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

Stakeholder perceptions and experiences from the implementation of the Gratuité user fee exemption policy in Burkina Faso: a qualitative study.

BACKGROUND: In 2016, the Gratuité policy was initiated by the Government of Burkina Faso to remove user fees for maternal, newborn, and child Health (MNCH) services. Since its inception, there has not been any systematic capture of experiences of stakeholders as it relates to the policy. Our objective was to understand the perceptions and experiences of stakeholders regarding the implementation of the Gratuité policy. METHODS: We used key informant interviews (KIIs) and focus group discussions (FGDs) to engage national and sub-national stakeholders in the Centre and Hauts-Bassin regions. Participants included policymakers, civil servants, researchers, non-governmental organizations in charge of monitoring the policy, skilled health personnel, health facility managers, and women who used MNCH services before and after the policy implementation. Topic guides aided sessions, which were audio recorded and transcribed verbatim. A thematic analysis was used for data synthesis. RESULTS: There were five key themes emerging. First, majority of stakeholders have a positive perception of the Gratuité policy. Its implementation approach is deemed to have strengths including government leadership, multi-stakeholder involvement, robust internal capacity, and external monitoring. However, collateral shortage of financial and human resources, misuse of services, delays in reimbursement, political instability and health system shocks were highlighted as concerns that compromise the government's objective of achieving universal health coverage (UHC). However, many beneficiaries were satisfied at the point of use of MNHC services, though Gratuité did not always mean free to the service users. Broadly, there was consensus that the Gratuité policy has contributed to improvements in health-seeking behavior, access, and utilization of services, especially for children. However, the reported higher utilization is leading to some perceived increased workload and altered health worker attitude. CONCLUSIONS: There is a general perception that the Gratuité policy is achieving what it set out to do, which is to increase access to care by removing financial barriers. While stakeholders recognized the intention and value of the Gratuité policy, and many beneficiaries were satisfied at the point of use, inefficiencies in its implementation undermines progress. As the country moves towards the goal of realizing UHC, reliable investment in the Gratuité policy is needed

Etude et réalisation d'un capteur de pression avec calibration in-situ pour application biomédicale implantée : application à la mesure de la pression intracrânienne

De nos jours, la mesure de la pression intracrânienne est devenue un acte quasi-routinier en présence de traumatisme crânien grave (neurotraumatologie). En effet, dans les pays développés, les traumatismes crâniens représentent une cause majeure de décès et de handicaps pour la population des adultes jeunes. Des protocoles ont donc été mis en place depuis plusieurs années permettant une prise en charge précoce du patient. Ceux-ci s'appuient sur les techniques d'imagerie avancées (CT-scan, IRM) mais surtout sur l'estimation de la pression à l'intérieure de l'enceinte crânienne. Cette mesure pratiquée depuis de début du XXe siècle a évolué jusqu'à l'emploi depuis ces dernières décennies de dispositifs à base de microsystèmes. Cela a permis la miniaturisation du capteur de pression, désormais intégré à l'extrémité d'un cathéter d'un diamètre de quelques millimètres, et positionné directement au contact du parenchyme cérébral (matière grise). Les avantages de ce type de capteur demeurent une facilité d'emploi accrue et un risque septique quasi absent. Cependant, leur défaut récurrent demeure une impossibilité du contrôle de l'intégrité du capteur une fois celui-ci implanté. En effet, des dérives des valeurs mesurées sont observées assez couramment sans toutefois pouvoir en déterminer l'origine. Les travaux réalisés au cours de cette thèse ont eu pour but la réalisation d'un dispositif permettant de remplir les fonctions de mesure de la pression intracrânienne tout en les combinant à un système permettant le contrôle de la dérive éventuelle du capteur de pression et permettant, le cas échéant, de la corriger. Pour cela, nous nous sommes appuyés sur une technologie silicium pour fabriquer un microsystème combinant un capteur de pression, de température et un actionneur électrostatique. Après avoir décrit en détail les enjeux de l'emploi croissant des dispositifs médicaux implantables actifs (DMIA) dans la médecine moderne, nous détaillons la conception et la fabrication d'une cellule sensible combinant deux capteurs et un actionneur. Cette cellule est ensuite caractérisée et comparée à l'état de l'art. Dans la partie finale, nous décrivons le processus d'encapsulation de la cellule sensible produite pour une utilisation dans le cadre de la mesure de la pression intracrânienne et d'une réglementation exigeante (DMIA). En collaboration avec l'INSERM, un démonstrateur fonctionnel a pu être mis en œuvre. Le système a ensuite été testé in vivo sur l'animal avec l'aide des équipes du CHU Purpan et de l'école vétérinaire de Toulouse.Severe head injury is considered among the main causes of disability and death for young adults. For this reason, several diagnostic protocols have been recently established to improve the patient outcomes. These protocols are based on new imaging techniques (for example CT, MRI) and mainly on invasive intracranial pressure (ICP) monitoring. The ICP measurement has been practiced since the early twentieth century, and has been considerably enhanced since the early eighties thanks to the microelectromechanical systems (MEMS) technology. Using this technology, it became possible to implement a miniaturized pressure sensor which is integrated at the end of a low diameter catheter and can be positioned directly in contact with the brain parenchyma. Among numerous advantages of this type of sensor, the easiness of use and the very low risk of infection are the most important. Once implanted in brain, checking the sensor's integrity is no more possible which is considered as a remarkable drawback. Finally, the drift of the sensor is normally observed while its origins are still unknown. In view of these weaknesses, the objective of our work was to implement a device for measuring ICP and to integrate it with a system in order to control and correct any possible drift of the pressure sensor. Silicon micro-fabrication technology was used to create a MEMS pressure sensor integrated with a temperature sensor and an electrostatic actuator. In collaboration with the French National Institute of Health and Medical Research (INSERM), a fully functional prototype was implemented. Afterwards, it was tested on animals with the help of teams from the university hospital Purpan and the veterinary school of Toulouse. The thesis manuscript is organized as follows. First, the main challenges of implantable medical devices in modern medicine are described in details. This is followed by presenting the design flow and the fabrication process of the chip which combines the two sensors and the actuator. Then, the characterization results of the system is introduced and compared to the state of the art devices. The last section describes the packaging process of the chip which meets the medical regulatory of implanted medical devices

Simulation d'une population synthétique : méthodologie et cas d'application sur Nantes SNCF TER Mobilités Pays de la Loire - Ifsttar / Livrable 2

Ce rapport est le deuxième rapport prévu au sein de ce contrat, écrit par l'équipe universitaire à destination de la SNCF dans le cadre de la convention de co-encadrement SNCF/UniversitéGustaveEiffel (anciennement Ifsttar) accompagne cette thèse (No Ifsttar : RP1-E19045) sous la responsabilité scientifique de Jean Calio, expert Data, Mobilité et Territoires et Développement Durable de la SNCF et de Pierre-Olivier Vandanjon

Allocating synthetic population to a finer spatial scale: an integer quadratic programming formulation

Agent-Based Models (ABM) are being increasingly used to evaluate urban systems, urban policies and environmental impacts. One prerequisite for using the ABM framework consists of generating a synthetic population representative of the actual population, featuring the appropriate attributes with respect to model objectives. A precise spatial positioning of the synthetic population agents is often key to ensuring ABM modeling quality. This paper considers the problem of allocating synthetic population agents to a finer spatial scale. Such an allocation process is performed from a higher-level statistical area where a synthetic population can be generated, i.e. a container statistical area (CSA), to several nested non-overlapping elementary statistical areas (ESA), where only marginals are available. This allocation step relies not only on common attributes between CSA and ESA, but also on additional discriminatory attributes, i.e. attributes of interest, estimated from external data sources. The case study examined herein is based on French census and fiscal data. Common attributes include 8 socio-demographic variables, totaling 17 modalities. An additional attribute of interest, i.e. income, has also been added. The allocation problem at hand is modeled as an integer quadratic programming problem. An exact algorithm is first applied to solve the problem; the applicability of this algorithm proves to be limited to small-size synthetic populations. A heuristic is proposed to handle the allocation of larger-size synthetic populations. Tests carried out on the case study show that this heuristic yields near optimal solutions; it is also computationally efficient and may fulfill the needs of a majority of users

Self Calibrating pressure sensor for biomedical applications

International audienceIn this paper we present for the first time a wireless self calibrating pressure sensor for biomedical applications. The proposed system consists of a piezoresistive pressure sensor implemented on a thin silicon membrane, a catheter tube and finally a protection capsule fabricated from a biocompatible polymer (PEEK). A double side flex with embedded conductors has been used to create the interconnections between the pressure sensor and the control circuit which is further connected to a wireless transceiver. The auto calibration capability of the proposed sensor enables to avoid the existing problem of drift with time and hence provides an excellent solution for long term monitoring. Moreover, the catheter of the proposed system has a reduced length of only 200mm in comparison to the 1m length for the existing wired solutions

Changement climatique, dégradation environnementale et terrorisme au Burkina Faso. Quand la COVID-19 vient complexifier la situation des personnes déplacées internes (PDI)

En date du 08 septembre 2020, le Burkina Faso comptait 1 034 609 personnes déplacées internes (PDI). Les déplacements de personne à l’intérieur de ce pays sont occasionnés par deux principaux facteurs : les conséquences des effets adverses du changement climatique et le terrorisme. Cet article présente les impacts de la COVID-19 sur la situation des PDI localisées dans la commune de Kongoussi, une région également touchée par les effets du changement climatique. Basé sur les résultats d’une enquête menée auprès de 106 PDI dans cette localité du 3 au 8 mai 2020, cet article démontre comment l’avènement de la pandémie a fortement augmenté la vulnérabilité des PDI présentes dans la région, en menaçant notamment leurs moyens de subsistance

Groundwater level changes since 1978 in an African city on basement rocks : the case of the CIEH borehole in Ouagadougou (Burkina Faso)

International audienceThe CIEH piezometer, located in the center of Ouagadougou city presents a water level record spanning the West African Drought which peaked during the 80s and 90s. Its water level is investigated as a potential proxy for groundwater water resources in West African basement rock aquifers submitted to climate changes. 23 boreholes and wells in various land uses and within a 2 km radius around the CIEH piezometer were monitored during the 2013-2014 hydrologic year. The minimum water level occurred in May, at the end of the dry season, while the maximum took place in October, one month after the end of the rainy season. The mean water level amplitude is 3 m, the minimum amplitude being reached at the CIEH piezometer (0.76 m). Moreover, the CIEH piezometer is located in a 2 m amplitude water table depression either in May or in October. Simplified 2d modeling using a general basement aqui-fer structure shows that (i) the water level in the piezometer is under ongoing influence of the spillway raise of the nearby dam#3 lake in 2002, (ii) the whole 1978-2004 period cannot be modelled with constant parameters. A 3% decrease of water uptake is adopted after 1985, presumably resulting from land use changes in the Ouagadougou city. The water table at the CIEH piezometer is presently at its 1978 level, which can considered as a pre-drought value. However this includes a 1.5 m contribution of the two abovementioned anth-ropic effects Further quantitative interpretations of the CIEH piezometer record will require additional geophysical and hydrological investigations