Women's perceptions of homebirths in two rural medical districts in Burkina Faso: a qualitative study

<p>Abstract</p> <p>Background</p> <p>In developing countries, most childbirth occurs at home and is not assisted by skilled attendants. The situation increases the risk of death for both mother and child and has severe maternal complications. The purpose of this study was to describe women's perceptions of homebirths in the medical districts of Ouargaye and Diapaga.</p> <p>Methods</p> <p>A qualitative approach was used to gather information. This information was collected by using focus group discussions and individual interviews with 30 women. All the interviews were tape recorded and managed by using QSR NVIVO 2.0, qualitative data management software.</p> <p>Results</p> <p>The findings show that homebirths are frequent because of prohibitive distance to health facilities, fast labour and easy labour, financial constraints, lack of decision making power to reach health facilities.</p> <p>Conclusion</p> <p>The study echoes the need for policy makers to make health facilities easily available to rural inhabitants to forestall maternal and child deaths in the two districts.</p

Persistent Submicroscopic Plasmodium falciparum Parasitemia 72 Hours after Treatment with Artemether-Lumefantrine Predicts 42-Day Treatment Failure in Mali and Burkina Faso.

A recent randomized controlled trial, the WANECAM (West African Network for Clinical Trials of Antimalarial Drugs) trial, conducted at seven centers in West Africa, found that artemether-lumefantrine, artesunate-amodiaquine, pyronaridine-artesunate, and dihydroartemisinin-piperaquine all displayed good efficacy. However, artemether-lumefantrine was associated with a shorter interval between clinical episodes than the other regimens. In a further comparison of these therapies, we identified cases of persisting submicroscopic parasitemia by quantitative PCR (qPCR) at 72 h posttreatment among WANECAM participants from 5 sites in Mali and Burkina Faso, and we compared treatment outcomes for this group to those with complete parasite clearance by 72 h. Among 552 evaluable patients, 17.7% had qPCR-detectable parasitemia at 72 h during their first treatment episode. This proportion varied among sites, reflecting differences in malaria transmission intensity, but did not differ among pooled drug treatment groups. However, patients who received artemether-lumefantrine and were qPCR positive at 72 h were significantly more likely to have microscopically detectable recurrent Plasmodium falciparum parasitemia by day 42 than those receiving other regimens and experienced, on average, a shorter interval before the next clinical episode. Haplotypes of pfcrt and pfmdr1 were also evaluated in persisting parasites. These data identify a possible threat to the parasitological efficacy of artemether-lumefantrine in West Africa, over a decade since it was first introduced on a large scale

KNOWLEDGE, ATTITUDES AND PRACTICES OF TRADITIONAL PRACTITIONERS ABOUT JAUNDICE IN BOBO-DIOULASSO, BURKINA FASO

Knowledge, Attitudes and Practices of traditional practitioners about jaundice in Bobo-Dioulasso, Burkina Faso Introduction: Jaundice, according to popular knowledge cannot be treated in modern medicine and that’s why people consult traditional Practitioners. The objective of this paper was to study knowledge, attitudes and practices of traditional Practitioners (TP) about jaundice. Material and Methods: A descriptive cross sectional study was carried out from February 1st to April 30th inBobo-Dioulasso, Burkina. An individual questionnaire was used to collect about 100 TP members of two associations in the Bobo-Dioulasso. Results: The average age of participants was 48.51 (± 14) years old and sex ratio 1.9. Most of TP half (59%) were illiterate. The average number of practice was18.28 (± 11... 4) years old and the majority of TP (73%) were trained in Their family. Only few TP had (18%) the authorization of practice. Despite that all the TP knew jaundice, the level of knowledge of the causes was unsufficient in more than 91%. Only10% of TP named as hepatitis because 69% versus malaria. A good knowledge of jaundice causes was statistically associated to the alphabe-literacy (p = 0.003) but not to the anciennity of practice (p = 0. 5). The majority of machinery (86.5%) used herbal plants for the jaundice treatment.The most herbal plants cited by the TP were Cochlospermumtinctorium,Terminaliamacroptera,Commiphoraafricana,Anogeissusleiocarpus. Decoction was the most representation form used (74. 7%) and drinking is the most administration route (92. 7%). Some TP (9. 1%) think that the modern treatment was at risk of death in the presence of jaundice. The medical complementary exams were the main reason for TP to refer patients suffering from jaundice in modern medicine (48. 7%). Conclusion: this study shows an unsufficient knowledge of TP about jaundice notably its etiology. Herbal plants were the material the most used for the treatment of PD

Leadership et vision exercée pour la couverture universelle des soins dans les pays à faible revenu

In Burkina Faso, as in most developing countries, the operational level of the health system is made up of Health Districts (HDs), the activities of which are typically coordinated by the District Team (DT). Assessing the the core functions of DTs, as described by WHO, shows two important weaknesses. Firstly, instructions from "above" are often implemented rather passively: DTs tend not to display much leadership. Secondly, the current organisation, based on input financing and centralised planning, does not sufficiently promote either the vision or research functions of DTs. In this article, we report our experience in the Orodora HD in Burkina Faso, where the DT's leadership and vision proved to be essential ingredients for effective health action in the district. Our description of six interventions implemented between 2004 and 2008 shows how DT leadership and vision have improved outputs at the HD level. Until 2004, the district applied static health planning. The health system was insufficiently financed and performed poorly. Faced with this situation, the DT decided to set up several priority interventions based on health care access criteria and patient concerns, while respecting and contextualizing national norms and objectives. Six interventions were then implemented. The first was ensure that quality blood (meeting transfusion security norms) was available at the District Hospital (DH), by picking blood up from the regional blood transfusion center weekly. This speeded up care at the DH, reduced the number of cases referred to the regional hospital for transfusion, and reduced neonatal and maternal mortality. The second intervention sought to improve the skills of health workers in managing emergency cases and to improve relationships with the referral hospital through the reintroduction of counter-referral procedures. This led to a decrease in unnecessary referrals and also reduced the mortality rates of serious cases. The third intervention, by implementing a decentralized approach to tuberculosis detection, succeeded in improving access to care and enabled us to quantify the rate of tuberculosis-HIV co-infection in the HD. The fourth intervention improved financial access to emergency obstetric care by providing essential drugs and consumables for emergency obstetric surgery free of charge. The fifth intervention boosted the motivation of health workers by an annual 'competition of excellence', organised for workers and teams in the HD. Finally, our sixth intervention was the introduction of a "culture" of evaluation and transparency, by means of a local health journal, used to interact with stakeholders both at the local level and in the health sector more broadly. We also present our experiences regularly during national health science symposia. Although the DT operates with limited resources, it has over time managed to improve care and services in the HD, through its dynamic management and strategic planning. It has reduced inpatient mortality and improved access to care, particularly for vulnerable groups, in line with the Primary Health Care and Bamako Initiative principles. This case study would have benefited from a stronger methodology. However, it shows that in a context of limited resources it is still possible to strengthen the local health system by improving management practices. To progress towards universal health coverage, all core functions of a DT are worth implementing, including leadership and vision. National and international health strategies should thus include a plan to provide for and train local health system managers who can provide both leadership and strategic vision

FACTORS ASSOCIATED WITH MINIMUM DIETARY DIVERSITY, MINIMUM MEAL FREQUENCY AND MINIMUM ACCEPTABLE DIET PRACTICES AMONG CHILDREN 6- 23 MONTHS OF AGE IN BOBO-DIOULASSO, BURKINA FASO

The study assessed infant and young child feeding practices and associated factors among 6–23-month-old children in order to inform ongoing and future programs and projects in Bobo-Dioulasso area, in Burkina Faso. Information on child feeding practices and determinants in urban areas is limited in Burkina Faso. Data of 301children, collected in 2013, were considered in this secondary analysis. Questionnaires were used to collect data on respondents’ socio-demographic and economic situation. In addition to the information on child care practices, food consumption data were also collected using a 24h dietary recall questionnaire. Indicators of minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were constructed and proportion of children meeting these indicators calculated. Binary logistic regression was used to see the association between the outcome variables and explanatory variables, and multivariable logistic regression was performed to identify factors associated with minimum dietary diversity, meal frequency and minimum acceptable diet. Data cleaning and analysis were done using SPSS version 25. Odds ratios (ORs) with 95 % confidence interval (CI) were computed to measure the strength of association. Almost 3 out of 4 mothers (72.5%) were housewives and 62.4% of them were illiterate. Among the 301 children, 40.2% were aged 18-23 months. About half of the children (45.2%) were born to mothers from high income households. The proportion of children 6–23 months who met the MDD and MMF for breastfed and non-breastfed children was 18.3% and 28.9%, respectively. Less than one fifth of breastfed children (16.1%) received MAD. Girls were more likely to meet the MDD (p=0.02) and MAD (p=0.04) than boys. The proportion of children 6- 23 months meeting the three complementary feeding practice indicators in Bobo- Dioulasso in Burkina Faso were far below the WHO-recommended standard of 90% coverage. The MDD and MAD were positively associated to the female gender. This finding could be used to better target the children in order to improve the effects of the ongoing or future interventions in increasing appropriate complementary feeding practices

FACTORS ASSOCIATED WITH MINIMUM DIETARY DIVERSITY, MINIMUM MEAL FREQUENCY AND MINIMUM ACCEPTABLE DIET PRACTICES AMONG CHILDREN 6- 23 MONTHS OF AGE IN BOBO-DIOULASSO, BURKINA FASO

The study assessed infant and young child feeding practices and associated factors among 6–23-month-old children in order to inform ongoing and future programs and projects in Bobo-Dioulasso area, in Burkina Faso. Information on child feeding practices and determinants in urban areas is limited in Burkina Faso. Data of 301children, collected in 2013, were considered in this secondary analysis. Questionnaires were used to collect data on respondents’ socio-demographic and economic situation. In addition to the information on child care practices, food consumption data were also collected using a 24h dietary recall questionnaire. Indicators of minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were constructed and proportion of children meeting these indicators calculated. Binary logistic regression was used to see the association between the outcome variables and explanatory variables, and multivariable logistic regression was performed to identify factors associated with minimum dietary diversity, meal frequency and minimum acceptable diet. Data cleaning and analysis were done using SPSS version 25. Odds ratios (ORs) with 95 % confidence interval (CI) were computed to measure the strength of association. Almost 3 out of 4 mothers (72.5%) were housewives and 62.4% of them were illiterate. Among the 301 children, 40.2% were aged 18-23 months. About half of the children (45.2%) were born to mothers from high income households. The proportion of children 6–23 months who met the MDD and MMF for breastfed and non-breastfed children was 18.3% and 28.9%, respectively. Less than one fifth of breastfed children (16.1%) received MAD. Girls were more likely to meet the MDD (p=0.02) and MAD (p=0.04) than boys. The proportion of children 6- 23 months meeting the three complementary feeding practice indicators in Bobo- Dioulasso in Burkina Faso were far below the WHO-recommended standard of 90% coverage. The MDD and MAD were positively associated to the female gender. This finding could be used to better target the children in order to improve the effects of the ongoing or future interventions in increasing appropriate complementary feeding practices

Secret intake of antiretroviral treatment and HIV-1 viremia in a public routine clinic in Burkina Faso : a surprising relationship

In sub-Saharan Africa, where people living with HIV are frequently stigmatized, the intake of antiretroviral treatment (ART) remains a critical issue for many patients. Although the secret intake of ART may hinder the adherence to treatment, data on its specific impact on therapeutic effectiveness are lacking. We therefore assessed the association between secret intake of ART (i.e., hidden from family) and HIV-1 viremia among patients treated in a public routine clinic in Burkina Faso. We performed a cross-sectional study from December 2012 to September 2013 among patients on ART at the Day Care Unit in Bobo Dioulasso. Patients were eligible for the study if they were 15 years old or over, infected with HIV-1 or HIV-1+2, and on ART for at least six months. HIV-1 viral load was measured using Biocentric or Abbott Real Time assay. Study-specific data were collected by social workers using face-to-face interviews, and medical data using the routine electronic database. The association between secret intake of ART and viral load >300 copies/mL was assessed using a multivariate logistic regression. Of 771 patients (women 81.4%; median age 41 years; median time on ART 51 months), 408 reported secret intake of ART and 363 declared open intake. Compared to the latter, patients who hid their intake were younger, more likely to be women and to be involved in a polygamist or in a non-cohabiting union. Viremia was observed in 4.4% of patients hiding ART intake and 9.4% of those taking it openly. By multivariate analysis, secret intake of ART was significantly associated with a lower risk of viremia (adjusted odds ratio 0.41, 95% confidence interval 0.22-0.76). The unexpected relation between secret intake of ART and viremia found in this study requires further investigations. Quantitative and qualitative studies need to be performed

The vulnerability of men to virologic failure during antiretroviral therapy in a public routine clinic in Burkina Faso

Introduction: Gender differences in antiretroviral therapy (ART) outcomes are critical in sub-Saharan Africa. We assessed the association between gender and virologic failure among adult patients treated in a public routine clinic (one of the largest in West Africa) in Burkina Faso. Methods: We performed a case-control study between July and October 2012 among patients who had received ART at the Bobo Dioulasso Day Care Unit. Patients were eligible if they were 15 years or older, positive for HIV-1 or HIV-1 + 2, and on first-line ART for at least six months. Cases were all patients with two consecutive HIV loads >1000 copies/mL (Biocentric Generic or Abbott Real Time assays), or one HIV load >1000 copies/mL associated with immunologic or clinical failure criteria. Controls were all patients who only had HIV loads B300 copies/mL. The association between gender and virologic failure was assessed using a multivariate logistic regression, adjusted on age, level of education, baseline CD4+ T cell count, first and current antiretroviral regimens and time on ART. Results: Of 2303 patients (74.2% women; median age: 40 years; median time on ART: 34 months), 172 had virologic failure and 2131 had virologic success. Among the former, 130 (75.6%) had confirmed virologic failure, 38 (22.1%) had viroimmunologic failure, and four (2.3%) had viro-clinical failure. The proportion of men was significantly higher among the cases than among the controls (37.2% vs. 24.9%; p<0.001). Compared to controls, cases were also younger, more immunodeficient at ART initiation, less likely to receive a protease inhibitor-based antiretroviral regimen and had spent a longer period of time on ART. After adjustment, male gender remained strongly associated with virologic failure (odds ratio 2.52, 95% CI: 1.77 - 3.60; p<0.001). Conclusions: Men on ART appeared more vulnerable to virologic failure than women. Additional studies are needed to confirm the poorer prognosis of men in this setting and to determine the causes for their vulnerability in order to optimize HIV care. From now on, efforts should be made to support the adherence of men to ART in the African setting

Mother-to-Children Plasmodium falciparum Asymptomatic Malaria Transmission at Saint Camille Medical Centre in Ouagadougou, Burkina Faso

Background. Malaria's prevalence during pregnancy varies widely in parts of sub-Saharan Africa, including Burkina Faso. The objective of this study was to evaluate the incidence of mother-to-child malaria transmission during childbirth at St. Camille Medical Centre in the city of Ouagadougou. Methods. Two hundred and thirty-eight (238) women and their newborns were included in the study. Women consenting to participate in this study responded to a questionnaire that identified their demographic characteristics. Asymptomatic malaria infection was assessed by rapid detection test Acon (Acon Malaria Pf, San Diego, USA) and by microscopic examination of Giemsa-stained thick and thin smears from peripheral, placental, and umbilical cord blood. Birth weights were recorded and the biological analyses of mothers and newborns' blood were also performed. Results. The utilization of long-lasting insecticidal nets (LLINs) and intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) were 86.6% and 84.4%, respectively. The parasitic infection rates of 9.5%, 8.9%, and 2.8% were recorded, respectively, for the peripheral, placental, and umbilical cord blood. Placental infection was strongly associated with the presence of parasites in the maternal peripheral blood and a parasite density of >1000 parasites/µL. Conclusion. The prevalence of congenital malaria was reduced but was associated with a high rate of mother-to-child malaria transmission