The use of video vignettes to measure health worker knowledge. Evidence from Burkina Faso

The quality of care is a crucial determinant of good health outcomes, but is difficult to measure. Survey vignettes are a standard approach to measuring medical knowledge among health care providers. Given that written vignettes or knowledge tests may be too removed from clinical practice, particularly where “learning by doing” may be an important form of training, we developed a new type of provider vignette. It uses videos presenting a patient visiting the clinic with maternal/early childhood symptoms. We tested these video vignettes with current and future (students) health professionals in Burkina Faso. Participants indicated that the cases used were interesting, understandable and common. Their performance was consistent with expectations. Participants with greater training (medical doctors vs. nurses and midwives) and experience (health professionals vs. students) performed better. The video vignettes can easily be embedded in computers, tablets and smart phones; they are a convenient tool to measure provider knowledge; and they are cost-effective instruction and testing tools

Implementation of active management of the third period of childbirth for the prevention of immediate post-partum bleeding in four regional maternity hospitals of Conakry, Guinea

Background: The objective of this study was to determine the frequency, skills level of health care service providers; to identify complications and difficulties related to the implementation of AMTPC/GATPA.Methods: It was about prospective study, descriptive of 6 months (1st March to 31st August 2014) carried out in the maternity hospitals of Faranah, Kindia, Mamou and Nzérékoré. It concerned the parturient women who had recently given birth and the personnel that carried out AMTPC/GATPA in these hospitals.Results: During the study period of 1,254 out of 1,305 births had benefited of AMTPC/GATPA, a frequency of 96.1%. The midwives were the most represented personnel in the implementation of GATPA (44.1%). In 46.4% of the cases, the health care service providers acquired this competence from the initial training. The release was obtained in the first trial in 64.9% cases. The duration of implementation of GATPA was less than 5 minutes in 72.6% cases. The different stages were respected in 91.5% cases. Complications were dominated by retention of placental fragments (10.2%). Lack of oxytocin was the main difficulty (36.6%).Conclusions: The sustainability of this achievement would depend on the systematic and correct implementation of AMTPC/GATPA at all childbirth attendants and the effective management of oxytocin

Determinants of unmet need for family planning in rural Burkina Faso: a multilevel logistic regression analysis

Background: Unmet need for family planning has implications for women and their families, such as unsafe abortion, physical abuse, and poor maternal health. Contraceptive knowledge has increased across low-income settings, yet unmet need remains high with little information on the factors explaining it. This study assessed factors associated with unmet need among pregnant women in rural Burkina Faso. Method: We collected data on pregnant women through a population-based survey conducted in 24 rural districts between October 2013 and March 2014. Multivariate multilevel logistic regression was used to assess the association between unmet need for family planning and a selection of relevant demand- and supply-side factors. Results: Of the 1309 pregnant women covered in the survey, 239 (18.26%) reported experiencing unmet need for family planning. Pregnant women with more than three living children [OR = 1.80; 95% CI (1.11–2.91)], those with a child younger than 1 year [OR = 1.75; 95% CI (1.04–2.97)], pregnant women whose partners disapproves contraceptive use [OR = 1.51; 95% CI (1.03–2.21)] and women who desired fewer children compared to their partners preferred number of children [OR = 1.907; 95% CI (1.361–2.672)] were significantly more likely to experience unmet need for family planning, while health staff training in family planning logistics management (OR = 0.46; 95% CI (0.24–0.73)] was associated with a lower probability of experiencing unmet need for family planning. Conclusion: Findings suggest the need to strengthen family planning interventions in Burkina Faso to ensure greater uptake of contraceptive use and thus reduce unmet need for family planning

Responding to policy makers' evaluation needs: combining experimental and quasi-experimental approaches to estimate the impact of performance based financing in Burkina Faso.

BACKGROUND: The last two decades have seen a growing recognition of the need to expand the impact evaluation toolbox from an exclusive focus on randomized controlled trials to including quasi-experimental approaches. This appears to be particularly relevant when evaluation complex health interventions embedded in real-life settings often characterized by multiple research interests, limited researcher control, concurrently implemented policies and interventions, and other internal validity-threatening circumstances. To date, however, most studies described in the literature have employed either an exclusive experimental or an exclusive quasi-experimental approach. METHODS: This paper presents the case of a study design exploiting the respective advantages of both approaches by combining experimental and quasi-experimental elements to evaluate the impact of a Performance-Based Financing (PBF) intervention in Burkina Faso. Specifically, the study employed a quasi-experimental design (pretest-posttest with comparison) with a nested experimental component (randomized controlled trial). A difference-in-differences approach was used as the main analytical strategy. DISCUSSION: We aim to illustrate a way to reconcile scientific and pragmatic concerns to generate policy-relevant evidence on the intervention's impact, which is methodologically rigorous in its identification strategy but also considerate of the context within which the intervention took place. In particular, we highlight how we formulated our research questions, ultimately leading our design choices, on the basis of the knowledge needs expressed by the policy and implementing stakeholders. We discuss methodological weaknesses of the design arising from contextual constraints and the accommodation of various interests, and how we worked ex-post to address them to the best extent possible to ensure maximal accuracy and credibility of our findings. We hope that our case may be inspirational for other researchers wishing to undertake research in settings where field circumstances do not appear to be ideal for an impact evaluation. TRIAL REGISTRATION: Registered with RIDIE (RIDIE-STUDY-ID- 54412a964bce8 ) on 10/17/2014

Potential analgesic activity of the methanolic F4 fraction of leaf extracts of Annona senegalensis Pers. (Annonaceae)

Objectives:  Pain management is provided by analgesics. While considerable progress has been made in recent years due to better knowledge of the pathophysiology and mechanism of pain, the search for new, more effective analgesics with fewer side effects remains relevant. Previous work carried out at the pharmacology laboratory of the Faculty of Medicine, Pharmacy and Odontology of UCAD (Senegal) had shown an anti-inflammatory activity of the ether extract, as well as that of the methanolic fraction and of ethyl acetate from Annona senegalensis leaves. This study concerns the fractionation of the total methanolic and ethyl acetate fractions by chromatography on a Sephadex column. A phytochemical characterization of the fractions obtained, followed by the study of the analgesic activity of the derivative fractions of the methanolic and ethyl acetate extracts carried out in mice. Methods: Sephadex gel fractionation yielded ten fractions. Characterization tests were carried out on the total extracts and the different derivatives fractions. Results: Phytochemical characterization of the fractions revealed the presence of tannins, alkaloids, flavonoids, sterols and triterpenes. The F4 and F'4 fractions, rich in sterols and triterpenes, significantly reduced the number of cramps at low doses (1 mg/kg and 3 mg/kg). Conclusion: The presence of sterols and triterpenes in the methanolic F4 fraction of the leaves of Annona senegalensis could be the cause of the analgesic activity of the plant. Keywords: Annona senegalensis, phytochemistry, sterols and triterpenes, analgesic

P31 Mise au point d’un savon à base de Lawsonia inermis, d’Aloe vera et d’Azadirachta indica pour accompagner la prise en charge de l’acné

Introduction : L’acné est l’un des motifs de consultations les plus fréquents dans les services de Dermatologie. Pour renforcer la prise en charge de l’acné, il est possible d’exploiter les données d’efficacité, de sécurité et de qualité de trois des plantes citées sur 21 plantes recensées en l’Afrique de l’Ouest. L’objectif est le développement puis la fabrication d’un savon dermo-pharmaceutique efficace et accessible économiquement à la majorité des patients de l’Hôpital de Dermatologie de Bamako. Méthodologie : Les échantillons des feuilles de Lawsonia inermis, du gel des bulbes de l’Aloès vera et de l’huile des graines d’Azadirachta indica ont été apprêtés au niveau Département de Médecine Traditionnelle de Bamako. La formulation a été réalisée au niveau de l’unité galénique de l’Hôpital de Dermatologie de Bamako. Le procédé de fabrication à froid a été adopté. Les ingrédients et leurs pourcentages sont : Beurre de Karité (23,6) / Huile de palmiste (17,7) / Huile végétale de Neem (17,7) / Gel d’Aloe Vera (5,9)/ Poudre du Henné (3) / Soude caustique (8,7) / Eau (20,4) / H.E d’Eucalyptus (1,8) / Jus de citron (1,2). La formule du savon a été développée selon le logiciel calculateur de saponification « Soaphomemade ». Le savon a été fabriqué et sa qualité physico-chimique a été déterminée. L’enquête de satisfaction a été réalisée par 10 testeurs hommes et femmes, sains, résidant à Bamako. La durée des tests était de 15   jours et les propriétés recherchées étaient le pouvoir moussant, nettoyant, exfoliant et émollient, aussi l’odeur et les recommandations. Le prix du savon a été estimé et comparé aux autres vendus en pharmacie. Résultats : Trois lots de savon de 6 morceaux de 75 g ont été fabriqués. Les savons avaient une couleur Brun foncé, avec des pH autour de 8 et étaient durs. L’odeur était caractéristique de l’huile de neem. Les savons respectaient toutes les normes de qualité selon le calculateur de saponification. 80% des testeurs étaient globalement satisfaits du produit. Le coût de fabrication a été estimé à 950 F CFA comparé aux savons : Mitracca 1300 F CFA ; Vegebom Purifiant 2000 F CFA ; Laino au soufre2350 F CFA ; Nobacter 3100 F CFA. Conclusion : Une étude sensorielle auprès de 10 testeurs/res a été satisfaisante. En perspective, il s’agira de valider ces résultats préliminaires chez un nombre important de patients