Integration of postpartum care into child health and immunization services in Burkina Faso: Findings from a cross-sectional study

Background: The Missed Opportunities for Maternal and Infant Health (MOMI) project, which aimed at upgrading maternal and infant postpartum care (PPC), implemented a package of interventions including the integration of maternal PPC in infant immunization services in 12 health facilities in Kaya Health district in Burkina Faso from 2013 to 2015. This paper assesses the coverage and the quality of combined mother-infant PPC in reproductive, maternal, newborn and child health services (RMNCH).Methods: We conducted a mixed methods study with cross-sectional surveys before and after the intervention in the Kaya health and demographic surveillance system. On the quantitative side, two household surveys were performed in 2012 (N = 757) and in 2014 (N = 754) among mothers within one year postpartum. The analysis examines the result of the intervention by the date of delivery at three key time points in the PPC schedule: the first 48 h, days 6–10 and during weeks 6–8 and beyond. On the qualitative side, in depth interviews, focus group discussions and observations were conducted in four health facilities in 2012 and 2015. They involved mothers in the postpartum period, facility and community health workers, and other stakeholders. We performed a descriptive analysis and a two-sample test of proportions of the quantitative data. The qualitative data were recorded, transcribed and analysed along the themes relevant for the intervention.Results: The findings show that the WHO guidelines, in terms of content and improvement of maternal PPC, were followed for physical examinations and consultations. They also show a significant increase in the coverage of maternal PPC services from 50% (372/752) before the intervention to 81% (544/672) one year after the start of the intervention. However, more women were assessed at days 6–10 than at later visits. Integration of maternal PPC was low, with little improvements in history taking and physical examination of mothers in immunization services. While health workers are polyvalent, difficulties in restructuring and organizing services hindered the integration.Conclusion: Unless a comprehensive strategy of integration within RMNCH services is implemented to address the primary health care challenges within the health system, integration will not yield the desired results

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 mothers’ postpartum visits

Connaissances et perceptions de la maladie à coronavirus (COVID-19) dans la commune de Ouagadougou

The COVID-19 disease has spread throughout the world. This has led health and political authorities from Burkina Faso to take measures to fight against this disease. Perceptions of the population about the disease are a hindrance to the fight against the pandemic. The objective of this study is to analyze and describe the general population's perception of the COVID-19 pandemic.  A qualitative study was conducted in Ouagadougou. 65 in-depth individual interviews were conducted in 2020. A thematic content analysis was conducted using NVIVO software. The results indicate a diverse community perception of coronavirus disease. Three periods of awareness of the disease were identified.  People identified physical contact and the respiratory tract as the main routes of contraction of the disease. As for the treatment, most of the participants indicate that a medical treatment is necessary to cure the coronavirus, while others believe in the effectiveness of the traditional treatment. Finally, to stop the spread of the virus, participants suggest the implementation of awareness in public places. In view of the diversity and importance of the popular perception of the coronavirus disease, the results of this study could contribute to the implementation of communication strategies by the government and the actors of the response.La COVID-19 s’est propagée à travers le monde entier. Ce qui a amené les autorités sanitaires et politiques du Burkina Faso à prendre des mesures pour lutter contre cette maladie. Certaines perceptions de la population sur la maladie constituent un frein à la lutte contre la pandémie. L’objectif de cette étude vise à analyser et à décrire la perception de la population générale face à la pandémie de COVID-19. Une étude qualitative a été réalisée à Ouagadougou. 65 entretiens individuels approfondis ont été menés en 2020. Une analyse thématique de contenu a été faite à l’aide du logiciel NVIVO. Les résultats indiquent une perception communautaire diversifiée de la maladie à coronavirus. Trois périodes de prise de connaissance de l’existence de la maladie ont été évoquées.  Pour les populations, les contacts physiques et les voies respiratoires constituent les principales voies de contractions de la maladie. Quant au traitement, la plupart des participants indiquent qu’un traitement médical est nécessaire pour guérir du coronavirus, d’autres en revanche croient à l’efficacité du traitement traditionnel. Enfin, pour arrêter la propagation du virus, les participants suggèrent la mise en œuvre de la sensibilisation dans les lieux publics. Au regard de la diversité et de l’importance de la perception populaire face à la maladie à coronavirus, les résultats de cette étude pourraient contribuer à la mise en œuvre de stratégies de communication par le gouvernement et les acteurs de la riposte

Geographic and Sociodemographic Disparities in Cardiovascular Risk in Burkina Faso: Findings from a Nationwide Cross-Sectional Survey.

BACKGROUND: Cardiovascular disease (CVD) risk assessment is a critical step in the current approach to the primary prevention of CVD, particularly in low-income countries such as Burkina Faso. In this study, we aimed to assess the geographic and sociodemographic disparities of the ten-year cardiovascular risk in Burkina Faso. METHODS: We conducted a secondary analysis of the data from the first nationwide survey using the World Health Organization (WHO) STEPwise approach. Ten-year cardiovascular risk was determined using the WHO 2019 updated risk chart (WHO risk) as main outcome, and the Framingham risk score (FRS) and the Globorisk chart for secondary outcomes. We performed a modified Poisson regression model using a generalized estimating equation to examine the association between CVD risk and sociodemographic characteristics. RESULTS: A total of 3081 participants aged 30 to 64 years were included in this analysis. The overall age and sex-standardized mean of absolute ten-year cardiovascular risk assessed using the WHO risk chart was 2.5% (95% CI: 2.4-2.6), ranging from 2.3% (95% CI: 2.2-2.4) in Centre Est to 3.0% (95% CI: 2.8-3.2) in the Centre region. It was 4.6% (95% CI: 4.4-4.8) for FRS and 4.0% (95% CI: 3.8-4.1) for Globorisk. Regarding categorized CVD risk (absolute risk ≥10%), we found out that the age and sex-standardized prevalence of elevated risk was 1.7% (95% CI: 1.3-2.1) for WHO risk, 10.4% (95% CI: 9.6-11.2) for FRS, and 5.9% (95% CI: 5.1-6.6) for Globorisk. For all of the three risk scores, elevated CVD risk was associated with increasing age, men, higher education, urban residence, and health region (Centre). CONCLUSION: We found sociodemographic and geographic inequalities in the ten-year CVD risk in Burkina Faso regardless of risk score used. Therefore, population-wide interventions are needed to improve detection and management of adult in the higher CVD risk groups in Burkina Faso

Connaissances et perceptions de la maladie à coronavirus (COVID-19) dans la commune de Ouagadougou

The COVID-19 disease has spread throughout the world. This has led health and political authorities from Burkina Faso to take measures to fight against this disease. Perceptions of the population about the disease are a hindrance to the fight against the pandemic. The objective of this study is to analyze and describe the general population's perception of the COVID-19 pandemic.  A qualitative study was conducted in Ouagadougou. 65 in-depth individual interviews were conducted in 2020. A thematic content analysis was conducted using NVIVO software. The results indicate a diverse community perception of coronavirus disease. Three periods of awareness of the disease were identified.  People identified physical contact and the respiratory tract as the main routes of contraction of the disease. As for the treatment, most of the participants indicate that a medical treatment is necessary to cure the coronavirus, while others believe in the effectiveness of the traditional treatment. Finally, to stop the spread of the virus, participants suggest the implementation of awareness in public places. In view of the diversity and importance of the popular perception of the coronavirus disease, the results of this study could contribute to the implementation of communication strategies by the government and the actors of the response.La COVID-19 s’est propagée à travers le monde entier. Ce qui a amené les autorités sanitaires et politiques du Burkina Faso à prendre des mesures pour lutter contre cette maladie. Certaines perceptions de la population sur la maladie constituent un frein à la lutte contre la pandémie. L’objectif de cette étude vise à analyser et à décrire la perception de la population générale face à la pandémie de COVID-19. Une étude qualitative a été réalisée à Ouagadougou. 65 entretiens individuels approfondis ont été menés en 2020. Une analyse thématique de contenu a été faite à l’aide du logiciel NVIVO. Les résultats indiquent une perception communautaire diversifiée de la maladie à coronavirus. Trois périodes de prise de connaissance de l’existence de la maladie ont été évoquées.  Pour les populations, les contacts physiques et les voies respiratoires constituent les principales voies de contractions de la maladie. Quant au traitement, la plupart des participants indiquent qu’un traitement médical est nécessaire pour guérir du coronavirus, d’autres en revanche croient à l’efficacité du traitement traditionnel. Enfin, pour arrêter la propagation du virus, les participants suggèrent la mise en œuvre de la sensibilisation dans les lieux publics. Au regard de la diversité et de l’importance de la perception populaire face à la maladie à coronavirus, les résultats de cette étude pourraient contribuer à la mise en œuvre de stratégies de communication par le gouvernement et les acteurs de la riposte

An exploratory analysis of the regionalization policy for the recruitment of health workers in Burkina Faso

BACKGROUND: Health personnel retention in remote areas is a key health systems issue wordwide. To deal with this issue, since 2002 the government of Burkina Faso has implemented a staff retention policy, the regionalized health personnel recruitment policy, aimed at front-line workers such as nurses, midwives, and birth attendants. This study aimed to describe the policy’s development, formulation, and implementation process for the regionalization of health worker recruitment in Burkina Faso. METHODS: We conducted a qualitative study. The unit of analysis is a single case study with several levels of analysis. This study was conducted in three remote areas in Burkina Faso for the implementation portion, and at the central level for the development portion. Indepth interviews were conducted with Ministry of Health officials in charge of human resources, regional directors, regional human resource managers, district chief medical officers, and health workers at primary health centres. In total, 46 indepth interviews were conducted (February 3 - March 16, 2011). RESULTS: Development The idea for this policy emerged after finding a highly uneven distribution of health personnel across urban and rural areas, the availability of a large number of health officers in the labour market, and the opportunity given to the Ministry of Health by the government to recruit personnel through a specific budget allocation. Formulation The formulation consisted of a call for job applications from the Ministry of Health, which indicates the number of available posts by region. The respondents interviewed unanimously acknowledged the lack of documents governing the status of this new personnel category. Implementation During the initial years of implementation (2002-2003), this policy was limited to recruiting health workers for the regions with no possibility of transfer. The possibility of job-for-job exchange was then approved for a certain time, then cancelled. Starting in 2005, a departure condition was added. Now, regionalized health workers can leave the regions after undergoing a competitive selection process. CONCLUSION: The policy was characterized by the absence of written directives and by targeting only one category of personnel. Moreover, there was no associated incentive—financial or otherwise—which poses the question of long-term viability

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

Integration of maternal postpartum services in maternal and child health services in Kaya health district (Burkina Faso): an intervention time trend analysis

Background: The Missed Opportunities in Maternal and Infant Health (MOMI) project aimed at reducing maternal and newborn mortality and morbidity within the year after childbirth in four sub-Saharan African countries. MOMI interventions including the integration of maternal and infant services in the postpartum (PP) period at day 6–10, week 6–8, and month 9 were implemented from September 2013 to December 2015. We hereby assess the effect of integrating maternal postpartum care (PPC) in infant immunization services in Kaya health district in Burkina Faso. Methods: We apply a longitudinal mixed method on monthly monitoring data collected from 12 months before the project start to the end. Outcome indicators were: attendance of PPC at day 6–10 and week 6–8, provision of PP family planning counselling, and management of PP morbidity in mother and infant. We tested the significance level of changes in the different indicators by performing an interrupted time series analysis with Newey–West standard errors and one lag. Additional data were extracted at the individual level which allowed to link infant immunization with maternal PPC from September 2013 to August 2014 in the health facilities’ (HF) PP and immunization registers. We also conducted a review of documents that allowed for a qualitative evaluation of the effects. Results: Show an increasing trend of all monitored indicators during the interventions, particularly at day 6–10 when PPC increased from 61% in 2013 to 81% in 2015 and especially in rural areas (p \u3c 0.05). We found large improvements in the detection and management of PP maternal hemorrhage, sepsis and newborn fever or low temperature. However, the intervention was less successful in raising PPC at week 6–8 and later due to the existence of structural barriers, caused for instance by the lack of collaboration among health workers and high turnover in the staff of HF. Conclusion: The overall package of community and facility interventions contributed to improve integrated PPC at day 6–10, particularly the role of community health workers. While the integration of maternal and child health services seems to be a valid concept, it needs to be rethought within the primary health care syste

How countries cope with competing demands and expectations: perspectives of different stakeholders on priority setting and resource allocation for health in the era of HIV and AIDS

Background: Health systems have experienced unprecedented stress in recent years, and as yet no consensus has emerged as to how to deal with the multiple burden of disease in the context of HIV and AIDS and other competing health priorities. Priority setting is essential, yet this is a complex, multifaceted process. Drawing on a study conducted in five African countries, this paper explores different stakeholders′ perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and Health and how different stakeholders perceive this. Methods: A sub-analysis was conducted of selected data from a wider qualitative study that explored the interactions between health systems and HIV and AIDS responses in five sub-Saharan countries (Burkina Faso, the Democratic Republic of Congo, Ghana, Madagascar and Malawi). Key background documents were analysed and semi-structured interviews (n = 258) and focus group discussions (n = 45) were held with representatives of communities, health personnel, decision makers, civil society representatives and development partners at both national and district level. Results: Health priorities were expressed either in terms of specific health problems and diseases or gaps in service delivery requiring a strengthening of the overall health system. In all five countries study respondents (with the exception of community members in Ghana) identified malaria and HIV as the two top health priorities. Community representatives were more likely to report concerns about accessibility of services and quality of care. National level respondents often referred to wider systemic challenges in relation to achieving the Millennium Development Goals (MDGs). Indeed, actual priority setting was heavily influenced by international agendas (e.g. MDGs) and by the ways in which development partners were supporting national strategic planning processes. At the same time, multi-stakeholder processes were increasingly used to identify priorities and inform sector-wide planning, whereby health service statistics were used to rank the burden of disease. However, many respondents remarked that health system challenges are not captured by such statistics. In all countries funding for health was reported to fall short of requirements and a need for further priority setting to match actual resource availability was identified. Pooled health sector funds have been established to some extent, but development partners′ lack of flexibility in the allocation of funds according to country-generated priorities was identified as a major constraint. Conclusions Although we found consensus on health priorities across all levels in the study countries, current funding falls short of addressing these identified areas. The nature of external funding, as well as programme-specific investment, was found to distort priority setting. There are signs that existing interventions have had limited effects beyond meeting the needs of disease-specific programmes. A need for more comprehensive health system strengthening (HSS) was identified, which requires a strong vision as to what the term means, coupled with a clear strategy and commitment from national and international decision makers in order to achieve stated goals. Prospective studies and action research, accompanied by pilot programmes, are recommended as deliberate strategies for HSS

Exposure to conditions of high concentrations of indoor air pollutants and prevalence of ARIs in children under 5 years of age, in Ouagadougou/Burkina Faso

The objective was to highlight effects of exposure to high concentrations of PM2.5 (emitted during cooking) on the prevalence of acute respiratory infections (ARI) in children under 5 years of age. Results showed that the use of biomass in indoor kitchens in residential buildings in Uganda was linked to the occurrence of ARI in children. Living in a house with several bedrooms was a protective factor. Fine particulate matter (PM2.5) is an air pollutant which can affect people's health when levels are high