Analyse de l’implantation de la sélection communautaire à large échelle des indigents en Afrique Sub-saharienne: cas du Burkina Faso

Indigent do not have access to health care, and selecting them from a predominantly poor population poses enormous challenges. Little evidence exists on the selection of indigents in relation to the performance of health services. The objective of this study is to analyse the implementation of indigent selection conducted in Burkina Faso, with a view to informing decisions for scaling up with universal health insurance. This is a research on implementation based on a multiple case study coupled with a reflective approach. The cases were the subject of reasoned choice according to the indigent’s selection. A conceptual model adapted from the Consolidated Framework for Implementation Research is used, considering the implementation of community-based selection of indigents as the result of the influence and interaction of the selection process, the steps, the actors, the organisation and the context, and the data collection tools. Data is collected through interviews and document review. Three coordination structures and two implementation structures are set up for the selection. Socio-political unrest and vaccination and drug administration campaigns disrupted the selection process. The selection process was subject to adaptations and power struggles between stakeholders. The desired proportion of indigents is not achieved. Selection is confronted with contextual realities and interactions between actors. A dynamic and adaptive selection process, supported by social communication, should be used in future selection process.Les indigents n’ont pas accès aux soins de santé, et les sélectionner parmi une population majoritairement pauvre pose d’énormes défis. Peu d’évidences existent sur la selection des indigents associés à la performance des services de santé. L’objectif de cette étude est d’analyser l’implantation de la sélection des indigents conduite au Burkina Faso, en vue d’éclairer les décisions pour un passage à l’échelle avec l’assurance maladie universelle. Il s’agit d’une recherche sur l’implantation basée sur une étude de cas multiples couplée à une approche réflexive. Les cas ont fait l’objet de choix raisonné en fonction de l’intervention de la sélection. Un cadre conceptuel adapté du Consolidated Framework for Implementation Research est utilisé en considérant l’implantation de la sélection communautaire des indigents comme le résultat de l’influence et de l’interaction du processus de sélection, des étapes, des acteurs, de l’organisation et du contexte, des outils de collecte de données. Les données sont collectées à travers des entretiens et la revue documentaire. Trois structures de coordination et de deux structures d’exécution sont mises en place pour la sélection. Les troubles socio-politiques et les campagnes de vaccination et d’administration de medicaments ont perturbé le processus de sélection. La sélection a subi des adaptations et des exercices de pouvoir entre parties prenantes. La proportion d’indigents recherchée n’est pas atteinte. La sélection est confrontée aux réalités contextuelles et aux interactions entre acteurs. Il convient d’avoir recours à un processus dynamique et adaptatif de sélection, soutenu par une communication sociale lors des interventions à veni

Analyse de l’implantation de la sélection communautaire à large échelle des indigents en Afrique Sub-saharienne: cas du Burkina Faso

Indigent do not have access to health care, and selecting them from a predominantly poor population poses enormous challenges. Little evidence exists on the selection of indigents in relation to the performance of health services. The objective of this study is to analyse the implementation of indigent selection conducted in Burkina Faso, with a view to informing decisions for scaling up with universal health insurance. This is a research on implementation based on a multiple case study coupled with a reflective approach. The cases were the subject of reasoned choice according to the indigent’s selection. A conceptual model adapted from the Consolidated Framework for Implementation Research is used, considering the implementation of community-based selection of indigents as the result of the influence and interaction of the selection process, the steps, the actors, the organisation and the context, and the data collection tools. Data is collected through interviews and document review. Three coordination structures and two implementation structures are set up for the selection. Socio-political unrest and vaccination and drug administration campaigns disrupted the selection process. The selection process was subject to adaptations and power struggles between stakeholders. The desired proportion of indigents is not achieved. Selection is confronted with contextual realities and interactions between actors. A dynamic and adaptive selection process, supported by social communication, should be used in future selection process.Les indigents n’ont pas accès aux soins de santé, et les sélectionner parmi une population majoritairement pauvre pose d’énormes défis. Peu d’évidences existent sur la selection des indigents associés à la performance des services de santé. L’objectif de cette étude est d’analyser l’implantation de la sélection des indigents conduite au Burkina Faso, en vue d’éclairer les décisions pour un passage à l’échelle avec l’assurance maladie universelle. Il s’agit d’une recherche sur l’implantation basée sur une étude de cas multiples couplée à une approche réflexive. Les cas ont fait l’objet de choix raisonné en fonction de l’intervention de la sélection. Un cadre conceptuel adapté du Consolidated Framework for Implementation Research est utilisé en considérant l’implantation de la sélection communautaire des indigents comme le résultat de l’influence et de l’interaction du processus de sélection, des étapes, des acteurs, de l’organisation et du contexte, des outils de collecte de données. Les données sont collectées à travers des entretiens et la revue documentaire. Trois structures de coordination et de deux structures d’exécution sont mises en place pour la sélection. Les troubles socio-politiques et les campagnes de vaccination et d’administration de medicaments ont perturbé le processus de sélection. La sélection a subi des adaptations et des exercices de pouvoir entre parties prenantes. La proportion d’indigents recherchée n’est pas atteinte. La sélection est confrontée aux réalités contextuelles et aux interactions entre acteurs. Il convient d’avoir recours à un processus dynamique et adaptatif de sélection, soutenu par une communication sociale lors des interventions à veni

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

An analysis of timing and frequency of malaria infection during pregnancy in relation to the risk of low birth weight, anaemia and perinatal mortality in Burkina Faso.

BACKGROUND: A prospective study aiming at assessing the effect of adding a third dose sulphadoxine-pyrimethamine (SP) to the standard two-dose intermittent preventive treatment for pregnant women was carried out in Hounde, Burkina Faso, between March 2006 and July 2008. Pregnant women were identified as earlier as possible during pregnancy through a network of home visitors, referred to the health facilities for inclusion and followed up until delivery. METHODS: Study participants were enrolled at antenatal care (ANC) visits and randomized to receive either two or three doses of SP at the appropriate time. Women were visited daily and a blood slide was collected when there was fever (body temperature > 37.5°C) or history of fever. Women were encouraged to attend ANC and deliver in the health centre, where the new-born was examined and weighed. The timing and frequency of malaria infection was analysed in relation to the risk of low birth weight, maternal anaemia and perinatal mortality. RESULTS: Data on birth weight and haemoglobin were available for 1,034 women. The incidence of malaria infections was significantly lower in women having received three instead of two doses of SP. Occurrence of first malaria infection during the first or second trimester was associated with a higher risk of low birth weight: incidence rate ratios of 3.56 (p < 0.001) and 1.72 (p = 0.034), respectively. After adjusting for possible confounding factors, the risk remained significantly higher for the infection in the first trimester of pregnancy (adjusted incidence rate ratio = 2.07, p = 0.002). The risk of maternal anaemia and perinatal mortality was not associated with the timing of first malaria infection. CONCLUSION: Malaria infection during first trimester of pregnancy is associated to a higher risk of low birth weight. Women should be encouraged to use long-lasting insecticidal nets before and throughout their pregnancy

Intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine during pregnancy in Burkina Faso: effect of adding a third dose to the standard two-dose regimen on low birth weight, anaemia and pregnancy outcomes

URL : Vhttp://www.malariajournal.com/content/9/1/324Background: Intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) is being implemented in most malaria endemic countries as a standard two-doses regimen as it reduces the risk of low birth weight (LBW) and the prevalence of maternal anaemia. Nevertheless, where the risk of infection close to delivery is high because of intense transmission, a third IPTp-SP dose may further reduce the negative effects of malaria on pregnancy outcome. Methods: Pregnant women in the 2nd or 3rd trimester were randomized to receive either 2 (SP2) or 3 doses (SP3) of SP. Trained field workers paid home visits to the women for drug administration according to a predefined drug delivery schedule. Women were encouraged to attend their scheduled ANC visits and to deliver at the health facilities where the new-born was weighed. The prevalence of LBW (<2500 g), severe anaemia (Hb < 8 g/dL) and premature birth was analysed using intention-to-treat (ITT) and per-protocol (PP) analysis. Results: Data from 1274 singleton pregnancies were analysed (641 in the SP3 and 633 in the SP2 group). The uptake of the intervention appeared to be low. Though the prevalence of LBW in both intervention groups was similar (adjusted Incident Rate Ratio, AIRR = 0.92, 95%CI: 0.69-1.24) in the ITT analysis, the risk of severe anaemia was significantly lower in the SP3 group compared to the SP2 group (AIRR = 0.38, 95%CI: 0.16 - 0.90). The PP analysis showed a trend of reduced risk of LBW, severe anaemia and premature delivery in the SP3 group, albeit the difference between two and three IPTp-SP did not reach statistical significance. Conclusion: The risk of LBW and severe anaemia tended to be lower in the SP3 group, though this was not statistically significant, probably due to the low uptake of the intervention which reduced the power of the study. Further studies are needed for establishing whether a third SP dose has a real benefit in preventing the negative effects of malaria in pregnancy in settings where transmission is markedly seasona

Removal of user fees no guarantee of universal health coverage: observations from Burkina Faso

In theory, the removal of user fees puts health services within reach of everyone, including the very poor. When Burkina Faso adopted the DOTS strategy for the control of tuberculosis, the intention was to provide free tuberculosis care. In 2007 - 2008, interviews were used to collect information from 242 smear-positive patients with pulmonary tuberculosis who were enrolled in the national tuberculosis control programme in six rural districts. The median direct costs associated with tuberculosis were estimated at 101 United States dollars (US$) per patient. These costs represented 23$ 45 per patient). Although the households of patients developed coping strategies, these had far-reaching, adverse effects on the quality of lives of the households' members and the socioeconomic stability of the households. Each tuberculosis patient lost a median of 45 days of work as a result of the illness. For a population living on or below the poverty line, every failure in health-care delivery increases the risk of "catastrophic" health expenditure, exacerbates socioeconomic inequalities, and reduces the probability of adequate treatment and cure. In Burkina Faso, a policy of "free" care for tuberculosis patients has not met with complete success. These observations should help define post-2015 global strategies for tuberculosis care, prevention and control

Le projet FORESA: un nouveau paradigme pour la coopération en santé ?

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L’intervention FORESA: une formation recherche action originale pour le développement continu des systèmes de santé

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Approche socioanthropologique de la tuberculose à Mopti (Mali): représentations populaires et recours thérapeutiques en cas de tuberculose.

In Mali, there were 4508 new cases of tuberculosis in 2003, and 5222 in 2006. Tuberculosis (TB) is thus an important public health problem, decreasing the physical, financial and social capital of individuals, their families and society. Because responses to TB have not yet applied a sufficiently integrated approach that can improve patients' access to quality care, this FORESA project advocates a patient-centered approach. Before any intervention, FORESA thus sought to analyse the situation of TB in Mali and responses to it. The study aims to analyse the discourse about and popular representations of TB (its forms, its signs), the situations in which people are exposed to it or transmit it, and popular practices related to its prevention and the experience of having it. This qualitative, descriptive and analytical study includes a literature review, in-depth interviews with opinion leaders, community health workers and TB patients, focus groups, and the observations of practices. The interviews were recorded, transcribed, and analysed. Subjects provided informed consent to participation. This study showed that: * the terms for TB in local languages (Bambara, Dogon and Fulfuldé) include white cough, big cough, and long cough; * These communities differentiate between 2 main forms of cough (simple and wet); * TB is perceived as a transmissible disease, a disease of contact with a contaminated body or objects; * TB is seen as a serious, contagious, hereditary, shameful disease that may result from the transgression of social norms; * The prevention of TB consists of avoiding people who have the disease or transmitting factors; * Therapeutic remedies, in order, are self-medication, the use of traditional healers, and finally visits to health centres; * The population wants more information about TB and be involved in the fight against it. This study shows the many points of convergence about TB nosology, etiology and therapy between the Mopti population and other groups in Mali (including the Mande, Senoufo and Soso), between the population of Mali and some ethnic groups in Burkina Faso (such as the Dioula, Bobo, Tiéfo Vigué), and between the population of Mali and, Burkina Faso and others in Africa (Gambia, Nigeria, South Africa, etc.). There is also a difference between popular knowledge about TB and biomedical knowledge. The population does not know that TB is transmitted mainly, even exclusively, by nasal droplets or that patients are no longer contagious after two weeks of treatment. The widespread dissemination of this information may have a positive effect, reducing stigmatization and improving access to treatment. Mali must strengthen the skills of all participants in the fight against tuberculosis, to strengthen their framework and to monitor and evaluate their activities.English AbstractJournal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe