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Evidence on the cost‐effectiveness of multisectoral maternal and child health and nutrition programmes is scarce. We conducted a prospective costing study of two food‐assisted maternal and child health and nutrition programmes targeted to pregnant women and children during the first 1,000 days (pregnancy to 2 years). Each was paired with a cluster‐randomized controlled trial to evaluate impact and compare the optimal quantity and composition of food rations (Guatemala, five treatment arms) and their optimal timing and duration (Burundi, three treatment arms). We calculated the total and per beneficiary cost, conducted cost consequence analyses, and estimated the cost savings from extending the programme for 2 years. In Guatemala, the programme model with the lowest cost per percentage point reduction in stunting provided the full‐size family ration with an individual ration of corn–soy blend or micronutrient powder. Reducing family ration size lowered costs but failed to reduce stunting. In Burundi, providing food assistance for the full 1,000 days led to the lowest cost per percentage point reduction in stunting. Reducing the duration of ration eligibility reduced per beneficiary costs but was less effective. A 2‐year extension could have saved 11% per beneficiary in Guatemala and 18% in Burundi. We found that investments in multisectoral nutrition programmes do not scale linearly. Programmes providing smaller rations or rations for shorter durations, although less expensive per beneficiary, may not provide the necessary dose to improve (biological) outcomes. Lastly, delivering effective programmes for longer periods can generate cost savings by dispersing start‐up costs and lengthening peak operating capacity.

To evaluated artemisinin partial resistance (ART-R) in malaria in Burundi, during December 2023-June 2024, we studied 423 children <5 years of age with uncomplicated Plasmodium falciparum malaria in 8 health facilities in the northern part of the country. After artemether/lumefantrine treatment with only the first dose directly observed, 4.5% remained parasitemic on day 3. No pfkelch13 mutations, validated or candidate markers of ART-R, were detected. However, markers of antifolate and 4-aminoquinoline resistance were widespread: the dhfr triple mutant N51I/C59R/S108N was nearly fixed (92%), dhps double and triple mutants were common (41% and 47%), and pfcrt CVIET, associated with chloroquine and amodiaquine resistance, predominated (84%). Geographic differences occurred in day-3 positivity and haplotype frequencies. Although ART-R markers were absent, delayed parasite clearance and near fixation of multidrug-resistant haplotypes serve as a warning. Strengthened efficacy monitoring and regional molecular surveillance are urgently needed to prevent drug-resistant P. falciparum from becoming established in Burundi.

Background Despite the implementation of a free healthcare policy for pregnant women and children under five since 2006, neonatal mortality remains high in Burundi. Indeed, twenty-one neonates per 1,000 live births died in 2019. This study aimed to assess neonatal survival and identify factors associated with neonatal mortality in one tertiary hospital of Bujumbura, Burundi. Methods We recruited 885 babies whose births occurred between October and December 2020 in Kamenge Teaching Hospital of the University of Burundi and followed them over four months. We applied life table methods and implemented the Cox proportional hazard regression model to evaluate neonatal survival and determine factors associated with neonatal mortality. Results Among 885 live births, 30 neonates died and 133 were lost to follow-up, resulting in a neonatal mortality rate of 36.65 per 1,000 live births. Notably, 90% of neonatal deaths occurred within the first week of life, with 40% within the first 24 h. The leading causes of death included complications related to prematurity (60%), asphyxia (13.33%), infections (13.33%), and congenital malformations (13.33%). Mortality increases with severe prematurity (AHR: 14.60, 95%CI 5.83–36.54), fewer ANC (AHR: 6.67, 95%CI 1.54–29.25), and Apgar score below 6 at five minutes (AHR: 4.37, 95%CI 1.66–11.44). Conclusion Neonatal mortality remains high, predominantly driven by preventable and curable complications. Further research is needed to explore this subject on a large scale to inform targeted interventions.

Fasciolosis is a zoonosis that limits the productivity of ruminants worldwide, but there is a lack of information on its occurrence in Burundi. Therefore, this study aimed to fill the information gap by determining the prevalence and risk factors associated with bovine fasciolosis in the Imbo Region of Burundi. Two prevalence studies were conducted in parallel in the five communes of the five provinces in the Imbo region. In the first study, a total of 426 fecal samples were collected from randomly selected cattle farms and microscopically examined to determine Fasciola egg burden. Survey data on cattle husbandry were collected from owners of these cattle and analyzed to determine the risk factors for bovine fasciolosis. In the second study, 467 cattle were randomly selected in abattoirs and their livers were examined postmortem to determine liver fluke burdens. Data were entered separately into Microsoft Excel and analyzed using R software. The overall prevalence of bovine fasciolosis was 47.7% (42.9–52.4, 95% CI) for microscopic examination and 33.2% (28.9–37.5, 95% CI) for postmortem examinations. The majority of positive cattle (60.6%) had light intensity infections as determined by eggs per gram of feces (epg). Postmortem examinations corroborated these results and indicated that 80% of cattle had light intensity infections. Chi-square analysis showed a statistical association with the presence of bovine fasciolosis and the age, sex, and origin of cattle and the practices of cattle owners ( P  < 0.05).

Knowledge of intrahousehold transmission dynamics of clade Ib mpox, especially in recently epidemic African contexts, is scarce. Our study aimed to quantify household transmission patterns of clade Ib mpox in Burundi, with a focus on children. We conducted a prospective cohort study in two health districts, Bujumbura and Kayanza, in Burundi from Jan 23 to March 20, 2025, enrolling 88 laboratory-confirmed primary mpox cases and 432 of their household contacts. We estimated household secondary attack rates (SARs), serial intervals, and basic reproduction number (R0), including a sensitivity analysis to assess the effect of potential misclassification of mpox index cases younger than 15 years. The primary outcome was occurrence of a secondary mpox infection within the household, defined as any laboratory-confirmed mpox case identified among contacts during the follow-up period. Of the 88 households, 18 (20%) experienced secondary transmission, with most primary mpox cases generating a single secondary case. The overall SAR across all households was 6·15% (95% CI 4·02–8·95) and was significantly higher among those younger than 15 years (8·77% [5·44 –13·22]) than among those aged 15 years or older (2·84% [0·92–6·50]). The overall R0 was 0·30 (95% CI 0·17–0·46), and was significantly higher for those younger than 15 years (0·43 [0·21–0·70]) than those aged 15 years or older (0·15 [0·03–0·27]). The sensitivity analysis showed significantly higher estimates (R0 0·9 [0·71–1·09]; SAR 17% [13·57–21·03]). Intrahousehold transmission of clade 1b mpox in Burundi was limited, and unlikely to sustain a broader community spread. The involvement of children in transmission chains within the household underscores their vulnerability, emphasising the need for accurate household investigation, early detection, and strategies to protect them. Our findings suggest that infection outside the household, with adults serving as a source for initial household introductions, might be a primary driver of the outbreak. The mpox outbreak response should adopt a dual approach combining interventions for household settings and targeted prevention strategies for adults at risk where community transmission is more probable. UNICEF Burundi Country Office.

The global health community has had more than a decade to develop pandemic preparedness programmes and apply lessons learnt to new disease outbreaks. Mpox has now been declared a global public health emergency, but the response appears to be missing important elements of equity, focusing instead on diagnosis and surveillance. This approach leaves vulnerable populations in countries grappling with the outbreak without the preventive and treatment services they need. Based on our experiences managing the current mpox outbreak in Burundi, we outline some limitations of ongoing response strategies and advocate for the adoption of core principles that emphasise an equitable approach. These strategies include: community partnerships; care provided across the spectrum of disease; gender-informed services; sensitive community education; and promotion of community cohesion. Although funding and implementing these activities is ultimately the responsibility of governments, additional support might be needed also from non-governmental organisations, especially in settings characterised by conflict and fledgling health systems where the current mpox outbreak is centred.

Children of key population individuals (CPK) often face the same stigma and discrimination as their parents, limiting their access to HIV services. The Meeting Targets and Maintaining Epidemic Control project analyzed pediatric HIV testing data from project-supported sites to better understand risk among CKP and improve comprehensive prevention, testing, and treatment for KP families. We conducted a retrospective analysis of routine program data collected October 1, 2021-September 30, 2022, in project-supported sites in Burundi, Côte d'Ivoire, Democratic Republic of Congo, Tanzania, and Togo. We compared HIV case finding (defined as the percentage of children diagnosed with HIV among those who were tested) and treatment initiation (defined as the percentage of children diagnosed with HIV who were initiated on antiretroviral therapy) data for children <15 years disaggregated by index versus non-index testing and CKP versus children of non-KP individuals (non-CKP). A total of 5,651 children were tested (n = 2,974 index testing; n = 2,677 non-index testing). Of those diagnosed with HIV, 33% (181/541) were CKP, with case finding 17% (181 positive/1,070 tested) among CKP and 8% among non-CKP (360 positive/4,581 tested). Almost half of CKP diagnosed were ages 1-4 years. Among the 2,974 (53%) reached through index testing, overall case finding was higher among CKP (17%; 178 positive/1,052 tested) than non-CKP (11%; 219 positive/1,922 tested). Treatment initiation was 97% among CKP and 94% among non-CKP. CKP were identified primarily through index testing which, although considered a priority strategy to identify children at high risk, has not been widely used within KP family networks. Most CKP reached were children of female sex workers, but those of other KPs should also be prioritized. KP-focused programs have often excluded children, but the case-finding approaches in the project's KP programs were effective in reaching CKP. Comprehensive, family-centered KP programming is needed that includes family planning, prevention of vertical transmission, early infant diagnosis, and other maternal and child health services to reduce the impact of HIV on families and achieve an HIV-free generation.

Background Taenia solium cysticercosis is a zoonotic disease that is endemic in many low- and middle-income countries where risk factors for disease transmission are present. The economic impact of cysticercosis on public health and on the pig production sector is not well known in many of those countries, including Burundi. This study aimed at estimating the burden of T. solium cysticercosis in Burundi including data on humans and pigs. Methods Epidemiological and economic data were collected from literature up to July 30, 2021 and governmental and non-governmental agencies. Direct and indirect costs for neurocysticercosis (NCC)-associated epilepsy and losses due to porcine cysticercosis were estimated to assess the economic burden, while the health burden was estimated using zoonotic disability-adjusted life years (zDALYs). Different probability distributions (Uniform, Beta, Dirichlet and Gamma) were applied depending on the type of epidemiological parameter. Monte Carlo simulations and 100,000 iterations were used to calculate the 95% uncertainty interval (UI) for each parameter and perform sensitivity analyses. Results In Burundi, 4.26 million USD (95% UI, 1,858,308–8,190,951) were estimated as economic impact due to T. solium cysticercosis in humans and pigs, of which 40.2% (95% UI, 10.3–75.1) of the total costs were due to NCC-associated epilepsy and 59.8% (95% UI, 24.9–89.7) of the losses due to porcine cysticercosis. The cost per NCC-associated epilepsy case was 72 USD (95% UI, 25–168), representing 30.8% of the GDP per capita in 2020. The probable incident cases and deaths for NCC-associated epilepsy were 9065 (95% UI, 2370–16,716) and 61 (95% UI, 16–114), respectively. More than 2 zDALYs (95% UI, 1.1–3.4) per thousand person-years was estimated, of which an average of 1.3 DALYs [0;0] (95% UI, 0.3–2.6) was due to NCC- associated epilepsy and 0.8 animal loss equivalents (ALEs) (95% UI, 0.3–1.5) due to porcine cysticercosis. Conclusions This study provides evidence of a significant burden of T. solium cysticercosis for Burundi’s population. We urge policy makers to use these evidence-based results and put T. solium cysticercosis on the public health agenda of the country. This study recommends urgent action to find solutions for integrated control strategies for T. solium cysticercosis in Burundi.

Currently, the life expectancy of people living with the human immunodeficiency virus (HIV) and the general population are similar. Hypertension is a major public health issue in Africa and is largely underdiagnosed. Most HIV-infected individuals, especially those on Anti-Retroviral Therapy (ART) have hypertension. Our project aims to determine the prevalence of hypertension and associated factors amongst HIV-infected adults treated by ART in Burundi. A cross-sectional study was conducted among HIV-infected subjects over the age of 20, managed in five healthcare centers for people living with HIV (PLWH). The World Health Organization STEPWISE survey and anthropometric measurements were employed. Blood pressure was measured according to the ESC 2018 recommendations. 1 250 HIV-infected patients aged between 35.4 and 50.2 years were included (18.4% men). The prevalence of hypertension was 17.4% (95% CI 13.2–22.1). Approximately 47.25% of HIV patients with hypertension were previously undiagnosed. Other factors were associated with HTN, such as being overweight (OR 2.88; 95% CI 1.46–5.62), obesity (OR 2.65; 95% CI 1.27–5.55), longer duration of HIV infection: ≥ 10 years (OR 1.04; 95% CI 1.14–3.20), diabetes (OR 2.1; 95% CI 1.37–3.32) and age (OR 1.13; 95% CI 1.09–1.14). Despite their young age, almost 20% of HIV-ART treated patients had hypertension, 50% of these were undiagnosed. Blood pressure monitoring is crucial in these patients, especially those identified as high-risk, with prompt life and disability-saving interventions.

An outbreak of Rift Valley fever (RVF) was officially reported for the first time in Burundi on 10 th May 2022. The outbreak originated in the northern provinces and progressively spread to other regions of the country. This study presents (i) epidemiological investigations that were carried out through a countrywide emergency response and (ii) the characterization of the genotype of the RVF virus that caused the outbreak through phylogenetic analyses. Field teams visited each affected farm, collected data on observed syndromes, species and number of animals affected, farm’s locations, and herd size. Blood, serum and tissue samples were collected from selected clinical cases. Epidemiological data were analyzed using R (version 4.4.2) to determine the spatiotemporal distribution of cases. Mixed effects Poisson regression models were fitted to the data to identify risk factors. A total of 1,739 clinical cases were recorded. Of 100 samples collected and screened using Reverse Transcription Polymerase Chain Reaction (RT-PCR), 36 tested positives. Phylogenetic analyses revealed that the outbreak was caused by an RVFV strain of lineage C, sub-clade C.2.2 of the dominant lineage that was circulating in East Africa, with a close relationship to RVFV that was isolated in Rwanda in 2022. Epidemiological analyses revealed the northeastern region as the epicenter of the outbreak. Multivariable analyses showed that increased RVF cases were significantly associated with high and persistent rainfall and an upsurge in the minimum temperatures that occurred 3–4 months earlier. The analyses conducted provided insights on the risk of RVF in the country. The results would help the development of risk maps and other decision support tools that would be used to manage future risks of the disease.