Annual Crop Yield Variation, Child Survival and Nutrition among Subsistence Farmers in Burkina Faso.

Whether year to year variation in crop yields affects the nutrition, health, and survival of subsistence farming populations is relevant to the understanding of the potential impacts of climate change. However, the empirical evidence is limited. We examined the association of child survival with inter-annual variation in food crop yield and middle-upper arm circumference (MUAC) in a subsistence farming population of rural Burkina Faso. The study was of 44,616 children < 5 years of age included in the Nouna Health and Demographic Surveillance System, 1992-2012, whose survival was analysed in relation to the food crop yield in the year of birth (which ranged from 65% to 120% of the period average) and, for a subset of 16,698 children, to MUAC, using shared frailty Cox proportional hazards models. Survival was appreciably worse in children born in years with low yield (fully adjusted hazard ratio of 1.11 (95% confidence interval: 1.02, 1.20) for a 90th to 10th centile decrease in annual crop yield) and in children with small MUAC (hazard ratio 2.72 (95% confidence interval: 2.15, 3.44) for a 90th to 10th centile decrease in MUAC). These results suggest an adverse impact of variations in crop yields which could increase under climate change

Surgical treatment of trochanteric fractures: An Ivorian experience

Background: Trochanteric fractures have become a major focus of orthopaedic interest. Surgical management is the best option for treating such fractures. Objective: To present our experience with the surgical treatment of trochanteric fractures with special attention to short-term results. Design: A retrospective study performed between 1993 and 2002. Setting: Department of orthopaedics surgery, Yopougon teaching hospital, Abidjan, Côte d'Ivoire. Patients and methods: There were 48 men and 17 women with a mean age of 44 years at the moment of the injury. Road traffic accident was the main cause of fractures accounting for 42 cases. Mean preoperative delay was 22 days. Surgical implants used were the Judet screw plate and Küntscher nail. Results: Postoperative death occurred in three cases. Fracture healing was achieved in 57 patients at an average of four months. Malunion and displacement into varus was noticed in 11.7% of patients. Infection occurred in seven patients, wound hematoma in eight and decubital ulcer in five. Conclusions: Trochanteric fractures in our environment are caused by severe trauma. These injuries could be managed surgically with simple methods that are readily available with immediate satisfactory outcome. Keywords: trochanteric fractures, surgical care Judet screw plate, Küntscher nail, complications Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 187–19

Is the lack of smartphone data skewing wealth indices in low-income settings?

BACKGROUND: Smartphones have rapidly become an important marker of wealth in low- and middle-income countries, but international household surveys do not regularly gather data on smartphone ownership and these data are rarely used to calculate wealth indices. METHODS: We developed a cross-sectional survey module delivered to 3028 households in rural northwest Burkina Faso to measure the effects of this absence. Wealth indices were calculated using both principal components analysis (PCA) and polychoric PCA for a base model using only ownership of any cell phone, and a full model using data on smartphone ownership, the number of cell phones, and the purchase of mobile data. Four outcomes (household expenditure, education level, and prevalence of frailty and diabetes) were used to evaluate changes in the composition of wealth index quintiles using ordinary least squares and logistic regressions and Wald tests. RESULTS: Households that own smartphones have higher monthly expenditures and own a greater quantity and quality of household assets. Expenditure and education levels are significantly higher at the fifth (richest) socioeconomic status (SES) quintile of full model wealth indices as compared to base models. Similarly, diabetes prevalence is significantly higher at the fifth SES quintile using PCA wealth index full models, but this is not observed for frailty prevalence, which is more prevalent among lower SES households. These effects are not present when using polychoric PCA, suggesting that this method provides additional robustness to missing asset data to measure underlying latent SES by proxy. CONCLUSIONS: The lack of smartphone data can skew PCA-based wealth index performance in a low-income context for the top of the socioeconomic spectrum. While some PCA variants may be robust to the omission of smartphone ownership, eliciting smartphone ownership data in household surveys is likely to substantially improve the validity and utility of wealth estimates

Attitudes towards female genital cutting among adolescents in rural Burkina Faso: A multilevel analysis Female genital cutting in Burkina Faso

Objective: Despite decades of abandonment efforts, female genital cutting (FGC) prevalence rates in Burkina Faso remain high. We present updated prevalence data from rural adolescents and examine factors associated with FGC receipt and attitudes, testing predictions of social convention and modernisation theory regarding the abandonment process. Methods: We interviewed 1644 adolescents aged 12–20 years from 10 villages and one sector of Nouna town in the Nouna Health and Demographic Surveillance site in late 2017. Response‐weighted prevalence for self‐reported FGC receipt, beliefs about religious requirements, and attitudes about abandonment were calculated. We used bivariate regression and two‐level hierarchical models to test whether social convention or modernisation theory‐related factors predicted current FGC attitudes. Results: 43% of women in our sample reported having undergone FGC; 74% of women and 76% of men believed FGC should be abandoned. The strongest predictors of FGC receipt were religion, ethnicity, the village’s FGC rate and mother’s education. The strongest predictors of FGC abandonment attitudes were religion, ethnicity, belief that FGC is religiously required, and own FGC status. Males’ attitudes were less determined by community factors than females’; females’ attitudes were more strongly influenced by factors linked to modernization, such as maternal education and household wealth. Conclusions: FGC continues to be common in rural and small‐town Burkina Faso, and our analysis suggests that social conventions play an important role in its continuation. However, modernisation‐related factors were stronger predictors of abandonment attitudes than of FGC status, particularly in adolescent women. The changes these relationships suggest may benefit the next generation of girls

Long-term effect of Mali phosphate rock on the grain yield of interspecifics and saltiva rice cultivars on acid soil in a humid forest zone of Côte d’Ivoire

To generate knowledge of upland rice intensification in West Africa, the grain yields of four interspecific cultivars (V2 = WAB450-1 B-P-38-HB; V3 = WAB450-11-1-P-40-HB; V4 = WAB450-11-1-P-40-1-H; and V5 = WAB450-24-3-2-P-18-HB) were compared with that of a soil acidity tolerant sativa (WAB 56-104 = V1) on acid soil at Man in the humid forest zone in Côte d’Ivoire during five cropping seasons (1998, 1999, 2000, 2001 and 2002). Nitrogen and potassium were annually applied at 100 and 50 kg ha-1 respectively. Mali phosphate rock from Tilemsi was applied once in 1998 at 0, 150, 300 and 450 kg P ha-1 in a randomized complete block design with three replications. The results revealed a grain yield ranging from 0.5 t ha-1 to 2.6 t ha-1 with highest productivity of interspecific cultivars V3 and V4 even at 0 kg P ha-1 compared to acid tolerant saltiva (V1). Annual optimum rates of P application were determined at 31.5 and 45 kg P ha-1 respectively for V3 and V4. Applying Mali PR at 31.5 and 45 kg P ha-1 respectively for V3 and V4 was recommended for upland rice intensification in the humid forest zone of Côte d’Ivoire.Keywords: Mali phosphate rock, rice, Côte d’Ivoire, interspecific, acid soil

Community perception regarding childhood vaccinations and its implications for effectiveness: a qualitative study in rural Burkina Faso

Background: Vaccination has contributed to major reductions in global morbidity and mortality, but there remain significant coverage gaps. Better knowledge on the interplay between population and health systems regarding provision of vaccination information and regarding health staff organization during the immunization sessions appears to be important for improvements of vaccination effectiveness. Methods: The study was conducted in the Nouna Health and Demographic Surveillance System (HDSS) area, rural Burkina Faso, from March to April 2014. We employed a combination of in-depth interviews (n = 29) and focus group discussions (n = 4) including children’s mothers, health workers, godmothers, community health workers and traditional healers. A thematic analysis was performed. All material was transcribed, translated and analyzed using the software ATLAS.ti4.2. Results: There was better social mobilization in the rural areas as compared to the urban area. Most mothers know the Expanded Program of Immunization (EPI) target diseases, and the importance to immunize their children. However, the great majority of informants reported that mothers don’t know the vaccination schedule. There is awareness that some children are incompletely vaccinated. Mentioned reasons for that were migration, mothers being busy with their work, the practice of not opening vaccine vials unless a critical number of children are present, poor interaction between women and health workers during immunization sessions, potential adverse events associated with vaccination, geographic inaccessibility during rainy season, and lack of information. Conclusions: Well organized vaccination programs are a key factor to improve child health and there is a clear need to consider community perceptions on program performance. In Burkina Faso, a number of factors have been identified which need attention by the EPI managers for further improvement of program effectiveness

‘If he sees it with his own eyes, he will understand’: how gender informed the content and delivery of a maternal nutrition intervention in Burkina Faso

A growing body of literature urges policymakers, practitioners and scientists to consider gender in the design and evaluation of health interventions. We report findings from formative research to develop and refine an mHealth maternal nutrition intervention in Nouna, Burkina Faso, one of the world's most resource-poor settings. Gender was not an initial research focus, but emerged as highly salient during data collection, and thus guided lines of inquiry as the study progressed. We collected data in two stages, first using focus group discussions (FGD; n = 8) and later using FGDs (n = 2), interviews (n = 30) and observations of intervention delivery (n = 30). Respondents included pregnant women, breastfeeding mothers and Close-to-Community (CTC) providers, who execute preventative and curative tasks at the community level. We applied Morgan et al.'s gender framework to examine intervention content (what a gender-sensitive nutrition programme should entail) and delivery (how a gender-sensitive programme should be administered). Mothers emphasized that although they are often the focus of nutrition interventions, they are not empowered to make nutrition-based decisions that incur costs. They do, however, wield some control over nutrition-related tasks such as farming and cooking. Mothers described how difficult it is to consider only one's own children during meal preparation (which is communal), and all respondents described how nutrition-related requests can spark marital strife. Many respondents agreed that involving men in nutrition interventions is vital, despite men's perceived disinterest. CTC providers and others described how social norms and gender roles underpin perceptions of CTC providers and dictate with whom they can speak within homes. Mothers often prefer female CTC providers, but these health workers require spousal permission to work and need to balance professional and domestic demands. We recommend involving male partners in maternal nutrition interventions and engaging and supporting a broader cadre of female CTC providers in Burkina Faso

Lack of antigenic diversification of major outer membrane proteins during clonal waves of Neisseria meningitidis serogroup A colonization and disease

In particular in the ‘meningitis belt' of sub-Saharan Africa, epidemic meningococcal meningitis is a severe public health problem. In the past decades, serogroup A lineages have been the dominant etiologic agents, but also other serogroups have caused outbreaks. A comprehensive vaccine based on subcapsular outer membrane proteins (OMPs) is not available. Here, we have investigated whether meningococcal populations overcome herd immunity by changing antigenic properties of their OMPs. Meningococcal isolates were collected in the context of longitudinal studies in Ghana between 2002 and 2008 and in Burkina Faso between 2006 and 2007. Serogroup A strains isolated during two clonal waves of colonization and disease showed no diversification in the genes encoding their PorA, PorB, and FetA proteins. However, we detected occasional allelic exchange of opa genes, as well as wide variation in the number of intragenic tandem repeats, showing that phase variation of Opa protein expression is a frequent event. Altogether we observed a remarkable antigenic stability of the PorA, PorB and FetA proteins over years. Our results indicate that while herd immunity may be responsible for the disappearance of meningococcal clones over time, it is not a strong driving force for antigenic diversification of the major OMPs analyzed her

Impairment in Activities of Daily Living and unmet need for care among older adults: A population-based study from Burkina Faso

OBJECTIVES: The importance of impairment in performing Activities of Daily Living (ADL) is likely to increase in sub-Saharan Africa since few care options for affected people exist. This study investigated the prevalence of ADL impairment, the extent to which care-need was met and described characteristics of people with ADL impairment and unmet need in Burkina Faso. METHODS: This study used data from the CRSN Heidelberg Aging Study, a population-based study among 3,026 adults aged over 40 years conducted in rural Burkina Faso. Information on six basic ADL items was sought, with a follow-up question asking whether care-needs were not met, partially met or met. Bivariable correlations and multivariable logistic regression were used to determine sociodemographic and health characteristics associated with ADL impairment and unmet need. RESULTS: ADL impairment of any kind was reported by 1,202 (39.7%) respondents and was associated with older age (Adjusted Odds Ratio: 1.05 [95% CI: 1.04-1.06]), being a woman (1.33 [1.06-1.60]) and reporting depressive symptoms (1.90 [1.65-2.18]). Among those with ADL impairment, 67.8% had at least one unmet need. Severe ADL impairment was found in 202 (6.7%) respondents, who reported lower prevalence of unmet need (43.1%). Severe ADL impairment was associated with depressive symptoms (2.55 [2.11-3.07]) to a stronger degree than any ADL impairment. DISCUSSION: Prevalence of ADL impairment and unmet need was high in this setting. Variation in impairment across the population highlighted key groups for future interventions. Unmet need for care was highest in middle-aged adults, indicating a gap in care provision

Mortality from external causes in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System Sites.

BACKGROUND: Mortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information. The INDEPTH Network maintains longitudinal surveillance, including cause of death, at population sites across Africa and Asia, which offers important opportunities to document external cause mortality at the population level across a range of settings. OBJECTIVE: To describe patterns of mortality from external causes at INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories. DESIGN: All deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. RESULTS: A total of 5,884 deaths due to external causes were documented over 11,828,253 person-years. Approximately one-quarter of those deaths were to children younger than 15 years. Causes of death were dominated by childhood drowning in Bangladesh, and by transport-related deaths and intentional injuries elsewhere. Detailed mortality rates are presented by cause of death, age group, and sex. CONCLUSIONS: The patterns of external cause mortality found here generally corresponded with expectations and other sources of information, but they fill some important gaps in population-based mortality data. They provide an important source of information to inform potentially preventive intervention designs