97 research outputs found
Yam Daabo interventionsâ effects on postpartum family planning use in Burkina Faso at 24 months after childbirth
Introduction
After testing the interventions for improving the prevalence of contraceptive use, very few studies have measured the long-term effects thereafter the end of the implementation. This study aimed to measure Yam Daabo interventionsâ effects on contraceptive use in Burkina Faso at twelve months after completion of the intervention.
Methods
Yam Daabo was a two-group, multi-intervention, single-blind, cluster randomized controlled trial. Interventions comprised refresher training for the provider, a counseling tool, supportive supervision, availability of contraceptive services 7âdays a week, client appointment cards, and invitation letters for partners. We used generalized linear mixed-effects models (log Poisson) to compare the modern contraceptive prevalence at 12âmonths post-intervention in the two groups. We collected data between September and November 2018. We conducted an intention-to-treat analysis and adjusted the prevalence ratios on cluster effects and unbalanced baseline characteristics.
Results
Twelve months after the completion of the Yam Daabo trial, we interviewed 87.4% (485 out of 555 women with available data at 12âmonths, that is, 247/276 in the intervention group (89.5%) and 238/279 in the control group (85.3%). No difference was observed in the use of hormonal contraceptive methods between the intervention and control groups (adjusted prevalence ratioâ=â1.21; 95% confidence interval [CI]â=â[0.91â1.61], pâ=â0.191). By contrast, women in the intervention group were more likely to use long-acting reversible contraceptives (LARC) than those in the control group (adjusted prevalence ratioâ=â1.35; 95% CIâ=â[1.08â1.69], pâ=â0.008).
Conclusion
Twelve months after completion of the intervention, we found no significant difference in hormonal contraceptive use between women in the intervention and their control group counterparts. However, women in the intervention group were significantly more likely to use long-acting reversible contraceptives than those in the control group.
Trial registration
The trial registration number at the Pan African Clinical Trials Registry is PACTR201609001784334. The date of the first registration is 27/09/2016
A review of factors associated with the utilization of healthcare services and strategies for improving postpartum care in Africa
Reducing maternal mortality continues to be a major challenge for African countries. We conducted a literature review to identify the factors associated with the utilization of maternal and child healthcare services during the postpartum period and the strategies for strengthening postpartum healthcare in Africa. We carried out an electronic search in several databases of texts published between 1995 and 2012 related to maternal and child health. Seventy-five publications fitted the eligibility criteria. Our analysis shows that to a large extent the socio-economic context was dominant among the factors associated with the quality and utilization of postpartum services. The best interventions were those on immediate postpartum maternal care combining several intervention packages such as community mobilization and provision of services, community outreach services and health training. The integration within health facilities of mother and child clinics was shown to contribute significantly to improving the frequency of mothersâ postpartum visits
Insulin Growth Factor-I in Protein-Energy Malnutrition during Rehabilitation in Two Nutritional Rehabilitation Centres in Burkina Faso
Objective. To investigate the relationship between IGF-I and the nutritional status of West-African children hospitalised for nutritional rehabilitation.
Patients and methods. A cohort study was performed in two centres for nutritional rehabilitation and education (CREN) in Burkina Faso. Children were followed and the anthropometric data as well as the capillary blood samples were taken on the 7th and on the 14th days after their admission. IGF-I levels were determined from dried blood spots on filter paper on IGF-I RIA, after separation of the IGF-I from its binding proteins, using Sep-Pak chromatography.
Results. A total of 59 children was included in the cohort. The IGF-I mean geometric values (SD) were 6.3 (1.4)
ÎŒg/L on admission, 8.6 (1.8) ÎŒg/L at day 7 and 13.6 (2.0) ÎŒg/L at day 14. The differences between these values were statistically significant (P < .001). There is a significant correlation between the changes of IGF-I with the change of weight for height Z-score (P = .01).
Conclusion. These results suggest that IGF-I can be considered as a potential marker to follow the nutritional status of children admitted in hospital for protein and energy malnutrition
Time to Long-Acting Reversible Contraceptive Uptake Over Twelve Months Postpartum: Findings of the Yam Daabo Cluster Randomized-Controlled Trial in Burkina Faso and the Democratic Republic of the Congo.
Purpose: An earlier adoption of contraceptive methods during the postpartum period could help women to extend the inter-pregnancy interval. This article aimed to determine and compare the timing of long-acting reversible contraceptives (LARC) use (ie, intrauterine device and implant) in Burkina Faso (BF) and DR Congo (DRC) between the intervention and control groups.
Patients and Methods: A total of 1120 postpartum women were enrolled and followed up to 12 months postpartum. We used Yam-Daabo trial data which was a multi-intervention, single-blinded, cluster-randomised controlled trial done in primary health-care centres (clusters) in both countries. Centres were randomly allocated to receive the six-component intervention or standard antenatal and postnatal care in matched pairs (1:1). We did a secondary analysis using Royston-Parmarâs semi-parametric model to estimate the effect of the interventions on the median time of LARC uptake.
Results: Our analysis included 567 postpartum women in BF (284 in the intervention group and 283 in the control group) and 553 in the DRC (274 in the intervention group and 279 in the control group). After showing an increase in family planning use in these two African countries, Yam Daaboâs interventions showed a reduction of the median time of LARCs adoption in the intervention group compared to the control group in both countries (difference of 39 days in Burkina Faso; difference of 86 days in the DR Congo).
Conclusion: The Yam Daabo intervention package resulted in increased and earlier adoption of LARC in rural settings in Burkina Faso and urban settings in DR Congo. Such an intervention could be relevant in similar contexts in Sub-Saharan Africa with very high fertility rates and high unmet needs for contraception
Transport urbain au Benin et pollution atmosphérique: évaluation quantitative de certains polluants chimiques de Cotonou
LâatmosphĂšre dans la ville de Cotonou au BĂ©nin en Afrique de lâOuest, se caractĂ©rise par la prĂ©sence de poussiĂšres soulevĂ©es au cours de la circulation sur toutes les voies et presque partout dans cette ville, par dâĂ©paisses fumĂ©es opaques, en particulier au niveau des grandes artĂšres et des carrefours. Ce phĂ©nomĂšne est liĂ© Ă une utilisation des moto Ă deux roues notamment les taxisâmoto appelĂ©s « ZĂ©midjan » dont le nombre en 2005 est estimĂ© Ă 96.095 selon les statistiques de la mairie de Cotonou. Le prĂ©sent article vise lâĂ©valuation quantitative de certains polluants chimiques supposĂ©s nocifs et ayant fait lâobjet de rĂ©glementation au niveau du BĂ©nin. Il met en relief le rĂŽle jouĂ© par le transport dans lâĂ©mission de ces polluants gazeux. A cet effet, les taux dans lâair du monoxyde de carbone (CO), du dioxyde dâazote (NO2), du dioxyde de soufre (SO2) et du plomb ont Ă©tĂ© dĂ©terminĂ©s. Le monoxyde de carbone et le dioxyde dâazote donnent des taux dĂ©passant souvent le seuil retenu par la rĂ©glementation BĂ©ninoise. Le carrefour du grand marchĂ© Tokpa de Cotonou prĂ©sente les plus forts taux mesurĂ©s avec un maximum de 214,7 mg/m3 de CO. La quantitĂ© du plomb fixĂ©e varie avec le temps dâexposition. Le travail a confirmĂ© le rĂŽle principal de pollution de lâair jouĂ© par le transport urbain Ă Cotonou. © 2013 International Formulae Group. All rights reserved.Mots clĂ©s: Transport urbain, Pollution atmosphĂ©rique, Evaluation quantitative, polluants chimiques, Cotonou
La gratuitĂ© des soins amĂ©liore grandement lâaccessibilitĂ© aux services de santĂ©, mais les gains demeurent fragiles
La recherche a bĂ©nĂ©ficiĂ© dâune subvention des Instituts de recherche en santĂ© du Canada (# GIR127070) et dâune subvention de lâinitiative Innovation pour la santĂ© des mĂšres et des enfants dâAfrique â un partenariat entre Affaires mondiales Canada (AMC), les Instituts de recherche en santĂ© du Canada (IRSC) et le Centre de recherches pour le dĂ©veloppement international (CRDI) du Canada.La gratuitĂ© des soins mise en oeuvre dans plusieurs districts au Burkina Faso amĂ©liore lâaccessibilitĂ© aux services de santĂ©. Notre Ă©tude, rĂ©alisĂ©e dans le district de Kaya, rĂ©vĂšle que la frĂ©quentation des centres de santĂ© a doublĂ© aprĂšs lâintroduction de la gratuitĂ© en milieu rural et en milieu urbain. Toutefois, les gains demeurent fragiles. Ils peuvent ĂȘtre rapidement effacĂ©s par un arrĂȘt inattendu de la gratuitĂ© et la rĂ©introduction du paiement direct. La durabilitĂ© de la mise en oeuvre et la pĂ©rennitĂ© du financement sont des enjeux-clĂ©s dâune politique de gratuitĂ©
Evaluation of the diagnostic performance and operational characteristics of four rapid immunochromatographic syphilis tests in Burkina Faso
Background and objective: Little information is available on the rapid diagnostic testing for syphilis in Burkina Faso. The objectives of the study were (i) to assess the sensitivity and specificity of four on site rapid tests in comparison with Treponema pallidum haemagglutination assay (TPHA) as a gold standard and (ii) to evaluate the operational characteristics of those tests among health workers in a maternity unit.Methods: Four rapid syphilis tests commercially available in Burkina Faso were evaluated using archived serum samples and Treponema pallidum hemagglutination assay (TPHA) as the gold standard. Blood samples were collected between November 2011 and June 2012 from blood donors at the Regional Blood Transfusion Center of Ouagadougou. The sensitivity and specificity of the tests were calculated. Evaluation of operational characteristics such as clarity of pamphlet, complexity of technique, duration, was conducted in a first-level healthcare center with health workers in maternity unit.Results: Alere DetermineTM Syphilis was the most sensitive of the four rapid syphilis tests evaluated. It was followed by SD Bioline Syphilis 3.0, Cypress Diagnostics Syphilis Quick test and Accu-Tell Âź Rapid Anti-TP, which was the least sensitive. The four tests demonstrated a good diagnostic specificity for syphilis (95â98%), and healthcare workers found them easy to use.Conclusions: The study allowed confirming the good performance of three of four rapid syphilis tests in Burkina Faso. More research will be conducted to assess the feasibility of introducing selected rapid tests for syphilis in antenatal care services.Keywords: syphilis, rapid test, performance, Burkina Fas
Effectiveness of a package of postpartum family planning interventions on the uptake of contraceptive methods until twelve months postpartum in Burkina Faso and the Democratic Republic of Congo: The YAM DAABO study protocol
© 2018 The Author(s). Background: Postpartum family planning (PPFP) information and services can prevent maternal and child morbidity and mortality in low-resource countries, where high unmet need for PPFP remains despite opportunities offered by routine postnatal care visits. This study aims to identify a package of PPFP interventions and determine its effectiveness on the uptake of contraceptive methods during the first year postpartum. We hypothesize that implementing a PPFP intervention package that is designed to strengthen existing antenatal and postnatal care services will result in an increase in contraceptive use. Methods: This is an operational research project using a complex intervention design with three interacting phases. The pre-formative phase aims to map study sites to establish a sampling frame. The formative phase employs a participatory approach using qualitative methodology to identify barriers and catalysts to PPFP uptake to inform the design of a PPFP intervention package. The intervention phase applies a cluster randomized-controlled trial design based at the primary healthcare level, with the experimental group implementing the PPFP package, and the control group implementing usual care. The primary outcome is modern contraceptive method uptake at twelve months postpartum. Qualitative research is embedded in the intervention phase to understand the operational reasons for success or failure of PPFP services. Discussion: Designing, testing, and scaling-up effective, affordable, and sustainable health interventions in low-resource countries is critical to address the high unmet need for PPFP. Due to socio-cultural complexities surrounding contraceptive use, this research assumes that this is more effectively accomplished by engaging key stakeholders, including adolescents, women, men, key community members, service providers, and policy-makers. At the individual level, knowledge, attitudes, and behaviors of women and couples toward PPFP will likely be influenced by a set of low-cost interventions. At the health service delivery level, the implementation of this trial will probably require a shift in behavior and accountability of providers regarding the systematic integration of PPFP into their clinical practice, as well as the optimization of health service organization to ensure the availability of competent staff and contraceptive supplies. Trial registration: Retrospectively registered in the Pan African Clinical Trials Registry (PACTR201609001784334, 27 September 2016)
Task sharing for family planning services, Burkina Faso
© 2019, World Health Organization. All rights reserved. Problem In Burkina Faso, the coverage of services for family planning is low due to shortage of qualified health staff and limited access to services. Approach Following the launch of the Ouagadougou Partnership, an alliance to catalyse the expansion of family planning services, the health ministry created a consortium of family planning stakeholders in 2011. The consortium adopted a collaborative framework to implement a pilot project for task sharing in family planning at community and primary health-care centre levels in two rural districts. Stakeholders were responsible for their areas of expertise. These areas included advocacy; monitoring and evaluation; and capacity development of community health workers (CHWs) to offer oral and injectable contraceptives to new users and of auxiliary nurses and auxiliary midwives to provide implants and intrauterine devices. The health ministry implemented supportive supervision cascades involving relevant planning and service levels. Local setting In Burkina Faso, only 15% (2563/17â087) of married women used modern contraceptives in 2010. Relevant changes Adoption of new policies and clinical care standards expanded task sharing roles in family planning. The consortium trained a total of 79 CHWs and 124 auxiliary nurses and midwives. Between January 2017 and December 2018, CHWs provided injectables to 3698 new users, and auxiliary nurses or midwives provided 726 intrauterine devices and 2574 implants to new users. No safety issues were reported. Lessons learnt The pilot project was feasible and safe, however, financial constraints are hindering scale-up efforts. Supportive supervision cascades were critical in ensuring success
Discontinuation and switching of postpartum contraceptive methods over twelve months in Burkina Faso and the Democratic Republic of the Congo: a secondary analysis of the Yam Daabo trial.
IntroductionWomen who use contraceptive methods sometimes stop early, use methods intermittently, or switched contraceptive methods. All these events (discontinuations and switching) contribute to the occurrence of unwanted and close pregnancies. This study aimed to explore contraceptive discontinuation and switching during the Yam-Daabo project to measure the effect of interventions on the continuation of contraceptive methods use.MethodsWe conducted a secondary analysis of the Yam-Daabo trial data. We choose the discontinuation and switching of a modern contraceptive method as outcome measures. We performed a survival analysis using the Stata software package to estimate the effect of the interventions on contraceptive discontinuation. We also studied the main reasons for discontinuation and switching.ResultsIn total, 637 out of the 1120 women used at least one contraceptive method (of any type), with 267 women in the control and 370 in the intervention group. One hundred seventy-nine women of the control group used modern methods compared to 279 women of the intervention group with 24 and 32 who discontinued, respectively. We observed no statistically significant association between interventions and modern methods discontinuation and switching. However, modern methods' discontinuation was higher in pills and injectables users than implants and IUDs users. The pooled data comparison showed that, in reference to the women who had not switched while using a modern method, the likelihood of switching to a less or equal effectiveness method among the women of the control group was 3.8(95% CI: 1.8-8.0) times the likelihood of switching to a less or equal effectiveness method among the women of the intervention group. And this excess was statistically significant (pâConclusionThe results of this study show no statistically significant association between interventions and modern methods discontinuation. Discontinuation is more related to the methods themselves than to any other factor. It is also essential to set up specific actions targeting women's partners and influential people in the community to counter inhibiting beliefs.Trial registrationPan African Clinical Trials Registry (PACTR201609001784334, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1784 )
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