Assessing changes in costs of maternal postpartum services between 2013 and 2014 in Burkina Faso

Introduction In Africa, a majority of women bring their infant to health services for immunization, but few are checked in the postpartum (PP) period. The Missed opportunities for maternal and infant health (MOMI) EU-funded project has implemented a package of interventions at community and facility levels to uptake maternal and infant postpartum care (PPC). One of these interventions is the integration of maternal PPC in child clinics and infant immunization services, which proved to be successful for improving maternal and infant PPC. Aim Taking stock of the progress achieved in terms of PPC with the implementation of the interventions, this paper assesses the economic cost of maternal PPC services, for health services and households, before and after the project start in Kaya health district (Burkina Faso). Methods PPC costs to health services are estimated using secondary data on personnel and infrastructure and primary data on time allocation. Data from two household surveys collected before and after one year intervention among mothers within one year PP are used to estimate the household cost of maternal PPC visits. We also compare PPC costs for households and health services with or without integration. We focus on the costs of the PPC intervention at days 6–10 that was most successful. Results The average unit cost of health services for days 6–10 maternal PPC decreased from 4.6 USD before the intervention in 2013 (Jan-June) to 3.5 USD after the intervention implementation in 2014. Maternal PPC utilization increased with the implementation of the interventions but so did days 6–10 household mean costs. Similarly, the household costs increased with the integration of maternal PPC to BCG immunization. Conclusion In the context of growing reproductive health expenditures from many funding sources in Burkina Faso, the uptake of maternal PPC led to a cost reduction, as shown for days 6–10, at health services level. Further research should determine whether the increase in costs for households would be deterrent to the use of integrated maternal and infant PPC

What criteria guide national entrepreneurs' policy decisions on user fee removal for maternal health care services? Use of a best-worst scaling choice experiment in West Africa.

Several countries in sub-Saharan Africa have implemented policies to remove or reduce user fees. Our aim was to identify criteria guiding such decisions among national policy entrepreneurs, those who link up problem definition,solution development and political processes.We administered a best–worst scaling (BWS) experiment to 89 policy entrepreneurs, asking them to identify the most and the least important criteria on a series of predefined sets. Sets were compiled using a Balance Incomplete Block Design which generated random combinations of all 11 criteria included in the experiment. In turn, those had emerged from a prior set of focus group discussions organized among policy entrepreneurs. Ordered logit models were used to investigate the value of single criteria as well as heterogeneity of preferences.Political commitment was identified as the most important criterion guiding policy decisions on user fee abolition or reduction to the overall sample, but particularly so for more experienced respondents aged over 50 years. International pressure and donor money were identified as least important while equity and institutional capacity were deemed of relatively little importance. Respondents more involved in advising on policy than on formulating policy rated economic issues such as financial sustainability and cost-effectiveness as less important

Characterization of Somba Cattle Breed Using Molecular Markers

The polymorphism of four categories of genome markers— 11 blood group systems, 5 lactoprotein loci, 2 blood protein loci and 33 microsatellites, i.e. 51 loci in total—was analyzed in four cattle populations or “breeds” from West Africa: the Somba and Lagoon taurine breeds, the Sudanese zebu Peul population and the Borgu population, crossbred between taurine and zebu. The aim of the study was to characterize the polymorphism of the Somba breed and to evaluate its genetic distance with the other three populations, especially the Lagoon breed, with which it shares a high phenotypical resemblance. Whatever the category of markers or the method used, the four populations were clearly separated. Based on the blood group systems, the most marked differences were observed between taurine and zebu breeds especially for the A, B and S systems. The typical high allele frequencies of AlbS and HbB were observed in zebus, as well as the well-known predominance of the αs1-CnC, β-CnA2, κ- CnA haplotype, in contrast with the αs1-CnB, β-CnA1, κ-CnB haplotype of African taurines. Based on microsatellites, reciprocal averaging highlighted the discriminating effect of ETH 225139 allele, whose frequency was very high in the Somba breed, and Hel 13182 and INRA 037114, which were apparently specific to zebu and Lagoon breeds, respectively. These allele frequencies in the Borgu population were roughly intermediate between those in zebus and taurine breeds. The study also tried to determine whether it was possible to identify the population of origin based on the knowledge of the 33-microsatellite genotype of an animal. Results showed that 97% of the animals were correctly classified; errors concerned zebus incorrectly classified as Borgus and vice versa

Evaluation du coût médical direct de il prise en charge du syndrome drépanocytaire majeur de l'enfant à Ouagadougou

English AbstractThe sickle cell disease is a major problem of public health in Burkina Faso. Prevalence of the major sickle syndromes affect approximately 8,42 % of the patients in a hospital environment. The families of these children spend a lot of money on vaccines, medicine, complementary examinations. The objective of our work was to estimate the annual expenses to cause by the sickle disease within families. To this end we led to the pediatric university hospital Charles de Gaulle and to the holy health center Camille of Ouagadougou a retrospective covering study a period of one year going from January 1st till December 31st, 2011 on hospitalized or consultant children from 0 to 15 years old to these structures. The medical  cases of these patients were of use to us as sources of data which were collected on an index of collection and treated with the software " Sphinx Lexica ". The average cost of a care in ambulatory is estimated at 41 838,82 FCFA a year and the average cost of the care in hospitalization to 106 688,70 FCFA. The sickle cell disease thus constitutes a considerable economic weight for our patients and especially families where from the necessity of an implication of the political powers for the implementation of well codified protocols and a subsidy for the care of this affection.Keywords: sickle cell disease major, child, taken care, medical cos

Will dairy cattle production in West Africa be challenged by heat stress in the future?

This study focuses on heat stress conditions for dairy cattle production in West Africa under current and future climatic conditions. After testing the accuracy of the dynamically downscaled climate datasets for simulating the historical daily maximum temperature (Tmax) and relative humidity (RH) in West Africa for 50 meteorological stations, we used the dataset for calculating the temperature-humidity index (THI), i.e., an index indicating heat stress for dairy cattle on a daily scale. Calculations were made for the historical period (1981–2010) using the ERA-Interim reanalysis dataset, and for two future periods (2021–2050 and 2071–2100) using climate predictions of the GFDL-ESM2M, HadGEM2-ES, and MPI-ESM-MR Global Circulation Models (GCMs) under the RCP4.5 emission scenario. Here, we show that during the period from 1981 to 2010 for > 1/5 of the region of West Africa, the frequency of severe/danger heat events per year, i.e., events that result in significant decreases in productive and reproductive performances, increased from 11 to 29–38 days (significant at 95% confidence level). Most obvious changes were observed for the eastern and southeastern parts. Under future climate conditions periods with severe/danger heat stress events will increase further as compared with the historical period by 5–22% depending on the GCM used. Moreover, the average length of periods with severe/danger heat stress is expected to increase from ~ 3 days in the historical period to ~ 4–7 days by 2021–2050 and even to up to 10 days by 2071–2100. Based on the average results of three GCMs, by 2071–2100, around 22% of dairy cattle population currently living in this area is expected to experience around 70 days more of severe/danger heat stress (compare with the historical period), especially in the southern half of West Africa. The result is alarming, as it shows that dairy production systems in West Africa are jeopardized at large scale by climate change and that depending on the GCM used, milk production might decrease by 200–400 kg/year by 2071–2100 in around 1, 7, or 11%. Our study calls for the development of improved dairy cattle production systems with higher adaptive capacity in order to deal with expected future heat stress conditions.</p