Monitoring the performance of the Expanded Program on Immunization: the case of Burkina Faso

<p>Abstract</p> <p>Background</p> <p>The greatest challenge facing expanded programs on immunization in general, and in Burkina Faso in particular, lies in their capacity to achieve and sustain levels of immunization coverage that will ensure effective protection of children. This article aims to demonstrate that full immunization coverage of children, which is the primary indicator for monitoring national immunization programs, is sufficient neither to evaluate their performance adequately, nor to help identify the broad strategies that must be implemented to improve their performance. Other dimensions of performance, notably adherence to the vaccination schedule and the efficacy of the approaches used to reach all the children (targeting) must also be considered.</p> <p>Methods</p> <p>The study was carried out using data from surveys carried out in Burkina Faso: the 1993, 1998 and 2003 Demographic and Health Surveys and the 2003 national Survey of Immunization Coverage. Essentially, we described levels of immunization coverage and their trends according to the indicators considered. Performance differences are illustrated by amplitudes and maximum/minimum ratios.</p> <p>Results</p> <p>The health regions' performances vary according to whether they are evaluated on the basis of full immunization coverage or vaccination status of children who have not completed their vaccinations. The health regions encompass a variety of realities, and efforts of substantially different intensity would be required to reach all the target populations.</p> <p>Conclusion</p> <p>Decision-making can be improved by integrating a tripartite view of performance that includes full immunization coverage, adherence to the vaccination schedule (timely coverage), and the status of children who are not fully vaccinated. With such an approach, interventions can be better targeted. It provides information on the quality and timeliness of vaccination and identifies the efforts required to meet the objectives of full immunization coverage.</p> <p>Abstract in French</p> <p>See the full article online for a translation of this abstract in French.</p

Concept traditionnel de la folie et difficultés thérapeutiques psychiatriques chez les Moosé du Kadiogo

L'exercice de la psychiatrie en Afrique au Sud du Sahara se heurte à de nombreux problêmes d'acceptabilité des soins par les malades et leurs familles. Le rejet fréquent de la démarche thérapeutique des psychiatres s'explique peut-être par l'inadaptation de l'approche étiopathogénique. En effet, en Afrique Noire, les responsables des maladies diffèrent selon qu'on a été à l'école ou non. L'école occidentale apprend aux minorités qui ont la chance d'y aller ou de l'approcher que le corps humain peut être agressé par des bactéries, des virus, des mycoses ou autoagressé par des modifications de sa propre physiologie. L'éducation traditionnelle, quant à elle, fait du corps une entité mystérieuse susceptible d'être pénétrée ou mangée par les génies et les sorciers anthropophages, suivant un mécanisme mystico-religieux lié aux croyances et coutumes. Chez la majorité des Moosé du plateau moaga du Burkina Faso, ces agresseurs sont des génies ancestraux ou des génies de brousse, en particulier dans le domaine de la folie. L'explication de la souffrance psychologique par un conflit familial, social ou intrapsychique indépendant du monde invisible est à la limite délirante pour eux, provoquant ainsi leur résistance à la prise en charge psychiatrique complète de ces malades. Une analyse des causes probables de cette résistance nous a paru nécessaire. À l'aide d'interviews, elle nous a montré que l'institution psychiatrique est vécue par les Moosé du Kadiogo comme une étape dans l'itinéraire thérapeutique de leurs malades mentaux, étape au cours de laquelle leur demande de soins se réduit à la suppression du symptôme qui dérange. Pour eux, la suppression de la cause relève d'un savoir que ne possède pas le psychiatre, ce qui rend la relation thérapeutique frustrante de part et d'autre.The practice of psychiatry in the south of the Sahara in Africa collides with many problems of acceptability of care for the ill and their families. The frequent rejection of the psychiatrist's therapeutic approach can often be explained by the inadaptation of the etiopathogenic approach. Indeed, in black Africa, responsibility of illness differs according to the fact that one has been schooled or not. The western world teaches minorities having the chance to live there or learn about it, that the human body can be assaulted by bacteria, viruses, mycoses or be self-assaulted by changes of its own physiology. Traditional education, for its part, regards the body as a mysterious entity susceptible of being penetrated or eaten by geniuses and anthrophagic sorcerers following a mystico-religious mechanism linked to beliefs and customs. In the majority of the Moose of the Moaga plateau in Burkina Faso, especially regarding madness, these assailants are ancestral geniuses or geniuses from the bush. Psychological suffering caused by a family, social or intrapsychic conflict independent of the invisible world is ultimately delirious for them thus provoking a resistance to give up complete charge of their mentally ill to psychiatric care. For us, an analysis of probable causes of this resistance appeared necessary. Interviews have shown that the psychiatric institution is experienced by the Moose of Kadiogo as a stage in the therapeutic itinerary of their mentally ill, a stage in the course of which their demand for care is reduced to the elimination of inconvenient symptoms. For them, the elimination of the cause derives from a knowledge that psychiatry does not possess, which renders the therapeutic relationship frustrating for both parties.El ejercicio de la siquiatrîa en el Sahara Sur Africano se tropieza con muchos problemas de aceptaciôn de los tratamientos por los enfermos y sus familias. El rechazo frecuente al tratamiento de los siquiatras se explica probablemente por la falta de adaptaciôn del enfoque etiopatogénico. En efecto, en el Africa negra, los responsables de las enfermedades difieren, segun que se haya o no se haya frecuentado la escuela. La escuela occidental ensena a las minorias que tienen la posibilidad de asistir, o de acercarse, que el cuerpo humano puede ser agredido por bacterias, virus, micosis, o puede ser autoagredido por las modificaciones de su propia fisiologia. La educaciôn tradicional, en cuanto a ella, hace del cuerpo una entidad misteriosa susceptible de ser penetrada o carcomida por los genios y los brujos antropofagos, siguiendo un mecanismo mistico y religioso ligado a las costumbres y creencias. Para la mayorîa de los Mossis del valle moaga en Burkina faso, particularmente en Io que concierne a la locura, esos agresores son los genios ancestrales o los genios de la selva. La explicaciôn del sufrimiento sicolôgico debido a un conflicto familiar, social, o siquico independiente del mundo visible es, a este punto, délirante para ellos, Io que provoca una resistencia al tratamiento siquiâtrico completo en esos enfermos. Un anâlisis de las causas posibles de esta resistencia nos parecio necesario. Ayudados con entrevistas, estas nos mostraron que los Mossis del Kadiogo viven la institution siquiâtrica como una etapa en el itinerario terapéutico de los enfermos mentales, etapa durante la cual el recurso a la ayuda se reduce a la supresiôn de los sintomas que molestan. Para ellos, la supresiôn de la causa proviene de un saber que el siquiatra no posée, Io que rinde la relation terapéutica frustrante de parte y parte

Social Ecological Factors Affecting Substance Abuse in Ghana (West Africa) Using Photovoice

Introduction: substance abuse is an important public health issue affecting West Africa; however, there is currently a dearth of literature on the actions needed to address it. The aim of this study was to assess the risks and protective factors of substance abuse in Ghana, West Africa, using the photovoice method. Methods: this study recruited and trained 10 participants in recovery from substance abuse and undergoing treatment in the greater Accra region of Ghana on the photovoice methodology. Each participant received a disposable camera to take pictures that represented the risk and protective factors pertinent to substance abuse in their communities. They were also given the opportunity to provide narratives of the pictures using pre-identified themes and the different levels of the social-ecological model and participatory action research (PAR). Results: participants identified at the individual level: ignorance; interpersonal level: family and peer pressure; organizational level: lack of regulation; community level: media, availability of drugs, cost of drugs, urbanization, slum communities and cultural factors; and policy level: lack of regulations and their enforcement. Education and beliefs were cited at the individual level; family at the interpersonal level; religion at the organizational level; organizing youth, media and narcotics anonymous at the community level; and nothing at the policy level. Conclusion: this is an exploratory study that will add to the limited body of knowledge in the scientific literature with respect to substance abuse in the country and also help develop interventions to address the respective needs of several communities in Ghana

System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study

<p>Abstract</p> <p>Background</p> <p>Despite rapid and tangible progress in vaccine coverage and in premature mortality rates registered in sub-Saharan Africa, inequities to access remain firmly entrenched, large pockets of low vaccination coverage persist, and coverage often varies considerably across regions, districts, and health facilities' areas of responsibility. This paper focuses on system-related factors that can explain disparities in immunization coverage among districts in Burkina Faso.</p> <p>Methods</p> <p>A multiple-case study was conducted of six districts representative of different immunization trends and overall performance. A participative process that involved local experts and key actors led to a focus on key factors that could possibly determine the efficiency and efficacy of district vaccination services: occurrence of disease outbreaks and immunization days, overall district management performance, resources available for vaccination services, and institutional elements. The methodology, geared toward reconstructing the evolution of vaccine services performance from 2000 to 2006, is based on data from documents and from individual and group interviews in each of the six health districts. The process of interpreting results brought together the field personnel and the research team.</p> <p>Results</p> <p>The districts that perform best are those that assemble a set of favourable conditions. However, the leadership of the district medical officer (DMO) appears to be the main conduit and the rallying point for these conditions. Typically, strong leadership that is recognized by the field teams ensures smooth operation of the vaccination services, promotes the emergence of new initiatives and offers some protection against risks related to outbreaks of epidemics or supplementary activities that can hinder routine functioning. The same is true for the ability of nurse managers and their teams to cope with new situations (epidemics, shortages of certain stocks).</p> <p>Conclusion</p> <p>The discourse on factors that determine the performance or breakdown of local health care systems in lower and middle income countries remains largely concentrated on technocratic and financial considerations, targeting institutional reforms, availability of resources, or accessibility of health services. The leadership role of those responsible for the district, and more broadly, of those we label "the human factor", in the performance of local health care systems is mentioned only marginally. This study shows that strong and committed leadership promotes an effective mobilization of teams and creates the conditions for good performance in districts, even when they have only limited access to supports provided by external partners.</p> <p>Abstract in French</p> <p>See the full article online for a translation of this abstract in French.</p

The Impact of Changes in Commodity Prices on Household Welfare in Rural Burkina Faso

We use unique panel data to estimate the effect of an increase in the price of food commodities on household welfare in Burkina Faso. Our analysis includes the negative impacts on households as food consumers, as well as the positive impacts as food producers to estimate their net welfare change. The data were collected each year by the Burkina Faso Ministry of Agriculture and Food Security, which covered periods of food price crises. To evaluate the welfare effect of the price shocks, we first estimate demand and supply responses and then derive the net welfare change at the household and country level. Overall, the price shocks are associated with a gain in the rural household welfare because the producer’s effect outweighed the consumer’s effect

Adult Granulosa Cell Tumor of the Testis: A case report and review of the literature

Adult Granulosa Cell Tumor of the Testis (AGCTT) is a rare sex-cord stromal tumor. About 73 cases have been previously reported in the literature. We report a case of AGCTT in a 64 years old male, located in the left testis. We performed left radical inguinal orchiectomy. A sagittal section of orchiectomy specimen showed a solid yellowish-white mass measuring 1cm of long axis. On microscopic examination, we noted a well-limited tumor proliferation of solid architecture. The proliferation was made up of cells with scant cytoplasm and incised oval nuclei in a fibrous stroma. Rare Call-Exner bodies were noted

Characteristics of Obstetric and Iatrogenic Urogenital Fistulas in Burkina Faso: A Cross-Sectional Study

Objective. To compare the sociodemographic, clinical, and therapeutic characteristics of obstetric urogenital fistulas (OF) and iatrogenic urogenital fistulas (IF) treated in seven centers in Burkina Faso. Material and Methods. We carried out a cross-sectional study over a seven years’ period (January 1, 2010 to December 31, 2016). We considered as iatrogenic all urogenital fistulas (UGF) occurred after elective caesarean section, gynecologic surgery (hysterectomy, myomectomy, and prolapse repair), or induced abortion. UGF following vaginal delivery after prolonged labor without obstetric maneuvers or caesarean section were considered as obstetric. UGF caused by other mechanisms (emergency caesarian section, congenital, and traumatic) were excluded from this study. The statistical analysis was carried out using version 14 of the STATA software. A logistic regression model was used to compare the two groups. Results. 310 cases of UGF were included. IF accounted for 25.8% (n = 80) versus 74.2% (n = 230) for OF. The median age was 35 years for IF and 35.38 years for OF. The vesicovaginal fistulas were predominant (74.5%) in the two groups. All circumferential fistulas were found in the OF group. OF were frequently associated with residence in rural areas (OR = 1.8; CI = [1.05–3.1]), low level of education (OR = 5.4; CI = [2.3–12.9]), and a height under 158 cm (OR = 3.4 CI = [1.7–6.6]). Vaginal sclerosis was less common among IF (OR = 2.2; CI = [1–4.6]). The failure of surgical treatment after 3 months was more associated with OF (OR = 4.7; CI = [1.1–20.5]). Conclusion. OF were the most common, frequently affecting short women living in rural area and with low level of schooling. Fistulas were also more severe in the OF group. IF gave better results after surgical repair

Prostate Cancer Presenting with Parietal Bone Metastasis

Bone metastases from prostate cancer are very common. They are usually located on the axial skeleton. However, cranial bone metastases especially to the parietal bone are rare. We report a case of metastatic prostate cancer presenting with left parietal bone metastasis in a patient with no urological symptoms or signs. We should consider prostate cancer in any man above 60 years presenting unusual bone lesions