La gratuité des soins améliore grandement l’accessibilité aux services de santé, mais les gains demeurent fragiles

La recherche a bénéficié d’une subvention des Instituts de recherche en santé du Canada (# GIR127070) et d’une subvention de l’initiative Innovation pour la santé des mères et des enfants d’Afrique – un partenariat entre Affaires mondiales Canada (AMC), les Instituts de recherche en santé du Canada (IRSC) et le Centre de recherches pour le développement international (CRDI) du Canada.La gratuité des soins mise en oeuvre dans plusieurs districts au Burkina Faso améliore l’accessibilité aux services de santé. Notre étude, réalisée dans le district de Kaya, révèle que la fréquentation des centres de santé a doublé après l’introduction de la gratuité en milieu rural et en milieu urbain. Toutefois, les gains demeurent fragiles. Ils peuvent être rapidement effacés par un arrêt inattendu de la gratuité et la réintroduction du paiement direct. La durabilité de la mise en oeuvre et la pérennité du financement sont des enjeux-clés d’une politique de gratuité

Comprendre le succès de l'implantation et l'expansion de la chimio-prophylaxie saisonnière du paludisme au Burkina Faso

La recherche a bénéficié d’une subvention de l’initiative Innovation pour la santé des mères et des enfants d’Afrique – un partenariat entre Affaires mondiales Canada (AMC), les Instituts de recherche en santé du Canada (IRSC) et le Centre de recherches pour le développement international (CRDI) du Canada.Le Burkina Faso a introduit la CPS en 2014 et l’a étendue au point de couvrir en 2018, 65 districts sanitaires, dont la quasi-totalité des districts sanitaires ruraux. Une recherche indépendante et les travaux de notre équipe suggèrent que l’implantation et l’expansion de la CPS ont été effectives, tant du point de vue de la réalisation des services prévus (fidélité de contenu), que de la manière dont ces services ont été rendus (fidélité des processus). Un système régulier de monitorage annuel mis en place par le PNLP révèle par ailleurs, de hauts niveaux de couverture des populations cibles. Une étude longitudinale suggère que la CPS a eu un impact significatif sur la transmission du paludisme : elle a permis dans un district sanitaire, de réduire de moitié la parasitémie chez les enfants de la population cible et d’un tiers l’anémie sévère en période de haute transmission du paludisme. La CPS apparait donc comme une stratégie pouvant compléter efficacement les activités de lutte contre le paludisme

La gratuité des soins de santé contribue à améliorer la santé des enfants de moins de cinq ans

La recherche a bénéficié d’une subvention des Instituts de recherche en santé du Canada (# GIR127070) et d’une subvention de l’initiative Innovation pour la santé des mères et des enfants d’Afrique – un partenariat entre Affaires mondiales Canada (AMC), les Instituts de recherche en santé du Canada (IRSC) et le Centre de recherches pour le développement international (CRDI) du Canada.L’objectif principal de la recherche est de mesurer chez les enfants de moins de cinq ans, les impacts de l’exposition à la gratuité. Le contexte particulier de l’étude permet de vérifier si ces impacts augmentent avec la durée de l’exposition à la gratuité. Le second objectif de l’étude consiste à vérifier dans quelle mesure la gratuité bénéficie davantage ou non, aux enfants qui, en raison de leur genre, leur milieu de vie ou leur pauvreté, sont plus vulnérables

Acceptability, feasibility, drug safety, and effectiveness of a pilot mass drug administration with a single round of sulfadoxine-pyrimethamine plus primaquine and indoor residual spraying in communities with malaria transmission in Haiti, 2018

For a malaria elimination strategy, Haiti's National Malaria Control Program piloted a mass drug administration (MDA) with indoor residual spraying (IRS) in 12 high-transmission areas across five communes after implementing community case management and strengthened surveillance. The MDA distributed sulfadoxine-pyrimethamine and single low-dose primaquine to eligible residents during house visits. The IRS campaign applied pirimiphos-methyl insecticide on walls of eligible houses. Pre- and post-campaign cross-sectional surveys were conducted to assess acceptability, feasibility, drug safety, and effectiveness of the combined interventions. Stated acceptability for MDA before the campaign was 99.2%; MDA coverage estimated at 10 weeks post-campaign was 89.6%. Similarly, stated acceptability of IRS at baseline was 99.9%; however, household IRS coverage was 48.9% because of the high number of ineligible houses. Effectiveness measured by Plasmodium falciparum prevalence at baseline and 10 weeks post-campaign were similar: 1.31% versus 1.43%, respectively. Prevalence of serological markers were similar at 10 weeks post-campaign compared with baseline, and increased at 6 months. No severe adverse events associated with the MDA were identified in the pilot; there were severe adverse events in a separate, subsequent campaign. Both MDA and IRS are acceptable and feasible interventions in Haiti. Although a significant impact of a single round of MDA/IRS on malaria transmission was not found using a standard pre- and post-intervention comparison, it is possible there was blunting of the peak transmission. Seasonal malaria transmission patterns, suboptimal IRS coverage, and low baseline parasitemia may have limited the effectiveness or the ability to measure effectiveness

Assessing the Quality of Care for Pneumonia in Integrated Community Case Management: A Cross-Sectional Mixed Methods Study

Background Pneumonia is the leading infectious cause of mortality in children under five worldwide. Community-level interventions, such as integrated community case management, have great potential to reduce the burden of pneumonia, as well as other diseases, especially in remote populations. However, there are still questions as to whether community health workers (CHW) are able to accurately assess symptoms of pneumonia and prescribe appropriate treatment. This research addresses limitations of previous studies using innovative methodology to assess the accuracy of respiratory rate measurement by CHWs and provides new evidence on the quality of care given for children with symptoms of pneumonia. It is one of few that assesses CHW performance in their usual setting, with independent re-examination by experts, following a considerable period of time post-training of CHWs. Methods In this cross-sectional mixed methods study, 1,497 CHW consultations, conducted by 90 CHWs in two districts of Luapula province, Zambia, were directly observed, with measurement of respiratory rate for children with suspected pneumonia recorded by video. Using the video footage, a retrospective reference standard assessment of respiratory rate was conducted by experts. Counts taken by CHWs were compared against the reference standard and appropriateness of the treatment prescribed by CHWs was assessed. To supplement observational findings, three focus group discussions and nine in depth interviews with CHWs were conducted. Results and Conclusion The findings support existing literature that CHWs are capable of measuring respiratory rates and providing appropriate treatment, with 81% and 78% agreement, respectively, between CHWs and experts. Accuracy in diagnosis could be strengthened through further training and the development of improved diagnostic tools appropriate for resource-poor settings

Integrated community case management in a peri-urban setting: a qualitative evaluation in Wakiso District, Uganda.

Integrated community case management (iCCM) strategies aim to reach poor communities by providing timely access to treatment for malaria, pneumonia and diarrhoea for children under 5 years of age. Community health workers, known as Village Health Teams (VHTs) in Uganda, have been shown to be effective in hard-to-reach, underserved areas, but there is little evidence to support iCCM as an appropriate strategy in non-rural contexts. This study aimed to inform future iCCM implementation by exploring caregiver and VHT member perceptions of the value and effectiveness of iCCM in peri-urban settings in Uganda.A qualitative evaluation was conducted in seven villages in Wakiso district, a rapidly urbanising area in central Uganda. Villages were purposively selected, spanning a range of peri-urban settlements experiencing rapid population change. In each village, rapid appraisal activities were undertaken separately with purposively selected caregivers (n = 85) and all iCCM-trained VHT members (n = 14), providing platforms for group discussions. Fifteen key informant interviews were also conducted with community leaders and VHT members. Thematic analysis was based on the 'Health Access Livelihoods Framework'.iCCM was perceived to facilitate timely treatment access and improve child health in peri-urban settings, often supplanting private clinics and traditional healers as first point of care. Relative to other health service providers, caregivers valued VHTs' free, proximal services, caring attitudes, perceived treatment quality, perceived competency and protocol use, and follow-up and referral services. VHT effectiveness was perceived to be restricted by inadequate diagnostics, limited newborn care, drug stockouts and VHT member absence - factors which drove utilisation of alternative providers. Low community engagement in VHT selection, lack of referral transport and poor availability of referral services also diminished perceived effectiveness. The iCCM strategy was widely perceived to result in economic savings and other livelihood benefits.In peri-urban areas, iCCM was perceived as an effective, well-utilised strategy, reflecting both VHT attributes and gaps in existing health services. Depending on health system resources and organisation, iCCM may be a useful transitional service delivery approach. Implementation in peri-urban areas should consider tailored community engagement strategies, adapted selection criteria, and assessment of population density to ensure sufficient coverage

Household costs and time to treatment for children with severe febrile illness in rural Burkina Faso: the role of rectal artesunate

UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland [Project ID number: Burkina Faso: A80553

Addressing vulnerability, building resilience:community-based adaptation to vector-borne diseases in the context of global change

Abstract Background The threat of a rapidly changing planet – of coupled social, environmental and climatic change – pose new conceptual and practical challenges in responding to vector-borne diseases. These include non-linear and uncertain spatial-temporal change dynamics associated with climate, animals, land, water, food, settlement, conflict, ecology and human socio-cultural, economic and political-institutional systems. To date, research efforts have been dominated by disease modeling, which has provided limited practical advice to policymakers and practitioners in developing policies and programmes on the ground. Main body In this paper, we provide an alternative biosocial perspective grounded in social science insights, drawing upon concepts of vulnerability, resilience, participation and community-based adaptation. Our analysis was informed by a realist review (provided in the Additional file 2) focused on seven major climate-sensitive vector-borne diseases: malaria, schistosomiasis, dengue, leishmaniasis, sleeping sickness, chagas disease, and rift valley fever. Here, we situate our analysis of existing community-based interventions within the context of global change processes and the wider social science literature. We identify and discuss best practices and conceptual principles that should guide future community-based efforts to mitigate human vulnerability to vector-borne diseases. We argue that more focused attention and investments are needed in meaningful public participation, appropriate technologies, the strengthening of health systems, sustainable development, wider institutional changes and attention to the social determinants of health, including the drivers of co-infection. Conclusion In order to respond effectively to uncertain future scenarios for vector-borne disease in a changing world, more attention needs to be given to building resilient and equitable systems in the present