Postpartum family-planning barriers and catalysts in Burkina Faso and the Democratic Republic of Congo: a multiperspective study.

PURPOSE: To address the high unmet need for postpartum family planning (PPFP) in resource-limited settings, particularly in sub-Saharan Africa, this study aimed to identify PPFP-related barriers and catalysts to inform policies and programs to increase access to postpartum contraception. METHODS: Using qualitative methodology, we explored the perspectives of women, adolescent girls, men, religious and community leaders, service providers, and decision makers from three rural communities in Burkina Faso and three rural-urban communities in the Democratic Republic of Congo. Both countries have high unmet need for PPFP and are priority countries of the French Muskoka Fund for Maternal and Child Health. RESULTS: Perceived catalysts included negative traditional views on the consequences borne by closely spaced children and their mothers; a 6-week postpartum visit dedicated to PPFP (albeit poorly attended); political will and enabling policies for FP; and support from certain religious leaders and men. Main reported barriers were the lack of male engagement; out-of-pocket copayment for contraceptives; reliance on amenorrhea for pregnancy prevention without knowing its limits; misconceptions about modern contraceptives, including prerequisites for the lactational amenorrhea method; sexual abstinence supported by religious and traditional norms for up to 3-6 months, although women reported earlier resumption of sexual activity; low prioritization of scheduled postpartum visits by women; and limited availability of readily accessible methods, PPFP counseling materials, and clinic days and scheduled visits dedicated to contraceptive services. CONCLUSION: Based on results found to be most actionable, the following interventions have the potential to optimize access to PPFP services: counseling women on postpartum-pregnancy risks and options at different points in time before and after childbirth through the use of appropriate information, education, and counseling materials; integrating PPFP services into existing maternal and child health visits; making contraceptives readily available and affordable; and meaningfully engaging male partners

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) μg/L on admission, 8.6 (1.8) μg/L at day 7 and 13.6 (2.0) μg/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

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 ® Rapid Anti-TP, which was the least sensitive. The four tests demonstrated a good diagnostic specificity for syphilis (95–98%), 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

Yam Daabo interventions’ 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 interventions’ 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 7 days 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 12 months 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 12 months, 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 ratio = 1.21; 95% confidence interval [CI] = [0.91–1.61], p = 0.191). 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 ratio = 1.35; 95% CI = [1.08–1.69], p = 0.008). 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

La gratuité des soins améliore grandement l’accessibilité aux services de santé, mais les gains demeurent fragiles

La recherche a bénéficié d’une subvention des Instituts de recherche en santé du Canada (# GIR127070) et d’une subvention de l’initiative Innovation pour la santé des mères et des enfants d’Afrique – un partenariat entre Affaires mondiales Canada (AMC), les Instituts de recherche en santé du Canada (IRSC) et le Centre de recherches pour le développement international (CRDI) du Canada.La gratuité des soins mise en oeuvre dans plusieurs districts au Burkina Faso améliore l’accessibilité aux services de santé. Notre étude, réalisée dans le district de Kaya, révèle que la fréquentation des centres de santé a doublé après l’introduction de la gratuité en milieu rural et en milieu urbain. Toutefois, les gains demeurent fragiles. Ils peuvent être rapidement effacés par un arrêt inattendu de la gratuité et la réintroduction du paiement direct. La durabilité de la mise en oeuvre et la pérennité du financement sont des enjeux-clés d’une politique de gratuité

Impact of an Antenatal Counseling on Use of Modern Family Planning Methods in the Postpartum in Rural Guinea

In Guinea, family planning (FP) uptake remains low. The objective of this study was to compare the impact of two types of antenatal counseling on modern FP uptake in the postpartum in rural Guinea. This was a two-group non-equivalent study comparing the impact of a reinforced antenatal counseling (intervention) to the routine antenatal counseling (control). The study included 404 pregnant women at five rural health centres in Forécariah district, Western Guinea. Each woman was followed up until the ninth month postpartum. The study was conducted from October 12, 2013 to December 30, 2014. Findings showed that at the ninth month postpartum, use of modern FP was significantly higher in the intervention group than in the control group (5.7% and 1.1%, respectively; p=0.024). However, 67.6% and 65.7% of women in the intervention group and the control group, respectively, abstained from sexual intercourse at the sixth month postpartum and had the intention to do so until the child walks. At the ninth month postpartum such women represented 70.5% and 59.5%, respectively. Therefore, a longer study period is recommended to assess the effect of antenatal counseling on use of modern FP in the postpartum in Guinea. Keywords: Antenatal counseling; Family planning; Postpartum; Rural; Guine

Transport urbain au Benin et pollution atmosphérique: évaluation quantitative de certains polluants chimiques de Cotonou

L’atmosphère dans la ville de Cotonou au Bénin en Afrique de l’Ouest, se caractérise par la présence de poussières soulevées au cours de la circulation sur toutes les voies et presque partout dans cette ville, par d’épaisses fumées opaques, en particulier au niveau des grandes artères et des carrefours. Ce phénomène est lié à une utilisation des moto à deux roues notamment les taxis–moto appelés « Zémidjan » dont le nombre en 2005 est estimé à 96.095 selon les statistiques de la mairie de Cotonou. Le présent article vise l’évaluation quantitative de certains polluants chimiques supposés nocifs et ayant fait l’objet de réglementation au niveau du Bénin. Il met en relief le rôle joué par le transport dans l’émission de ces polluants gazeux. A cet effet, les taux dans l’air du monoxyde de carbone (CO), du dioxyde d’azote (NO2), du dioxyde de soufre (SO2) et du plomb ont été déterminés. Le monoxyde de carbone et le dioxyde d’azote donnent des taux dépassant souvent le seuil retenu par la réglementation Béninoise. Le carrefour du grand marché Tokpa de Cotonou présente les plus forts taux mesurés avec un maximum de 214,7 mg/m3 de CO. La quantité du plomb fixée varie avec le temps d’exposition. Le travail a confirmé le rôle principal de pollution de l’air joué par le transport urbain à Cotonou. © 2013 International Formulae Group. All rights reserved.Mots clés: Transport urbain, Pollution atmosphérique, Evaluation quantitative, polluants chimiques, Cotonou