Feasibility of introducing an onsite test for syphilis in the package of antenatal care at the rural primary health care level in Burkina Faso

Philosophiae Doctor - PhDBackground: Syphilis transmission remains a global problem with an estimated 12 million people infected each year. Ninety percent of syphilis cases occur in low income countries. Syphilis is a serious source of adverse pregnancy outcomes for both mother and infant. Ideally, syphilis screening should be provided as part of a package of maternal and newborn health-care services. This thesis reports on a pilot intervention study to develop, implement and evaluate a point of care test for syphilis in antenatal care services in rural Burkina Faso. Methods: This study used a pre post intervention mixed methods quasi-experimental design with a group of health facilities offering ANC services (primary health centers in rural area) as the sampling units. This study was conducted in three phases, which consisted of a situational analysis using qualitative methods (Phase 1), selecting an appropriate test through evaluating 4 candidate tests and the participatory design and implementation of an intervention that included onsite training, provision of supplies and medicines, quality control and supervision (Phase 2), and an evaluation combining review of record tools, interviews, time motion study and estimating incremental costs (Phase 3). The conceptual framework draws on multilevel assessment (MLA), policy triangle framework, MRC framework for designing complex interventions and the Normalization Process Model (NPM). Methods included document review, seventy five interviews were conducted with health providers, district managers, facility managers, traditional healers, pregnant women, community health workers, and Non-Governmental Organizations (NGO) managers in phase I and fourteen in phase III, non-participant observation, time-motion study, incremental cost analysis, and sensitivity, specificity and ease of use analysis of four candidate point-of care tests. Data were collected between 2012 and 2014. Qualitative data were analyzed through thematic analysis supported by Nvivo software. Quantitative data were analyzed through descriptive statistics such as frequency, mean and median supported by SPSS. Findings: Phase I identified barriers to implementation and uptake of syphilis testing at health provider and community levels. The most important barriers at provider level included fragmentation of services, poor communication between health workers and clients, failure to prescribe syphilis test, and low awareness of syphilis burden. Cost of testing, distance to laboratory and lack of knowledge about syphilis were identified as barriers at community level. Phase II: Alere DetermineTM Syphilis was the most sensitive of the four point-of-care tests evaluated. The components of the intervention were successfully implemented in the selected health facilities. Overall, phase III showed that it is feasible and acceptable to introduce a point of care test for syphilis in antenatal care services at primary health care level using the available staff. The intervention was reported as acceptable, but of 812 pregnant women who came for their first visit 39% were screened during the study period. Rural facilities had higher coverage (66.8%) than the urban ones (25.6%). Quality control found no discordance between the rapid test and TPHA results. The average cost of ANC per unscreened pregnant woman was 3.11 USD (±0.14) vs 5.06 USD (±0.16) per screened woman. The main cost driver was the material costs notably the test itself. The test’s cost is comparable to HIV test costs, but funder support for integrating this additional test is less readily available than for HIV tests. Conclusions: The findings suggested that an intervention that introduces point of care test for syphilis at antenatal care services is feasible, acceptable, and of comparable costs to HIV screening in pregnancy. Nonetheless, instructions and supervision need to be clearer to achieve optimal levels of screening and quality control, and barriers identified by health workers need to be overcome. The point-of care test for syphilis is likely to be acceptable by health workers as a routine service and incorporated as a normal practice in Burkina Faso context.This research was made financially possible by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR); and the African Doctoral Dissertation Research Fellowship (ADDRF 2012) award offered by the African Population and Health Research Center (APHRC) in partnership with the International Development Research Centre (IDRC)

The health care burden in rural Burkina Faso: Consequences and implications for insurance design

This paper maps the health care burden of households in rural Burkina Faso. More specifically we investigate the financial burden of health shocks and the manner in which households respond. Our data allows us to differentiate the burden of chronic illness and handicap, more frequent and recurring illnesses and episodes of severe illness, accident and mortality. We find that the burden of health shocks and health spending is high, ranging from one third of monthly non-medical consumption for the treatment of common infectious illnesses to almost three times the monthly non-medical spending in case of death of a household member. To cope, households deplete savings, sell livestock or reduce consumption. In case of severe shocks they are also heavily reliant on transfers from outside. Looking at the economic consequences of health shocks we find that illness of whichever type – severe, chronic or more common – reduces household consumption. Furthermore, households which suffered from a severe illness show significantly lower livestock holdings. Many of the health insurance schemes implemented in developing countries are not yet taking note of the burden of severe and chronic illness. However, in light of the universal health insurance coverage objectives of the Sustainable Development Goals (SDGs) it should be considered an area for future expansion

Connaissances et perceptions de la maladie à coronavirus (COVID-19) dans la commune de Ouagadougou

The COVID-19 disease has spread throughout the world. This has led health and political authorities from Burkina Faso to take measures to fight against this disease. Perceptions of the population about the disease are a hindrance to the fight against the pandemic. The objective of this study is to analyze and describe the general population's perception of the COVID-19 pandemic.  A qualitative study was conducted in Ouagadougou. 65 in-depth individual interviews were conducted in 2020. A thematic content analysis was conducted using NVIVO software. The results indicate a diverse community perception of coronavirus disease. Three periods of awareness of the disease were identified.  People identified physical contact and the respiratory tract as the main routes of contraction of the disease. As for the treatment, most of the participants indicate that a medical treatment is necessary to cure the coronavirus, while others believe in the effectiveness of the traditional treatment. Finally, to stop the spread of the virus, participants suggest the implementation of awareness in public places. In view of the diversity and importance of the popular perception of the coronavirus disease, the results of this study could contribute to the implementation of communication strategies by the government and the actors of the response.La COVID-19 s’est propagée à travers le monde entier. Ce qui a amené les autorités sanitaires et politiques du Burkina Faso à prendre des mesures pour lutter contre cette maladie. Certaines perceptions de la population sur la maladie constituent un frein à la lutte contre la pandémie. L’objectif de cette étude vise à analyser et à décrire la perception de la population générale face à la pandémie de COVID-19. Une étude qualitative a été réalisée à Ouagadougou. 65 entretiens individuels approfondis ont été menés en 2020. Une analyse thématique de contenu a été faite à l’aide du logiciel NVIVO. Les résultats indiquent une perception communautaire diversifiée de la maladie à coronavirus. Trois périodes de prise de connaissance de l’existence de la maladie ont été évoquées.  Pour les populations, les contacts physiques et les voies respiratoires constituent les principales voies de contractions de la maladie. Quant au traitement, la plupart des participants indiquent qu’un traitement médical est nécessaire pour guérir du coronavirus, d’autres en revanche croient à l’efficacité du traitement traditionnel. Enfin, pour arrêter la propagation du virus, les participants suggèrent la mise en œuvre de la sensibilisation dans les lieux publics. Au regard de la diversité et de l’importance de la perception populaire face à la maladie à coronavirus, les résultats de cette étude pourraient contribuer à la mise en œuvre de stratégies de communication par le gouvernement et les acteurs de la riposte

Connaissances et perceptions de la maladie à coronavirus (COVID-19) dans la commune de Ouagadougou

The COVID-19 disease has spread throughout the world. This has led health and political authorities from Burkina Faso to take measures to fight against this disease. Perceptions of the population about the disease are a hindrance to the fight against the pandemic. The objective of this study is to analyze and describe the general population's perception of the COVID-19 pandemic.  A qualitative study was conducted in Ouagadougou. 65 in-depth individual interviews were conducted in 2020. A thematic content analysis was conducted using NVIVO software. The results indicate a diverse community perception of coronavirus disease. Three periods of awareness of the disease were identified.  People identified physical contact and the respiratory tract as the main routes of contraction of the disease. As for the treatment, most of the participants indicate that a medical treatment is necessary to cure the coronavirus, while others believe in the effectiveness of the traditional treatment. Finally, to stop the spread of the virus, participants suggest the implementation of awareness in public places. In view of the diversity and importance of the popular perception of the coronavirus disease, the results of this study could contribute to the implementation of communication strategies by the government and the actors of the response.La COVID-19 s’est propagée à travers le monde entier. Ce qui a amené les autorités sanitaires et politiques du Burkina Faso à prendre des mesures pour lutter contre cette maladie. Certaines perceptions de la population sur la maladie constituent un frein à la lutte contre la pandémie. L’objectif de cette étude vise à analyser et à décrire la perception de la population générale face à la pandémie de COVID-19. Une étude qualitative a été réalisée à Ouagadougou. 65 entretiens individuels approfondis ont été menés en 2020. Une analyse thématique de contenu a été faite à l’aide du logiciel NVIVO. Les résultats indiquent une perception communautaire diversifiée de la maladie à coronavirus. Trois périodes de prise de connaissance de l’existence de la maladie ont été évoquées.  Pour les populations, les contacts physiques et les voies respiratoires constituent les principales voies de contractions de la maladie. Quant au traitement, la plupart des participants indiquent qu’un traitement médical est nécessaire pour guérir du coronavirus, d’autres en revanche croient à l’efficacité du traitement traditionnel. Enfin, pour arrêter la propagation du virus, les participants suggèrent la mise en œuvre de la sensibilisation dans les lieux publics. Au regard de la diversité et de l’importance de la perception populaire face à la maladie à coronavirus, les résultats de cette étude pourraient contribuer à la mise en œuvre de stratégies de communication par le gouvernement et les acteurs de la riposte

Costs and cost-effectiveness of cervical cancer screening strategies in women living with HIV in Burkina Faso: The HPV in Africa Research Partnership (HARP) study.

INTRODUCTION: This study estimated the costs and incremental cost per case detected of screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+) in women living with HIV (WLHIV) attending HIV clinics in Burkina Faso. METHODS: The direct healthcare provider costs of screening tests (visual inspection with acetic acid (VIA), VIA combined visual inspection with Lugol's iodine (VIA/VILI), cytology and a rapid HPV DNA test (careHPV)) and confirmatory tests (colposcopy, directed biopsy and systematic four-quadrant (4Q) biopsy) were collected alongside the HPV in Africa Research Partnership (HARP) study. A model was developed for a hypothetical cohort of 1000 WLHIV using data on CIN2+ prevalence and the sensitivity of the screening tests. Costs are reported in USD (2019). RESULTS: The study enrolled 554 WLHIV with median age 36 years (inter-quartile range, 31-41) and CIN2+ prevalence of 5.8%. The average cost per screening test ranged from US$3.2 for VIA to US$24.8 for cytology. Compared to VIA alone, the incremental cost per CIN2+ case detected was US$48 for VIA/VILI and US$814 for careHPV. Despite higher costs, careHPV was more sensitive for CIN2+ cases detected compared to VIA/VILI (97% and 56%, respectively). The cost of colposcopy was US$6.6 per person while directed biopsy was US$33.0 and 4Q biopsy was US$48.0. CONCLUSION: Depending on the willingness to pay for the detection of a case of cervical cancer, decision makers in Burkina Faso can consider a variety of cervical cancer screening strategies for WLHIV. While careHPV is more costly, it has the potential to be cost-effective depending on the willingness to pay threshold. Future research should explore the lifetime costs and benefits of cervical cancer screening to enable comparisons with interventions for other diseases

Can informal redistribution withstand formal safety nets? Insights from urban-rural transfers in Burkina Faso

Households in rural areas still depend on informal transfers to meet subsistence needs and cope with shocks. Yet, to provide additional monetary support, formal safety nets are increasingly introduced in developing countries. However, it remains unclear whether such social protection policies will have the desired welfare effects. This article addresses this question by analyzing the private transfer response to changes in the income of rural recipients using novel data from Burkina Faso. We assume that the transfer-income relationship is a non-linear one where transfer motives, and therefore also transfer responses, vary with the recipient's position in the income distribution. Our findings support this view. We find a pronounced, negative private transfer response among the poorest of the poor. This observation has important policy implications, because those households that depend most on private transfers, would be most affected by crowding-out effects. In terms of transfer motives, the negative relationship for the lowest income class is consistent with transfers being altruistically motivated. With increasing income levels, transfers cease being altruistic at the margin and switch toward exchange motives. However, the observed transfer pattern is also indicative of an (informal) insurance role of private transfers. Rural households receive higher private transfers in response to negative shocks. These results can serve as a basis for the design of formal social protection mechanisms in a context where informal redistribution still plays an important role

The COVID-19 Risk Perception: A Qualitative Study among the Population in an Urban Setting in Burkina Faso

Background: The population’s adherence to public health recommendations depends on many individual and collective cultural, socioeconomic, institutional, and environmental factors and the perception of the risks involved. This study aimed to describe and analyze the perception of risk related to coronavirus in the general population. Methods: A qualitative, exploratory cross-sectional study was conducted in Ouagadougou, the capital city of Burkina Faso. It involved the general population (youth and adults, men and women, traditional practitioners, religious leaders, and opinion leaders). The data were analyzed using the thematic analysis method. Results: Respondents perceived COVID-19 as deadly, dangerous, and highly contagious. It emerged that respondents perceived themselves to be at risk of being infected by the virus. This risk exposure is linked to several factors. These include the dangerousness of the disease contaminated by direct contact, the feeling of vulnerability linked to working conditions (traders, exposing themselves and others to the disease), status (elderly, and sick,), gender (mobility of men compared to women), and the risk relationship (the individual perceived as being a potential danger to his family/relatives). Vulnerability depended on the immune status of the people (elderly people, pregnant women, and people with chronic diseases), working conditions (shopkeepers, and traders), and also socioeconomic categories (wealthy people). Conclusion: Policymakers and actors in the response to COVID-19 should develop communication strategies to better address ongoing challenges

DECIDE : a cluster-randomized controlled trial to reduce unnecessary caesarean deliveries in Burkina Faso

International audienceBACKGROUND:In Burkina Faso, facility-based caesarean delivery rates have markedly increased since the national subsidy policy for deliveries and emergency obstetric care was implemented in 2006. Effective and safe strategies are needed to prevent unnecessary caesarean deliveries.METHODS:We conducted a cluster-randomized controlled trial of a multifaceted intervention at 22 referral hospitals in Burkina Faso. The evidence-based intervention was designed to promote the use of clinical algorithms for caesarean decision-making using in-site training, audits and feedback of caesarean indications and SMS reminders. The primary outcome was the change in the percentage of unnecessary caesarean deliveries. Unnecessary caesareans were defined on the basis of the literature review and expert consensus. Data were collected daily using a standardized questionnaire, in the same way at both the intervention and control hospitals. Caesareans were classified as necessary or unnecessary in the same way, in both arms of the trial using a standardized computer algorithm.RESULTS:A total of 2138 and 2036 women who delivered by caesarean section were analysed in the pre and post-intervention periods, respectively. A significant reduction in the percentage of unnecessary caesarean deliveries was evident from the pre- to post-intervention period in the intervention group compared with the control group (18.96 to 6.56% and 18.27 to 23.30% in the intervention and control groups, respectively; odds ratio [OR] for incremental change over time, adjusted for hospital and patient characteristics, 0.22; 95% confidence interval [CI], 0.14 to 0.34; P < 0.001; adjusted risk difference, - 17.02%; 95% CI, - 19.20 to - 13.20%). The intervention did not significantly affect the rate of maternal death (0.75 to 0.19% and 0.92 to 0.40% in the intervention and control groups, respectively; adjusted OR 0.32; 95% CI 0.04 to 2.23; P = 0.253) or intrapartum-related neonatal death (4.95 to 6.32% and 5.80 to 4.29% in the intervention and control groups, respectively, adjusted OR 1.73; 95% CI 0.82 to 3.66; P = 0.149). The overall perinatal mortality data were not available.CONCLUSION:Promotion and training on clinical algorithms for decision-making, audit and feedback and SMS reminders reduced unnecessary caesarean deliveries, compared with usual care in a low-resource setting.TRIAL REGISTRATION:The DECIDE trial is registered on the Current Controlled Trials website: ISRCTN48510263