Conditions de vie, santé et soutien aux personnes âgées en milieu rural africain : cas de Nouna, Burkina Faso

La question du vieillissement de la population n’est pas encore d’actualité dans les pays subsahariens. Pourtant, si la proportion des personnes âgées demeure certes faible, leur effectif augmente de plus en plus rapidement dans un contexte d’absence de sécurité sociale généralisée. La prise en charge des personnes âgées représente alors un des véritables défis futurs pour les pays africains au sud du Sahara. L’élaboration d’interventions publiques en faveur de ces personnes nécessite une connaissance approfondie de leurs conditions de vie. L’objectif principal de la présente thèse est donc d’apporter une contribution à la production de résultats de recherches sur les conditions de vie des personnes âgées en Afrique subsaharienne afin d’informer et d’éventuellement orienter les politiques de prise en charge de ce groupe de personnes. Spécifiquement, la thèse visait à 1) mieux faire connaître les différentes caractéristiques des personnes âgées dans un contexte rural africain, 2) contribuer à une meilleure compréhension des conditions qui prédisposent les personnes âgées à vivre seules, 3) caractériser l’état de santé des personnes âgées à travers leur arrangement résidentiel, et enfin 4) mettre en évidence les changements épidémiologiques qui se sont opérés sur une période de 20 ans chez les personnes âgées. Quatre articles ont été rédigés en utilisant les données de l’observatoire de population de Nouna, Burkina Faso. Dans le premier article, il est ressorti que la réalité du vieillissement est différente pour les hommes et pour les femmes. Les hommes âgés sont plus susceptibles de vivre avec leur (s) conjointe (s) que les femmes âgées. Les femmes âgées se déclarent plus en mauvaise santé que les hommes âgés. Par ailleurs, les résultats de ce premier article ont montré qu’il y a une baisse dans le temps de l’accueil des personnes âgées dans les ménages des autres et une augmentation des proportions des ménages à une personne. Pour le deuxième article, les résultats confirment l’augmentation dans le temps de la propension des personnes âgées à vivre seules. Pour ce qui concerne les facteurs prédisposant les personnes âgées à vivre seules, les résultats n’ont décelé aucune différence de risque entre les hommes et les femmes pour la population totale âgée. En revanche, en ne considérant que le groupe des personnes âgées non mariées, les hommes ont plus de risques de vivre seuls comparativement aux femmes. Pour le troisième article, les résultats attestent que la santé des personnes âgées varie selon leur arrangement résidentiel avec un avantage pour celles qui vivent avec leur (s) conjoint(e) s. Les hommes vivant seuls ou avec des jeunes dépendants déclarent plus de maladies chroniques que leurs homologues de sexe féminin. Par contre, les hommes en couple déclarent être en meilleure santé que les femmes du même groupe. En outre, les veufs vivant avec des enfants non dépendants ont un risque plus élevé de décès comparativement aux femmes de la même catégorie. Pour le quatrième et dernier article, les résultats ont révélé que les personnes âgées de la zone de Nouna souffrent de maladies transmissibles (paludisme et maladies respiratoires) et non transmissibles (maladies cardiovasculaires et tumeurs). La première catégorie de causes de décès dans cette population demeure les maladies transmissibles avec néanmoins une montée rapide des maladies non transmissibles.Population ageing is not yet an important issue in sub-Saharan countries. However, while the proportion of the older population remains low, their numbers are growing rapidly in a context of largely absent social security. Assuring adequate care for the older segments of the population constitutes a future challenge for sub-Saharan countries. The development of effective public interventions for these people requires a thorough knowledge of their living conditions. The main objective of this thesis is to contribute to the production of evidence regarding the living conditions of older people in sub-Saharan Africa, in order to provide the information necessary for policy and interventions. More specifically, this thesis aims to provide a better understanding of: (1) the characteristics of the older people in a West African rural context, (2) the conditions that predispose older people to live alone, (3) the health status of older men and women and its association with their residential arrangements, and finally, 4) the epidemiological situation and changes that have occurred over a 20-year period with regard to these people. Four articles on these topics have been written, using the data from the longitudinal Nouna population observatory in Burkina Faso. The first article shows that the reality of ageing differs considerably by gender. Older men are more likely to live with their spouse(s) than their female counterparts. Older women report having worse health conditions than older men. Moreover, there appears to have been a decline over time in the propensity of “other” households welcoming older people to live in their homes, as well as an increase in the proportion of households in which older people live alone. The second article further confirms the growing likelihood of older people living alone over the 20-year study period. For the older population as a whole, the results do not reveal significant differences between older men and women in terms of the determinants of living along, although among those who are currently unmarried, men are more likely to live alone than women. The third article shows that the health of older people in this population varies by residential arrangement, with those living as couples presenting generally better health conditions. Men living alone or with dependent youth report having more chronic diseases than their female counterparts. On the other hand, men living with their spouse(s) report being healthier than women in the same category. In addition, widowers living with non-dependent children exhibit a higher risk of death compared to widows of the same group. In the fourth and final article, the results indicate that older people in Nouna suffer from both communicable diseases (malaria and respiratory diseases) and non-communicable diseases (cardiovascular diseases and tumors). While the most important category of causes of death remains communicable diseases, there has been a rapid rise in the importance of non-communicable diseases over the past two decades in this population

Civil registration and vital statistics (CRVS) systems in the face of the COVID-19 pandemic : a literature review

This paper outlines the magnitude of pandemic mortality; it presents the effects of COVID-19 on registration of births, marriages, deaths, and causes of death; it examines the resilience of CRVS systems during this health crisis; it suggests alternative solutions and post-covid scenarios in terms of CRVS systems. The literature review looks at civil registration and vital statistics (CRVS) systems which, in the face of the COVID-19 pandemic shows that current CRVS functioning is unable to meet urgent needs for reliable updated data during times of crisis. Pandemic measures have resulted in interruptions of most daily activities: the shutdown of transit and schools, the enormous strain on health systems, and closure of workplaces, including CRVS offices.Global Affairs Canad

Geographical and gender disparities in the registration of births, marriages, and deaths in the Nouna health and demographic surveillance system, Burkina Faso

The study provides an overview of the civil registration and vital statistics (CRVS) system in Burkina Faso. Based on evidence, it recommends that health facilities should be established as secondary birth and death registration centres. This would increase birth registration rates from the current level of 37 percent to more than 95 percent. Similarly, if health facilities serve as death registration centres, death registration would increase from the current level of 2.7 percent to 30.4 percent. The legality of religious marriage should be recognized by the state. In the study area, death certificates are drawn up only for people who leave behind an inheritance.Global Affairs Canad

Disparités géographiques et de sexe de l’enregistrement des naissances, mariages et décès à l’état civil dans l’observatoire de population de Nouna, Burkina Faso

Affaires mondiales Canad

Systèmes d’enregistrement et de statistiques de l’état civil (ESEC) à l’épreuve de la pandémie de COVID-19 : une revue de littérature

Affaires mondiales Canad

Le principe d’autonomie individuelle et le respect de la hiérarchie : La situation particulière des agents de santé participant à une recherche au Burkina Faso

Étude de cas / Case studyCette étude de cas trait aux difficultés liées au respect de l’autonomie des participants dans certaines recherches scientifiques dans le contexte de l’administration sanitaire au Burkina Faso.This case study relates to difficulties regarding the autonomy of participants in some scientific research in the context of health administration in Burkina Faso

Childhood mortality and its association with household wealth in rural and semi-urban Burkina Faso

Background This study aimed to investigate the relationship between household wealth and under-5 year mortality in rural and semi-urban Burkina Faso. Methods The study included 15 543 children born between 2005 and 2010 in the Nouna Health and Demographic Surveillance System. Information on household wealth was collected in 2009. Two separate wealth indicators were calculated by principal components analysis for the rural and the semi-urban households, which were then divided into quintiles accordingly. Multivariable Cox proportional hazards regression was used to study the effect of the respective wealth measure on under-5 mortality. Results We observed 1201 childhood deaths, corresponding to 5-year survival probability of 93.6% and 88% in the semi-urban and rural area, respectively. In the semi-urban area, household wealth was significantly related to under-5 mortality after adjustment for confounding. There was a similar but non-significant effect of household wealth on infant mortality, too. There was no effect of household wealth on under-5 mortality in rural children. Conclusions Results from this study indicate that the more privileged children from the semi-urban area with access to piped water and electricity have an advantage in under-5 survival, while under-5 mortality in the rural area is rather homogeneous and still relatively hig

The effect of distance to health-care facilities on childhood mortality in rural Burkina Faso.

This study aims to investigate the relation between distance to health facilities, measured as continuous travel time, and mortality among infants and children younger than 5 years of age in rural Burkina Faso, an area with low health facility density. The study included 24,555 children born between 1993 and 2005 in the Nouna Health and Demographic Surveillance System. The average walking time from each village to the closest health facility was obtained for both the dry and the rainy season, and its effect on infant (<1 year), child (1-4 years), and under-5 mortality overall was analyzed by Cox regression. The authors observed 3,426 childhood deaths, corresponding to a 5-year survival of 85%. Walking distance was significantly related to both infant and child mortality, although the shape of this effect varied distinctly between the 2 age groups. Overall, under-5 mortality, adjusted for confounding, was more than 50% higher at a distance of 4 hours compared with having a health facility in the village (P < 0.0001, 2 sided). The region of residence was an additional determinant for under-5 mortality. The findings of this study emphasize the importance of geographic accessibility of health care for child survival in sub-Saharan Africa and demonstrate the need to improve health-care access to achieve the Millennium Development Goals

The Health and Demographic Surveillance System (HDSS) in Nouna, Burkina Faso, 1993–2007

The Nouna Health and Demographic Surveillance System (HDSS) is located in rural Burkina Faso and has existed since 1992. Currently, it has about 78,000 inhabitants. It is a member of the International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), a global network of members who conducts longitudinal health and demographic evaluation of populations in low- and middle-income countries. The health facilities consist of one hospital and 13 basic health centres (locally known as CSPS). The Nouna HDSS has been used as a sampling frame for numerous studies in the fields of clinical research, epidemiology, health economics, and health systems research. In this paper we review some of the main findings, and we describe the effects that almost 20 years of health research activities have shown in the population in general and in terms of the perception, economic implications, and other indicators. Longitudinal data analyses show that childhood, as well as overall mortality, has significantly decreased over the observation period 1993–2007. The under-five mortality rate dropped from about 40 per 1,000 person-years in the mid-1990s to below 30 per 1,000 in 2007. Further efforts are needed to meet goal four of the Millennium Development Goals, which is to reduce the under-five mortality rate by two-thirds between 1990 and 2015