctor and the explanatory variables were place of residence, age, education level, religion, marital status of the woman, household wealth index and delivery place of the woman. Data processing and data analysis were done using using Quantum Geographic Information System (QGIS) and R software, version 3. 5. 0. The ANC prevalence varied from 0. 0 to 16. 2% with a median of 0. 5%. A highest predicted ANC prevalence was observed at Muyinga and Kirundo provinces’ junction. Low prevalence was observed in several locations in all regions and provinces. The woman’s education level and delivery place were significantly associated with antenatal care with a medical doctor. Globally, the ANC prevalence is low in Burundi. It varies across the country. There is an intra-regional or intra-provincial heterogeneity in term of ANC prevalence. Woman’s education level and delivery place are significantly associated antenatal care. There is a need to consider these ANC disparities and factors in the design and strengthening of existing interventions aimed at increasing ANC visits.

Introduction: In 2003, Ghana abolished direct out of pockets payments and implemented health financing reforms including the national health insurance scheme in 2004. Treatment of childhood infections is a key component of services covered under this scheme, yet, outcomes on incidence and treatment of these infections after introducing these reforms have not been covered in evaluation studies. This study fills this gap by assessing the impact on the reforms on the two most dominant childhood infections; fever (malaria) and diarrhoea. Methods: Nigeria was used as the control country with pre-intervention period of 1990 and 2003 and 1993 and 1998 in Ghana. Post-intervention period was 2008 and 2014 in Ghana and 2008 and 2018 in Nigeria. Data was acquired from demographic health surveys in both countries and propensity score matching was calculated based on background socioeconomic covariates. Following matching, difference in difference analysis was conducted to estimate average treatment on the treated effects. All analysis were conducted in STATA (psmatch2, psgraph and pstest) and statistical significance was considered when p-value ≤ 0.05. Results: After matching, it was determined that health reforms significantly increased general medical care for children with diarrhoea (25 percentage points) and fever (40 percentage points). Also for those receiving care specifically in government managed facilities for diarrhoea (14 percentage points) and fever (24 percentage points). Conclusions: Introduction of health financing reforms in Ghana had positive effects on childhood infections (malaria and diarrhoea).

Background The use of antenatal care by pregnant women enables them to receive good pregnancy monitoring. This monitoring includes counseling, health instructions, examinations and tests to avoid pregnancy-related complications or death during childbirth. To avoid these complications, the World Health Organization (WHO) recommends at least four antenatal visits. Therefore, this study sought to understand the spatial distribution and predictive factors of antenatal care (ANC) among women aged 15 to 49 years with a medical doctor in Burundi. Methods We used data from the Second Burundi Demographic and Health Survey (DHS). A descriptive and spatial analysis of ANC prevalence were done. The ANC prevalence was mapped by region and by province. In unsampled data points, a cluster based interpolation of ANC prevalence was done using the kernel method with an adaptive window. Predictive factors of ANC were assessed using a fixed effects binary logistic regression. The dependent variable was antenatal care with a medical doctor and the explanatory variables were place of residence, age, education level, religion, marital status of the woman, household wealth index and delivery place of the woman. Data processing and data analysis were done using R software, version 3.5.0. Results The ANC prevalence varied from 0.0 to 16.2% with a median of 0.5%. A highest predicted ANC prevalence was observed at Muyinga and Kirundo provinces’ junction. Low prevalence was observed in several locations in all regions and provinces. The woman’s education level and delivery place were significantly associated with antenatal care with a medical doctor. Conclusion Globally, the ANC prevalence is low in Burundi. It varies across the country. There is an intra-regional or intra-provincial heterogeneity in term of ANC prevalence. Woman’s education level and delivery place are significantly associated antenatal care.

Introduction: Hypertension is a major threat to public health globally. Especially in sub-Saharan African countries, this coexists with high burden of other infectious diseases, creating a complex public health situation which is difficult to address. Tackling this will require targeted public health intervention based on evidence that well defines the at risk population. In this study, using retrospective data from two referral hospitals in Burundi, we model the risk factors of hypertension in Burundi. Materials and methods: Retrospective data of a sample of 353 randomly selected from a population of 4,380 patients admitted in 2019 in two referral hospitals in Burundi: Military and University teaching hospital of Kamenge. The predictive risk factors were carried out by fixed effect logistic regression. Model performance was assessed with Area under Curve (AUC) method. Model was internally validated using bootstrapping method with 2000 replications. Both data processing and data analysis were done using R software. Results: Overall, 16.7% of the patients were found to be hypertensive. This study didn’t showed any significant difference of hypertension’s prevalences among women (16%) and men (17.7%). After adjustment of the model for cofounding covariates, associated risk factors found were advanced age (40–59 years) and above 60 years, high education level, chronic kidney failure, high body mass index, familial history of hypertension. In absence of these highlighted risk factors, the risk of hypertension occurrence was about 2 per 1000 persons. This probability is more than 90% in patients with more than three risk factors. Conclusion: The relatively high prevalence and associated risk factors of hypertension in Burundi raises a call for concern especially in this context where there exist an equally high burden of infectious diseases, other chronic diseases including chronic malnutrition. Targeting interventions based on these identified risk factors will allow judicious channel of resources and effective public health planning.

Background: Despite the World Health Organization efforts to expand access to the tuberculosis treatment, multidrug resistant tuberculosis (MDR-TB) remains a major threat. MDR-TB represents a challenge for clinicians and staff operating in national tuberculosis (TB) programmes/centres. In sub-Saharan African countries including Burundi, MDR-TB coexists with high burden of other communicable and non-communicable diseases, creating a complex public health situation which is difficult to address. Tackling this will require targeted public health intervention based on evidence which well defines the at-risk population. In this study, using data from two referral anti-tuberculosis in Burundi, we model the key factors associated with MDR-TB in Burundi. Methods: A case-control study was conducted from 1^stAugust 2019 to 15^th January 2020 in Kibumbu Sanatorium and Bujumbura anti-tuberculosis centres for cases and controls respectively. In all, 180 TB patients were selected, comprising of 60 cases and 120 controls using incidence density selection method. The associated factors were carried out by mixed effect logistic regression. Model performance was assessed by the Area under Curve (AUC). Model was internally validated via bootstrapping with 2000 replications. All analysis were done using R Statistical 3.5.0. Results: MDR-TB was more identified among patients who lived in rural areas (51.3%), in patients’ residence (69.2%) and among those with a household size of six or more family members (59.5%). Most of the MDR-TB cases had already been under TB treatment (86.4%), had previous contact with an MDR-TR case (85.0%), consumed tobacco (55.5%) and were diabetic (66.6 %). HIV prevalence was 32.3 % in controls and 67.7 % among cases. After modelling using mixed effects, Residence of patients (aOR= 1.31, 95%C: 1.12-1.80), living in houses with more than 6 family members (aOR= 4.15, 95% C: 3.06-5.39), previous close contact with MDR-TB (aOR= 6.03, 95% C: 4.01-8.12), history of TB treatment (aOR= 2.16, 95% C: 1.06-3.42), tobacco consumption (aOR = 3.17 ,95% C: 2.06-5.45) and underlying diabetes’ ( aOR= 4.09,95% CI = 2.01-16.79) were significantly associated with MDR-TB. With 2000 stratified bootstrap replicates, the model had an excellent predictive performance, accurately predicting 88.15% (95% C: 82.06%-92.8%) of all observations. The coexistence of risk factors to the same patients increases the risk of MDR-TB occurrence. TB patients with no any risk factors had 17.6% of risk to become MDR-TB. That probability was respectively three times and five times higher among diabetic and close contact MDR-TB patients. Conclusion: The relatively high TB’s prevalence and MDR-TB occurrence in Burundi raises a cause for concern especially in this context where there exist an equally high burden of chronic diseases including malnutrition. Targeting interventions based on these identified risk factors will allow judicious channel of resources and effective public health planning.