Has the Gratuité policy reduced inequities in geographic access to antenatal care in Burkina Faso? Evidence from facility-based data from 2014 to 2022

BACKGROUND: Evidence shows that user fee exemption policies improve the use of maternal, newborn, and child health (MNCH) services. However, addressing the cost of care is only one barrier to accessing MNCH services. Poor geographic accessibility relating to distance is another. Our objective in this study was to assess the effect of a user fee exemption policy in Burkina Faso (Gratuité) on antenatal care (ANC) use, considering distance to health facilities. METHODS: We conducted a cross-sectional study with sub-analysis by intervention period to compare utilization of ANC services (outcome of interest) in pregnant women who used the service in the context of the Gratuité user fee exemption policy and those who did not, in Manga district, Burkina Faso. Dependent variables included were socio-demographic characteristics, obstetric history, and distance to the lower-level health facility (known as Centre de Santé et Promotion Sociale) in which care was sort. Univariate, bivariate, and multivariate analyses were performed across the entire population, within those who used ANC before the policy and after its inception. RESULTS: For women who used services before the Gratuité policy was introduced, those living 5-9 km were almost twice (OR = 1.94; 95% CI: 1.17-3.21) more likely to have their first ANC visit (ANC1) in the first trimester compared to those living 10 km from the nearest facility were almost twice (OR = 1.86; 95% CI: 1.14-3.05) and over twice (OR = 2.04; 95% CI: 1.20-3.48) more likely respectively to use ANC1 in the first trimester compared to those living within 5 km of the nearest health facility. Also, women living over 10 km from the nearest facility were 1.29 times (OR = 1.29; 95% CI: 1.00-1.66) more likely to have 4+ ANC than those living less than 5 km from the nearest health facility. CONCLUSIONS: Insofar as the financial barrier to ANC has been lifted and the geographical barrier reduced for the populations that live farther away from services through the Gratuité policy, then the Burkinabé government must make efforts to sustain the policy and ensure that benefits of the policy reach the targeted and its gains maximized

Angiome plan de la face: À propos de deux cas dont l’un révélant un syndrome de Sturge Weber et Krabb

Sturge Weber and Krabbe syndrome or Sturge weber Syndrome (SWS) is a rare and sporadic disease. It associates with a variety of degrees a flat facial skin angioma in the V1 territory of the trigeminal, a pial angioma and a choroidal angioma all in the one side. The neurological involvement of epileptic seizures in fact all the gravity. The authors report two cases of angiomas plane of the face. The first case presents a complete association of the 3 signs in a 5 year old child. The second case presents an association of angioma and choroidal involvement without cerebral damage to imaging in a 25-year-old adult. They thus highlight the interest of imaging examinations in particular MRI in the diagnosis through the classification and follow-up of this pathology

Wide Variations in Compliance with Tuberculosis Screening Guidelines and Tuberculosis Incidence between Antiretroviral Therapy Facilities — Côte d’Ivoire

<div><p>Background</p><p>In Côte d’Ivoire, tuberculosis (TB) is a common cause of death among HIV-infected antiretroviral therapy (ART) enrollees. Ivorian guidelines recommend screening for TB and initiation of TB treatment before ART initiation. Compliance with these guidelines can help reduce TB-related mortality during ART and possibly nosocomial TB transmission.</p><p>Methods and Findings</p><p>In a retrospective cohort study among 3,682 randomly selected adults (≥15 years old) starting ART during 2004–2007 at 34 randomly selected facilities, documentation of TB screening completion, prevalence of active TB at ART initiation, and incidence of TB during ART were evaluated. At ART initiation, median age was 36 years, 67% were female, and median CD4 count was 135 cells/μL. Among all 3,682 enrollees, 73 (2%) were on TB treatment at the time of referral to the ART facility. Among the 3,609 not on TB treatment, 1,263 (36%) were documented to receive some TB screening before ART initiation; 21% were screened for cough, 21% for weight loss, 18% for fever, 18% for TB contacts, and 12% for night sweats. Among the 1,263 screened, 111 (11%) were diagnosed with TB and started TB treatment before ART. No associations between patient characteristics and probability of being screened were noted. However, documentation of TB screening completion before ART varied widely by ART facility from 0–100%. TB incidence during ART was 3.0 per 100 person-years but varied widely by ART facility from 0/100 person-year to 13.1/100 person-years.</p><p>Conclusions</p><p>Screening for TB before ART initiation was poorly documented. Facility-level variations in TB screening documentation suggest facility-level factors, such as investment in training programs, might determine documentation practices. Targeting under-performing ART facilities with improvement activities is needed. Variations among facilities in TB incidence warrant further research. These incidence variations could reflect differences between facilities in TB screening, diagnostic tests, documentation practices, or TB risk possibly related to infection control practices or local community TB incidence.</p></div

Variations in the Incidence Rate of Tuberculosis during Antiretroviral Therapy between Health Facilities in Côte d’Ivoire during 2004–2008.

<p>Variations in the Incidence Rate of Tuberculosis during Antiretroviral Therapy between Health Facilities in Côte d’Ivoire during 2004–2008.</p

First Line Antiretroviral Therapy Regimen Distribution by Tuberculosis Treatment Status and HIV Type at Antiretroviral Therapy Initiation in Côte d’Ivoire during 2004–2007.

<p>First Line Antiretroviral Therapy Regimen Distribution by Tuberculosis Treatment Status and HIV Type at Antiretroviral Therapy Initiation in Côte d’Ivoire during 2004–2007.</p

Associations between Patient Characteristics and Prevalence of Tuberculosis Treatment at ART Initiation.

<p>Associations between Patient Characteristics and Prevalence of Tuberculosis Treatment at ART Initiation.</p

Percentages of Adults with Documentation of Screening for the Recommended Five Tuberculosis Symptoms before Antiretroviral Therapy Initiation in Côte d’Ivoire during 2004–2007*.

<p>*Error bars represent 95% confidence intervals derived using survey procedures that accounted for study design.</p

Facility-Level Variations in the Percentage of Adults Screened for Tuberculosis before Antiretroviral Therapy Initiation in Côte d’Ivoire during 2004–2007.

<p>Facility-Level Variations in the Percentage of Adults Screened for Tuberculosis before Antiretroviral Therapy Initiation in Côte d’Ivoire during 2004–2007.</p