Universal Coverage in Developing Countries: A Summative Evaluation of Maternal Policies in Ghana and Burkina Faso

The Word Health Organization (WHO) has declared health to be a fundamental human right, yet more than 400 million people around the world do not have access to essential health services. Millions of Africans are unable to access or afford needed services without sustaining economic hardship. Sub-Saharan Africa is behind the rest of the world on coverage of essential health services such as planning, immunization, and sanitation and continues to grapple with higher rates of child mortality, maternal death, and communicable diseases. Despite bearing 25 percent of the world’s disease burden, the region only retains 3 percent of its doctors. Universal health coverage (UHC) has gained attention in recent years as a viable means of ensuring access to care for all, including the most vulnerable and those residing in developing parts of the world. The underlying assumption is that by assuring basic health care coverage for all, UHC can minimize impoverishment resulting from catastrophic health expenditures. Many low-income countries have taken the lead in implementing universal health coverage reforms, among them Ghana and Burkina Faso – a Sub-Saharan country. Ghana passed the National Health Insurance Scheme (NHIS) in 2003 with the aim of moving towards universal health care coverage and improving the quality of health of its population. Ghana’s NHIS is a tax-funded national health insurance system that provides financial protection and expands health care coverage to the citizenry (Health Systems 20/20 Project and Research & Development Division of the Ghana Health Service, 2009). In 2008, this law was amended to include a maternal free care policy that extended care services to all pregnant women and their newborns free of charge. On the other side, Burkina Faso adopted a policy in 2006 that subsidized deliveries and emergency obstetric care. The subsidy for deliveries and emergency obstetric and neonatal care (EmONC) funds 80% of deliveries and caesarean sections, and the patient pays the remainder 20%. The policy entirely exempts those categorized as “the poorest.” Contrary to Ghana, the country did not receive all the support required in formulating the plan, and those in charge had to learn through trial and error. This study will evaluate the effectiveness of each program separately at increasing the utilization of maternal health services and at improving child health outcomes. The outcomes evaluated include antenatal, perinatal, and postnatal health care utilization and neonatal and infant mortality

Ethnobotanical study of cultivated yellow nutsedge, (Cyperus esculentus L.) in Burkina Faso

The yellow nutsedge, Cyperus esculentus L. is an herbaceous species whose tubers are the edible parts. The tubers are very popular with children, and can be eaten raw, fried or after processing into a drink (Horchata). However, it does not exist in Burkina, a centralized collection and studies on the genetic variability, the socio-cultural and economic aspects of this species. In order to identify the morphotypes and to welcome the peasant knowledge on the management of the, yellow nutsedge, a prospection followed by collection of tubers were carried out in the main areas of production of this crop. A total of 22 villages in eight districts were visited and 108 accessions of tubers were collected. It emerges from this study that the cultivation is mainly practiced by women (97% of farmers). The cultivated yellow nutsedge is adapted to drought and to several types of soil. In addition, farmers classify the tubers according to their shape and size. Thus, the spherical tubers are qualified as "small tubers the non-spherical tubers as" large tubers. The number of tubers produced per foot varies from 20 to 60. Farmers use phenotypic characters, sexual dimorphism and ethnicity to name accessions for sweet peas. Vernacular names and methods of producing yellow nutsedge vary by region and ethnicity. According to the respondents, 84.34% think that the nut is of Burkinabé origin, 9.26% Ghanaian, 1.85% from Mali and 5.35% have no answers. There is great diversity in local knowledge and accessions collected in Burkina.Keywords: Ethnobotany, tubers, accessions, morphotypes

Effect of Silica on Rice Agromorphological Diversity Under Iron Toxicity Conditions in Lowland Rice of Guinea Conakry

Rice is the second most important cereal in West Africa and is an essential element in the diet of the population. However, iron toxicity is one of the major edaphic constraints in lowland rice cultivation. The large amount of ferrous ions in solution causes an imbalance in nutrients involving a nutritional disorder affecting the growth of crops including rice. The present study conducted in 2014 in Guinea Conakry in the lowlands of the Kilissi Agronomic Research Station aimed to evaluate the effect of silica on reducing of the effect of iron toxicity in rice. Thus, rice varieties were evaluated according to a split plot device with three (3) randomized replications for two factors (rice varieties and silica doses) and three (3) silica treatments (D0 g, D120 g and D240 g). The results showed a significant effect of silica on most agronomic parameters of the rice varieties tested. The D240 g dose gave the best yields of up to 6.9 t/h. Seventeen (17) varieties exhibited good agronomic characteristics of yield, cycle, and weight of 1000 grains. In addition, the study reveals a possibility of reducing the effect of iron toxicity in lowlands in Guinea by the combined use of silica and rice varieties resistant or tolerant to iron. The genetic variability observed with certain tolerant varieties with ferrous toxicity like CK4 could be exploited in our national rice breeding program

Genetic Diversity of Jatropha curcas in Burkina Faso Revealed by Microsatellite Markers

Jatropha curcas L. is a perennial oleaginous plant commonly used in tropical areas as a medicinal plant in the construction of defensive hedges against animals, and in the fight against water erosion. It produces oil which can be used as agrofuel or soap-making. Despite its potential, the species remain under-exploited and its genetic diversity is still not very well-known in Burkina Faso. This paper focuses on determining the level and structure of the genetic diversity of 50 accessions collected in three phytogeographical sectors of the country using 12 microsatellite markers. Resultsrevealed a total of 37 alleles in the studied population with an average of 3 alleles per locus, a number of 2.717 effective alleles, and a Shannon diversity index of 1.663. Mean observed heterozygosity and mean expected heterozygosity were 0.144 and 0.356, respectively. Accessions were structured into three genetic groups. The high genetic distance of 0.177 was observed between groups A and B, and a low genetic distance of 0.075 was observed between groups B and C. These preliminary results showed that microsatellites are promising tools that can be used for the characterization of J. curcas. They indicate that the population studied has a low genetic diversity, but it is sufficient to develop programs for conservation and sustainable development of the species

Profil épidémiologique de la rougeole au Mali de 2009 à 2018: Epidemiological profile of measles in Mali from 2009 to 2018

Introduction: La rougeole, maladie virale hautement contagieuse causée par un Morbillivirus, reste un important problèeme de santé publique dans de nombreux pays malgré l'existence d'un vaccin efficace. La surveillance de la rougeole est l'un des aspects clés de la lutte contre cette maladie. La présente étude avait pour objectif de décrire la mortalité et la morbidité de la rougeole au Mali entre 2009 et 2018. Méthodes: Il s'agissait d'étude transversale descriptive. Les données de surveillance de la rougeole au Mali de 2009 à 2018 ont été analysées en personne, lieu et temps. Résultats: De 2009 à 2018, le nombre de cas confirmés de rougeole était de 6461 dont 29 décès soit une létalité de 0,45%. La confirmation des cas avait été faite par le laboratoire pour 2551 cas (39,48%), par lien épidémiologique pour 3738 cas (57,85%) et cliniquement pour 172 cas (2,66%). Les enfants de moins de 5 ans représentaient 50,97% des cas et 75,86% des décès. La majorité des cas (95,71 %) n'avaient jamais été vaccinés contre la rougeole. Les incidences les plus élevées avaient été observées en 2009 (22,65 pour 100 000 hbts) et 2010 (11,81 pour 100 000 hbts). Tombouctou, Gao et Mopti avaient enregistrés les plus grands nombres de cas en 2009 et Bamako, Koulikoro et Mopti en 2010. Conclusion: La majorité des cas et des décès étaient les enfants non vaccinés de moins de cinq ans. Un renforcement du programme élargi de vaccination de routine, une riposte aux épidéemies et des stratéegies de vaccination couvrant tout le pays sont nécessaires. Introduction: Measles, a highly contagious viral disease caused by a Morbillivirus, remains an important public health problem in many countries despite the availability of an effective vaccine. Measles surveillance is one of the key aspects of measles control. The objective of this study was to describe measles mortality and morbidity in Mali between 2009 and 2018. Methods: This was a descriptive cross-sectional study. Measles surveillance data in Mali from 2009 to 2018 were analysed by person, place and time. Results: From 2009 to 2018, the number of confirmed measles cases was 6461 including 29 deaths, i.e. a case-fatality rate of 0.45%. Cases were confirmed by the laboratory for 2551 cases (39.48%), by epidemiological link for 3738 cases (57.85%) and clinically for 172 cases (2.66%). Children under 5 years of age represented 50.97% of cases and 75.86% of deaths. The majority of cases (95.71%) had never been vaccinated against measles. The highest incidences were observed in 2009 (22.65 per 100,000 inhabitants) and 2010 (11.81 per 100,000 inhabitants). Timbuktu, Gao and Mopti had the highest number of cases in 2009 and Bamako, Koulikoro and Mopti in 2010. Conclusion: The majority of cases and deaths were among unvaccinated children under five years of age. Strengthening of the routine expanded programme of immunisation, response to epidemics and nationwide immunisation strategies are needed

Évaluation de la teneur en vitamine A et de l’indice de peroxyde des huiles végétales couramment vendues dans les marchés au Burkina Faso

La carence en vitamine A constitue un problème de santé publique dans les pays en développement et affecte en particulier les jeunes enfants et les femmes en âge de procréer. Le but de cette étude était d'évaluer l’application de la politique nationale en matière de production et d’importation, des huiles végétales raffinées, d’enrichissement obligatoire en vitamine A au Burkina Faso, à travers la détermination de la teneur en vitamine A et de l'indice de peroxyde des huiles végétales vendues sur le marché. Cette étude transversale a été menée dans cinq villes sélectionnées selon la densité de la population. Cinquante-neuf échantillons d’huile ont été achetés dans ces villes pour évaluer la teneur en vitamine A, l'indice de peroxyde et leur conformité aux normes nationales et internationales. Dans l'ensemble, 76,27% des huiles n'étaient pas suffisamment enrichies en vitamine A. Pour l'indice de peroxyde, 3,39% des huiles n'étaient pas conformes. Globalement, 77,97% des huiles n'étaient pas conformes pour ces deux paramètres. Au regard de ces résultats il est nécessaire d’intensifier la lutte contre la mise à la consommation des huiles non enrichies en vitamine A au Burkina Faso. English title: valuation of the vitamin A content and the peroxide value of vegetable oils commonly sold in markets in Burkina Faso Vitamin A deficiency is a public health problem in developing countries and particularly affects young children and women of childbearing age. The aim of this study was to assess the implementation of the national policy on the production and importation of refined vegetable oils and mandatory vitamin A fortification in Burkina Faso, through the determination of the vitamin A content and peroxide value of vegetable oils sold on the market. A cross-sectional study was conducted in five cities selected according to population density. Fifty-nine oil samples were purchased in these cities to assess vitamin A content, peroxide value and compliance with national and Codex standards. Overall, 76.17% of the oils were not adequately fortified with vitamin A. For the peroxide value, 3.39% of the oils did not comply. Overall, 77.97% of the oils did not comply for these two parameters. In view of these results, it is necessary to intensify the fight against the consumption of oils not enriched in vitamin A in Burkina Faso

Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* survey of Belgian specialists *THESIS: treatment of hypothyroidism in Europe by specialists: an international survey.

[en] BACKGROUND: Hypothyroidism is a topic that continues to provoke debate and controversy with regards to specific indications, type of thyroid hormone substitution and efficacy. We investigated the use of thyroid hormones in clinical practice in Belgium, a country where currently only levothyroxine (LT4) tablet formulations are available. METHOD: Members of the Belgian Endocrine Society were invited to respond to an online questionnaire. Results were compared with those from other THESIS surveys. RESULTS: Eighty (50%) of the invited 160 individuals, completed the questionnaire. LT4 was the first treatment of choice for all respondents. As secondary choice, some also prescribed liothyronine (LT3) and LT4 + LT3 combinations (2 and 7 respondents, respectively). Besides hypothyroidism, 34 and 50% of respondents used thyroid hormones for infertile euthyroid TPOAb positive women and the treatment of a growing non-toxic goiter, respectively. Had alternative formulations of LT4 to tablets been available (soft gel or liquid L-T4), 2 out of 80 (2.5%) participants would consider them for patients achieving biochemical euthyroidism but remaining symptomatic. This proportion was higher in case of unexplained poor biochemical control of hypothyroidism (13.5%) and in patients with celiac disease or malabsorption or interfering drugs (10%). In symptomatic euthyroid patients, 20% of respondents would try combined LT4 + LT3 treatment. Psychosocial factors were highlighted as the main contributors to persistent symptoms. CONCLUSIONS: LT4 tablets is the preferred treatment for hypothyroidism in Belgium. A minority of the respondents would try combined LT4 + LT3 in symptomatic but biochemically euthyroid patients. Thyroid hormones are prescribed for euthyroid infertile women with thyroid autoimmunity and patients with non-toxic goiter, a tendency noted in other European countries, despite current evidence of lack of benefit

Investigating new approaches to improve Heart Failure management

Despite significant advances in therapeutic methods over the decades, Heart Failure (HF) remains today a major public health problem with a significant economic burden. HF is currently the leading cause of hospitalization in people older than 65 years with still high early post-discharge readmission rates. The present thesis was conducted to develop new management strategies to improve HF prognosis and reduce its economic burden. In a first step, we built a new individualized dynamic non-invasive automated and autonomous alert triggering system for early detection and early preventive therapeutic intervention of HF deterioration which performed better than the previous systems. In a second step, we showed that traditional health status measures of morbidity and mortality and quality-of-life health status measures provide additive information in defining HF prognosis. Both health instruments should now be used together to assess health in a global perspective for HF patients.(MED - Sciences médicales) -- UCL, 201

Early Melanoma Detection in Primary Care: Clinical Recognition of Melanoma is Not Enough, One Must Also Learn the Basics.

To improve early melanoma detection, educational programs have been developed for general practitioners (GPs). This study aimed to determine whether the adjunct of teaching basic knowledge of pigmented skin lesions (PSL) to the training in melanoma diagnosis improves the GPs' diagnostic accuracy of melanoma. An interventional prospective study was conducted over a 3-month period where GPs attended a 2-h training course. The 1 session taught clinical melanoma recognition and the 2 session instructed basic knowledge of PSL. Prior to training, after the 1, and after the 2 session, GPs were asked to select the malignant or benign nature of 15 clinical images associated to their clinical history. In total, 56 GPs participated in this study. The number of GPs identifying correctly ≥ 50% of the melanomas increased the most after the 1 session from 15 (26.8%; CI = (15.2; 38.4)) to 44 (78.6%; CI = (67.8; 89.3)) GPs (P < 0.001). The number of GPs correctly identifying ≥ 50% of the benign PSL only increased after completing the entire training, going from 10 (17.9%; CI = [(7.8; 27.9)) GPs to 50 (89.3%; CI = (81.2; 97.4)) GPs (P < 0.001). In this study, GPs identified benign PSL most accurately after the 2 session. This suggested that teaching GPs the basics of PSL would especially improve their diagnostic accuracy for benign PSL, which could reduce unnecessary referrals to dermatologists. Teaching basic knowledge of PSL in addition to melanoma recognition seemed to enable GPs to triage skin lesions more effectively than when they were only trained to recognize melanoma