Epidemiology of perinatal mortality in rural Burkina Faso: A community-based prospective cohort study

Background: Perinatal mortality is one of the major public health problems in Sub-Saharan Africa. It is estimated that over 6 millions infant deaths occur each year during the perinatal period either as stillbirths or early neonatal deaths. However, the accurate estimates on this burden are rare, especially in Africa where over 40% of all perinatal deaths take place. The lack of reliable data on PNMR in developing countries could be one of the reasons that make it invisible and therefore getting little attention from the funding agencies. We took the opportunity of the PROMISE-EBF trial, a randomized community-based study that aimed at assessing the effect of the promotion of exclusive breastfeeding by peer-counsellors on EBF rates and child morbidity at 12 weeks of age, to describe the magnitude of PNMR in Banfora health district, a rural area, South of Burkina Faso. Study objectives: To measure the PNMR in the EBF cohort in Banfora health district To identify potential risk factors for perinatal death in this cohort. Methods: We performed a secondary analysis on the datasets of the EBF study which was a cluster-randomized trial in 24 villages of Banfora with an intervention package consisting of one antenatal and 6 postnatal individual counselling sessions on EBF. Data of the two arms were considered as those of a single cohort and the PNMR, the stillbirth and the early neonatal mortality rates were estimated. In a multivariable logistic regression using baseline characteristics of the study participants as exposures and the perinatal death as outcome, we calculated crude and adjusted OR for perinatal death, stillbirth and early neonatal death. Covariates with an OR statistically significant (p<0.05) were considered as risk factors for PNMR. Results: 900 pregnant women were sampled for data collection in the EBF trial. Five women were excluded later (wrong inclusions) and 20 women got multiple births (20 pairs of twins), and were excluded from further follow-up. 875 women with a single birth were followed up to day 7 postpartum and included in the final analysis. The PNMR, the stillbirth and the early neonatal mortality rates, were 73.1‰ [95% CI: 55.8-90.4], 56‰ [95% CI:40.7-71.2], and 18.1‰ [95% CI:9-27.2], respectively. In the crude analysis, the young age of the mother (<20 years), the parity (nulliparous women), the season of birth (dry season), and the intervention appeared as the main risk factors for PNMR. In a multivariable logistic regression adjusting for all variables that were found to be important in the occurrence of perinatal deaths, we found that the young age of the mother (OR=2.93 95% CI:1.54-5.57), a birth during the dry season (OR=1.85 95% CI: 1.19-2.87), and the intervention (OR=2.16 95% CI:1.20-3.89) were factors that increased significantly the risk of perinatal death. The intention of the mother to not EBF the future baby had a marginal effect on PNMR (OR=1.55 95% CI:0.97-2.49) but a statistically significant effect on the risk of stillbirth (OR=1.90 95% CI:1.04-3.47). Conclusion: Our study showed the burden of perinatal deaths in a rural area in Burkina with the highest PNMR ever reported in this country. The risk factors identified in this study have been reported in previous studies except the intention of the mother to EBF that need further investigations.Master of philosophy in international healthMAMD-INTHINTH39

Alive & Thrive Evaluation in Burkina Faso: endline data

The data are the endline survey of a before-after cluster-randomised trial evaluating the Alive & Thrive programme in Burkina Faso. This was a cross-sectional household survey (N=3,367), designed to select a population-representative sample of women of reproductive age with at least one live birth in the previous 23 months living in rural areas of Boucle du Mouhoun, Burkina Faso. The dataset contains information on the following: socio-demographic characteristics of the woman & her husband; household assets; reproductive history; antenatal, delivery & postnatal care relating to the index birth; illnesses the infant has experienced in the past fortnight; initiation of breastfeeding; current infant feeding patterns (food diaries); problems/difficulties experienced relating to breastfeeding; sources of information & advice relating to infant feeding; and the woman’s knowledge of optimal infant feeding practices

Alive & Thrive Evaluation in Burkina Faso: baseline data

The data constitutes the baseline survey of a before-after cluster-randomised trial evaluating the Alive & Thrive programme in Burkina Faso. This was a cross-sectional household survey (N=2,288), designed to select a population-representative sample of women of reproductive age (15 to 49 years) with at least one live birth in the previous 12 months living in rural areas of Boucle du Mouhoun, Burkina Faso. The dataset contains information on the following: socio-demographic characteristics of the woman & her husband; household assets; reproductive history; antenatal, delivery & postnatal care relating to the index birth; illnesses the infant has experienced in the past fortnight; initiation of breastfeeding; current infant feeding patterns (food diaries); problems/difficulties experienced relating to breastfeeding; sources of information & advice relating to infant feeding; and the woman’s knowledge of optimal infant feeding practices

The effect of the Alive & Thrive initiative on exclusive breastfeeding in rural Burkina Faso: a repeated cross-sectional cluster randomised controlled trial.

BACKGROUND: The benefits of exclusive breastfeeding on mortality, health, and development of children have been well documented. In Burkina Faso, the Alive & Thrive initiative combined interpersonal communication and community mobilisation activities with the aim of improving knowledge, beliefs, skills, and, ultimately, breastfeeding outcomes. The objective of this study was to determine the effect of the Alive & Thrive initiative on exclusive breastfeeding in Boucle du Mouhoun, Burkina Faso. METHODS: We did a cluster-randomised trial with data collected with two independent, population-representative, cross-sectional surveys: a baseline survey done before the start of the initiative implementation and an endline survey done 2 years later. Rural villages in Boucle du Mouhoun, Burkina Faso, were randomly allocated by use of computer generated pseudo-random numbers, and women were eligible for participation if they had a livebirth in the 12 months preceding the survey and resided in a village selected for the study. The primary outcome was exclusive breastfeeding among infants younger than 6 months. Masking was not possible for the intervention implementation. All women who participated in the trial were included in the analysis population. The trial is registered with ClinicalTrials.gov, number NCT02435524. FINDINGS: Between June 2 and July 28, 2015, 2288 mothers participated in the baseline survey and between June 12 and July 25, 2017, 2253 mothers participated in the endline survey. At endline, there was a risk difference of 38·9% (95% CI 32·2-45·6, p<0·001) between the reported prevalence of exclusive breastfeeding in the intervention group and that of the control group. INTERPRETATION: A multidimensional intervention deliverable at scale in a low-income setting resulted in substantial increases in mothers' optimal breastfeeding knowledge and beliefs and in reported exclusive breastfeeding practices. However, it is possible that the findings might have been influenced by social desirability bias. FUNDING: Bill & Melinda Gates Foundation, London School of Hygiene & Tropical Medicine

Mortalité néonatale au centre hospitalier universitaire de Tengandogo, Ouagadougou, Burkina Faso: une étude de cohorte retrospective: Neonatal mortality at Tengandogo University Hospital, Ouagadougou, Burkina Faso: a retrospective cohort study

Introduction: Selon l’organisation mondiale de la santé, les décès néonataux représentent 41% de la mortalité infanto-juvénile. L’Afrique subsaharienne a le taux de mortalité néonatale le plus élevé à 28‰. L’objectif de l’étude était de mesurer le taux de mortalité néonatale et d’identifier les facteurs associés au décès au Centre hospitalier universitaire de Tengandogo, Ouagadougou, Burkina Faso. Méthodes: Les nouveaux nés de 0 à 28 jours, hospitalisés entre le 1er janvier 2013 et le 31 décembre 2017 ont été inclus dans cette étude de cohorte rétrospective au service de néonatologie et de pédiatrie. Les informations ont été extraites à partir des dossiers cliniques. La survie a été estimée par la méthode de Kaplan Meier. Un modèle de Cox a permis d’identifier les facteurs associés. Résultats: Au total 641 nouveau-nés ont été inclus. Les enfants admis dès le premier jour de leur naissance représentaient 80%. La durée médiane de séjour était de 6 jours avec un intervalle interquartile de 3-12 jours. Les principaux diagnostics étaient la prématurité (36,05%), les infections néonatales (33,23%) et l’asphyxie (17,86%). Le taux de mortalité néonatale était de 22,25 pour 1000 personnes jours. Après ajustement, le poids de naissance inferieur 1500gramme (HRa = 4,13 ; IC 95% (2,58-6,67)) et la notion de réanimation à la naissance (HRa2,62 ; IC 95% [1,64-4,39)) étaient les facteurs de risque. Conclusion: Le taux de mortalité néonatale reste élevé. Le suivi prénatal, la prévention des infections, le renforcement des moyens de réanimation et la compétence des acteurs sont essentiels pour réduire ce taux. Introduction: According to the World Health Organization, neonatal deaths account for 41% of infant and child mortality. Sub-Saharan Africa has the highest neonatal mortality rate at 28‰. The objective of the study was to measure the neonatal mortality rate and identify factors associated with death at the Tengandogo University Hospital, Ouagadougou, Burkina Faso. Method: New-borns aged 0 to 28 days, hospitalised between 1 January 2013 and 31 December 2017 were included in this retrospective cohort study in the neonatology and paediatrics department. Information was extracted from clinical records. Survival was estimated by the Kaplan Meier method. A Cox model was used to identify associated factors. Results: A total of 641 new-borns were included. Children admitted on the first day of birth accounted for 80%. The median length of stay was 6 days with an interquartile range of 3-12 days. The main diagnoses were prematurity (36.05%), neonatal infections (33.23%) and asphyxia (17.86%). The neonatal mortality rate was 22.25 per 1000 person days. After adjustment, birth weight below 1500 grams (HRa = 4.13; 95% CI (2.58-6.67)) and the notion of resuscitation at birth (HRa2.62; 95% CI (1.64-4.39)) were the risk factors. Conclusion: The neonatal mortality rate remains high. Prenatal follow-up, infection prevention, strengthening of resuscitation resources and competence of actors are essential to reduce this rate

Growth effects of exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa: the cluster-randomised PROMISE EBF trial

Background: In this multi-country cluster-randomized behavioural intervention trial promoting exclusive breastfeeding (EBF) in Africa, we compared growth of infants up to 6 months of age living in communities where peer counsellors promoted EBF with growth in those infants living in control communities. Methods: A total of 82 clusters in Burkina Faso, Uganda and South Africa were randomised to either the intervention or the control arm. Feeding data and anthropometric measurements were collected at visits scheduled 3, 6, 12 and 24 weeks post-partum. We calculated weight-for-length (WLZ), length-for-age (LAZ) and weight-for-age (WAZ) z-scores. Country specific adjusted Least Squares Means with 95% confidence intervals (CI) based on a longitudinal analysis are reported. Prevalence ratios (PR) for the association between peer counselling for EBF and wasting (WLZ < −2), stunting (LAZ < −2) and underweight (WAZ < −2) were calculated at each data collection point. Results: The study included a total of 2,579 children. Adjusting for socio-economic status, the mean WLZ at 24 weeks were in Burkina Faso −0.20 (95% CI −0.39 to −0.01) and in Uganda −0.23 (95% CI −0.43 to −0.03) lower in the intervention than in the control arm. In South Africa the mean WLZ at 24 weeks was 0.23 (95% CI 0.03 to 0.43) greater in the intervention than in the control arm. Differences in LAZ between the study arms were small and not statistically significant. In Uganda, infants in the intervention arm were more likely to be wasted compared to those in the control arm at 24 weeks (PR 2.36; 95% CI 1.11 to 5.00). Differences in wasting in South Africa and Burkina Faso and stunting and underweight in all three countries were small and not significantly different. Conclusions: There were small differences in mean anthropometric indicators between the intervention and control arms in the study, but in Uganda and Burkina Faso, a tendency to slightly lower ponderal growth (weight-for-length z-scores) was found in the intervention arms. Trial registration number: ClinicalTrials.gov: NCT0039715

Perinatal mortality in rural Burkina Faso: a prospective community-based cohort study

BACKGROUND: There is a scarcity of reliable data on perinatal mortality (PNM) in Sub-Saharan Africa. The PROMISE-EBF trial, during which we promoted exclusive breastfeeding, gave us the opportunity to describe the epidemiology of PNM in Banfora Health District, South-West in Burkina Faso. STUDY OBJECTIVES: To measure the perinatal mortality rate (PNMR) in the PROMISE-EBF cohort in Banfora Health District and to identify potential risk factors for perinatal death. METHODS: We used data collected prospectively during the PROMISE-EBF-trial to estimate the stillbirth rate (SBR) and early neonatal mortality rate (ENMR). We used binomial regression with generalized estimating equations to identify potential risk factors for perinatal death. RESULTS: 895 pregnant women were enrolled for data collection in the EBF trial and followed-up to 7 days after birth. The PNMR, the SBR and the ENMR, were 79 per 1000 (95% CI: 59-99), 54 per 1000 (95% CI: 38-69) and 27 per 1000 (95% CI: 9-44), respectively. In a multivariable analysis, nulliparous women (RR = 2.90, 95% CI: 1.6-5.0), primiparae mothers (RR = 2.20, 95% CI: 1.2-3.9), twins (RR = 4.0, 95% CI: 2.3-6.9) and giving birth during the dry season (RR = 2.1 95% CI: 1.3-3.3) were factors associated with increased risk of perinatal death. There was no evidence that risk of perinatal death differed between deliveries at home and at a health centre CONCLUSION: Our study observed the highest PNMR ever reported in Burkina. There is an urgent need for sustainable interventions to improve maternal and newborn health in the country