The impact of user fee removal policies on household out-of-pocket spending: evidence against the inverse equity hypothesis from a population based study in Burkina Faso. Eur J Health Econ. doi

Abstract Background User fee removal policies have been extensively evaluated in relation to their impact on access to care, but rarely, and mostly poorly, in relation to their impact on household out-of-pocket (OOP) spending. This paucity of evidence is surprising given that reduction in household economic burden is an explicit aim for such policies. Our study assessed the equity impact on household OOP spending for facility-based delivery of the user fee reduction policy implemented in Burkina Faso since 2007 (i.e. subsidised price set at 900 Communauté Financière Africaine francs (CFA) for all, but free for the poorest). Taking into account the challengeslinked to implementing exemption policies, we aimed to test the hypothesis that the user fee reductionpolicy had favoured the least poor more than the poor. Methods We used data from six consecutive rounds (2006)(2007)(2008)(2009)(2010)(2011) of a household survey conducted in the Nouna Health District. Primary outcomes are the proportion of households being fully exempted (the poorest 20 % according to the policy) and the actual level of household OOP spending on facility-based delivery. The estimation of the effects relied on a Heckman selection model. This allowed us to estimate changes in OOP spending across socio-economic strata given changes in service utilisation produced by the policy

The impact of user fee removal policies on household out-of-pocket spending: evidence against the inverse equity hypothesis from a population based study in Burkina Faso. Eur J Health Econ. doi

Abstract Background User fee removal policies have been extensively evaluated in relation to their impact on access to care, but rarely, and mostly poorly, in relation to their impact on household out-of-pocket (OOP) spending. This paucity of evidence is surprising given that reduction in household economic burden is an explicit aim for such policies. Our study assessed the equity impact on household OOP spending for facility-based delivery of the user fee reduction policy implemented in Burkina Faso since 2007 (i.e. subsidised price set at 900 Communauté Financière Africaine francs (CFA) for all, but free for the poorest). Taking into account the challengeslinked to implementing exemption policies, we aimed to test the hypothesis that the user fee reductionpolicy had favoured the least poor more than the poor. Methods We used data from six consecutive rounds (2006)(2007)(2008)(2009)(2010)(2011) of a household survey conducted in the Nouna Health District. Primary outcomes are the proportion of households being fully exempted (the poorest 20 % according to the policy) and the actual level of household OOP spending on facility-based delivery. The estimation of the effects relied on a Heckman selection model. This allowed us to estimate changes in OOP spending across socio-economic strata given changes in service utilisation produced by the policy

Facteurs associes aux tendinopathies de la main chez les employés de banque à Ouagadougou

Introduction : La répétitivité des gestes et l’implication régulière des membres supérieurs dans les activités manuelles en milieu professionnel les exposent au développement des troubles musculo-squelettiques. Les conditions de travail spécifiques des employés de banque au Burkina-Faso pourraient favoriser l’émergence de ces pathologies. L’objectif de ce travail était de déterminer la prévalence et les facteurs associés aux tendinopathies de la main et du poignet en milieu de banque à Ouagadougou.Méthode : L’étude transversale analytique s’est déroulée du 1er avril 2015 au 30 novembre 2015 dans cinq établissements bancaires de Ouagadougou. L’échantillon, constitué aléatoirement, comprenait les employés travaillant principalement avec un écran de visualisation, les guichetiers et les trieuses de billets. Les variables étudiées ont été collectées à l’aide d’un questionnaire, complétées par un examen clinique et des investigations radiographiques.Résultats : le taux de participation était moyen (48%). La prévalence de la tendinopathie de la main et du poignet était de 35%. Le sexe (p<0,001), les pathologies préexistantes au poignet ou à la main (p<0,001), les mouvements répétitifs de pince entre le pouce et l'index (p<0,032), les mouvements répétitifs d’extension du poignet (p<0,031) et le stress perçu (p<0,001) sont les facteurs associés à la survenue de la tendinopathie. Le sexe féminin et le stress augmentent de 2 à 4 fois le risque de tendinopathies.Conclusion : ces résultats nos interpellent sur la nécessité de renforcer la prévention et le dépistage précoce des TMS en entreprise. Mots clés : Tendinopathie, main, poignet, banque, Ouagadougou. English Title: Factors associated with hand and wrist tendinopathies in the middle of banking in Ouagadougou The repetitive gestures and the regular involvement of upper limbs in manual activities in 50 a professional environment expose them to the development of musculoskeletal disorders. 51 The specific working conditions of bank employees in Burkina Faso could favor the 52 emergence of these pathologies. 53 The objective of this work was to determine the prevalence and the factors associated with 54 tendinopathies of the hand and wrist in a banking environment in Ouagadougou. 55Method : The analytical cross-sectional study took place from April 1, 2015 to November 30, 56 2015 in 5 banking establishments in Ouagadougou. The sample, randomly drawn, included 57 employees working mainly with a display screen, tellers and ticket sorters. The variables 58 studied were collected using a questionnaire, supplemented by a clinical examination and 59 radiographic investigations 60.Results : the participation rate was average (48%). The prevalence of tendinopathy of the 61 hand and wrist was 35%. Sex (p <0.001), pre existing pathologies on the wrist or hand (p 62 <0.001), repetitive movements of the pincers between the thumb and forefinger (p <0.032), 63 repetitive movements of wrist extension (p <0.031) and perceived stress (p <0.001) are the 64 factors associated with the onset of tendinopathy. The female sex and the stress increase by 2 65 to 4 times the risk of tendinopathies. 66 Keywords : Tendinopathy, hand, wrist, bank, Ouagadougou