La gratuité des soins associée à l’amélioration de la qualité des soins est-elle efficace pour maintenir l’utilisation des services à long terme et améliorer la santé infantile au Burkina Faso ?

Problématique : L’amélioration de l’accessibilité financière aux soins de santé est essentielle pour réduire la morbidité et de la mortalité infantile dans les pays à ressources limitées. Cependant, les preuves disponibles sur la relation entre un accès accru aux soins et l’amélioration la santé infantile, dans le long terme, demeurent insuffisantes et parfois inconnues. Dans le contexte spécifique de la région du Sahel au Burkina Faso où les niveaux élevés de morbidité et de malnutrition coïncident avec un faible recours aux soins, une intervention de santé publique associant la gratuité des soins à l’amélioration de la qualité des soins et à la prise en charge de la malnutrition dans la communauté a été mise en œuvre en septembre 2008. Objectifs : En utilisant des approches statistiques et épidémiologiques appliquées aux données transversales et de séries chronologiques, cette thèse vise à apporter une meilleure compréhension de la façon dont la présence de l’intervention dans les communautés peut augmenter et maintenir l’utilisation des services de santé à long terme et améliorer la santé des enfants de moins de cinq ans. Les objectifs spécifiques sont : 1) évaluer le maintien à long terme des effets de l’intervention sur l’utilisation des services de santé chez les enfants de moins de cinq ans, 2) évaluer l’effet contextuel de l’intervention, quatre ans après le début de sa mise en œuvre, sur la probabilité de survenue d’une maladie et sur la probabilité d’utilisation des services de santé chez les enfants de moins de cinq ans, et 3) évaluer l’effet contextuel de l’intervention, quatre ans après le début de sa mise en œuvre, sur le retard de croissance chez les enfants de moins de cinq ans. Méthodes : Les données proviennent du système national d’information sanitaire, d’une enquête rétrospective sur les services de santé ainsi que d’une enquête de ménages réalisée quatre ans après le début de l’intervention dans 41 villages du district d’intervention et 51 villages du district de comparaison. Nous avons utilisé un plan quasi expérimental à séries temporelles interrompues avec groupe de comparaison pour évaluer les effets immédiats et à long terme de l’intervention sur les taux d’utilisation des services de santé. Ensuite, un plan d’étude transversale post-intervention avec un groupe de comparaison nous a permis d’évaluer l’effet contextuel de l’intervention sur la probabilité de survenue d’une maladie, sur la probabilité d’utilisation des services de santé et sur le retard de croissance chez les enfants de moins de cinq ans. La stratégie analytique a combiné la méthode de pondération par les scores de propension pour équilibrer les covariables entre les deux groupes, la modélisation binomiale négative à effets mixtes, les régressions linéaire et logistique multiniveaux. Résultats : L’intervention de gratuité des soins associée à l’amélioration de la qualité des soins et à la prise en charge de la malnutrition dans la communauté était associée à l’augmentation et au maintien de l’utilisation des services de santé au-delà de quatre ans (ratio des taux d’incidence = 2,33 ; IC 95 % = 1,98 – 2,67). En outre, comparativement aux enfants vivant dans le district de contrôle, la probabilité d’utiliser les services de santé était de 17,2 % plus élevée chez les enfants vivant dans le district d’intervention (IC 95 % = 15,01–26,6) ; et de 20,7 % plus élevée lorsque l’épisode de maladie était sévère (IC 95 % = 9,9–31,5). Ces associations étaient significatives, quels que soient la distance par rapport aux centres de santé et le statut socio-économique du ménage. Par ailleurs, alors que le contexte de résidence expliquait 9,36 % de la variance du retard de croissance (corrélation intraclasse = 9,36 % ; IC 95 % = 6,45–13,38), la présence de l’intervention dans les villages n’explique que 2 % de la variance du retard de croissance. Cependant, nous n’avons pas pu démontrer que la présence de l’intervention dans les communautés était associée à une réduction de la probabilité de survenue d’un épisode de maladie (Différentiel des probabilités = 4.4 ; IC 95% = -1.0 – 9.8), ni à une amélioration significative de l’état nutritionnel des enfants de moins de cinq ans (RC = 1,13 ; IC 95 % = 0,83–1,54). Conclusion : Cette thèse souligne que la gratuité des soins associée à l’amélioration de la qualité des soins et à la prise en charge de la malnutrition dans la communauté est efficace pour augmenter et maintenir l’utilisation des services de santé et réduire les inégalités géographiques de recours aux soins. Cependant, cette intervention n’était pas associée à une amélioration des résultats de santé infantile. Bien que des études longitudinales rigoureuses soient nécessaires pour comprendre pleinement l’influence potentielle de cette intervention sur la morbidité, cette thèse plaide pour la nécessité d’agir simultanément sur les autres déterminants sociaux de la santé et d’intégrer, de manière synergique, des interventions spécifiques à la nutrition pour plus d’impact sur la santé infantile.Introduction: Improving financial access to health care is believed to be essential for reducing the burden of child morbidity and mortality in resource-limited settings, but the available evidence on the relationship between increased access and health remains scarce and the long-term issues are still unknown. In the specific context of the Sahel region in Burkina Faso where high levels of morbidity and malnutrition coincide with low health care use, a pilot intervention for free health care including quality of care improvement and management of malnutrition at the community level was implemented in September 2008. Objectives: Using statistical and epidemiological approaches applied to cross-sectional and time series data, this thesis aims to provide a better understanding of how the presence of intervention in communities can increase and maintain long-term use of health services and improve the health of children under five years. The specific objectives are: 1) to evaluate the long-term effects of the intervention on the use of health services in children under the age of five, 2) to estimate the contextual effect of intervention on the probability of occurrence of and the likelihood of health services being used by children under five, four years after the start of its implementation, and 3) to evaluate the contextual effect of the intervention on stunting in children under five, four years after the start of its implementation. Methods: The data for the analyses were provided from a variety of sources including the national health information system, a retrospective health services survey, and a household survey conducted four years after the intervention onset in 41 villages in the intervention district and 51 villages in the comparison district. We used a quasi-experimental controlled interrupted time-series design group to analyze the immediate and long-term effects of the intervention on the rate of health services utilization in children under five. Then, a quasi-experimental post-test-only design that included a control group allowed us to evaluate the contextual effect of the intervention on the probability of occurrence of a disease, on the probability of use of health services, and stunting in children under five. The analytic strategy combined the propensity score weighting method to balance the covariates between the two groups, two-level mixed-effects negative binomial, and linear and logistic regression models to account for the hierarchical structure of data. Results: The intervention for free health care including quality of care improvement and management of malnutrition at the community level was associated with an increased and maintained use of health services beyond four years after the onset of intervention (incidence rate ratio = 2.33; 95% CI = 1.98–2.67). In addition, compared to children living in the comparison district, the probability of using health services was 17.2% higher among those living in the intervention district (95% CI = 15.0–26.6); and 20.7% higher when the illness episode was severe (95% CI = 9.9–31.5). These associations were significant regardless of the distance to health centers and the socio-economic status of households. In addition, inequalities in the use of care were less pronounced in the intervention villages compared to those in the control village. Finally, the results also showed that the residence context accounted for 9.36% of the variance in stunting (intra-class correlation = 9.36% ; 95% CI = 6.45–13.38), and only 2% of the variance in stunting was explained by the intervention. However, we could not demonstrate that the intervention in these communities was associated with a reduced probability of an illness occurring (AME=4.4 (95% CI: -1.0 – 9.8), nor with a significant improvement in the nutritional status among children under five (OR = 1.13; 95% CI = 0.83–1.54). Conclusion: This thesis underlines the importance that affordable health care, including quality of care, as well as improving the management of malnutrition at the community level, are effective in increasing and maintaining the use of health services and reduce geographical inequalities in the use of care. However, this intervention was not associated with improved child health outcomes. Although rigorous longitudinal studies are necessary to fully understand the potential influence of this intervention on morbidity, this thesis highlights the need to simultaneously act on other social determinants of health and to synergistically integrate nutrition-specific interventions for greater impact on child health

Caractérisation morphologique des bas-fonds dans la province du Yatenga. Rapport n° 1 : généralités, géomorphologie et morphopédologie régionale

Ce rapport présente les premiers résultats d'une étude morphostructurale des bas-fonds du Nord-Ouest du Yatenga. Après un bref aperçu sur le cadre naturel de l'étude et une présentation de la méthodologie de travail, les unités géomorphologiques et morphopédologiques sont décrites et analysées. Ces données sont illustrées par deux cartes (géomorphologie et morphopédologie) à l'échelle du 1/000 000e. La cartographie morphopédologique fait apparaître six types de sols dont les sols peu évolués d'érosion et les lithosols sur cuirasse ferrugineuse sont fortement représentés dans les glacis érodés. En revanche, les sols hydromorphes et les sols ferrugineux peu lessivés qui sont dominants respectivement dans les bas-fonds et les glacis colluviaux ne représentent que 11%. Ces derniers sont les plus cultivés en raison de leurs potentialités agricoles intéressantes. (Résumé d'auteur

Valorisation de substrats organiques divers dans l'agriculture péri-urbaine de Ouagadougou (Burkina Faso) pour l'amendement et la fertilisation des sols : acteurs et pratiques

Organic substrates recycling in the sub-urban agriculture of Ouagadougou (Burkina Faso) for soils fertilization: description of the different actors and their practices. This study aimed to establish an overview of the main actors of the sub-urban agriculture of Ouagadougou, their practices and expectations, and to characterize the used organic substrates (OS). For that, a farm survey was carried out on the most representative sites with 64 persons (cereal farmers, truckers and nurserymen) randomly chosen. OS were sampled with each actor, when available. Thus, 27 samples were taken and characterized through chemical analyses and laboratory incubations to follow organic carbon mineralization. The results highlighted that 35% of cereal farmers, 69% of truckers and 95% of nurserymen were 20 to 40 years old, that a large proportion of cereal farmers and truckers were not sent to school while 70% of nurserymen had at least primary education. Sub-urban agriculture was the only activity for 43% of farmers, 83% of truckers and 91% of nurserymen. Moreover, 71% of cereal farmers and 73% of nurserymen used municipal wastes as source of organic matter against only 17% of truckers, the majority of them using animal manures. The main criterion of choice of OS was their availability without any other consideration. Even if a large majority of the actors think that composts of OS were better than brut OS, a minority of them used currently composts. The best ways for an adoption and utilization of OS composts were to facilitate their accessibility and to promote these composts, composting techniques and their interests through advertising in mass media. Chemical analyses and laboratory incubations showed a great variability of the SUW, both in the same group and actors' groups. However, in case of total organic carbon, total nitrogen and total phosphorous contents, the following tendencies were observed: Contenttruckers > Contentfarmers > Contentnurserymen. For the sum of major elements Ca, K, Mg, Na (SME), it was observed that SMEtruckers ≈ SMEfarmers > SMEnurserymen. In addition, except a few atypical substrates, OS used by nurserymen were largely stabilized compared to those of cereal farmers and truckers

In vitro efficacy of some plant aqueous extracts against two species of Lasiodiplodia associated to mango decline in Burkina Faso

Mango decline is a serious disease in production areas in Burkina Faso. The aim of this study was to contribute to the management of the disease through the use of plant aqueous extracts. Antifungal activities of Azadirachta indica, Calotropis procera, Gmelina arborea, Jatropha curcas, Eucalyptus camaldulensis and the synthetic fungicide (Mancozeb) were tested against Lasiodiplodia theobromae and Lasiodiplodia pseudotheobromae associated to mango decline in Burkina Faso. Three different concentrations of leaf extracts which 25%, 50%, 75% and 500 ppm of Mancozeb were tested for their antifungal activity in vitro. The results showed that leaf extracts have an inhibitor effect on the growth of the two Lasiodiplodia species. The aqueous extract of G. arborea was the most effective with average inhibition rates of L. theobromae of 42.62%, 73.84% and 74.23% respectively with the concentrations of 25 g/l, 50 g/l and 75 g/l. The aqueous extract of A. indica against L. pseudotheobromae showed maximum percentage inhibition with 50 g/l of 63.10% and with 75 g/l of 72.02%. Mancozeb completely inhibits the mycelial growth of both species of fungi. Ours findings showed that aqueous extracts from plants could be tried for the eco-friendly management of mango decline pathogens.Keywords: Antifungal, plants extract, Lasiodiplodia spp., mango decline, Burkina Faso

Evaluation of the 19 varieties and accessions of tomato against bacterial wilt in Bobo-Dioulasso, Burkina Faso

Bacterial wilt caused by Ralstonia solanacearum E. F. Smith is one of the most harmful phytobacteriosis in the world. The search for varieties resistant or tolerant to this disease is the main method of control. However, there is very little information on tomato accessions and varieties deemed resistant or tolerant to the disease in Burkina Faso, hence the resistance assessment of 19 tomato varieties and accessions in the field in order to improve the productivity of tomatoes in Burkina Faso. With respect to varietal screening, a completely randomized Fisher block was used and agromorphological parameters were evaluated. The evaluation has shown that CRA 66, F1 Platinum, NC72TR4-4, Hawaii 7996, BF-Okitsu and FBT4 are more resistant with respective incidences of 1.25%; 1.25; 1.47%; 2.50%; 2.95% and 4.37%; while L390 was the most sensitive (38.80%). In terms of production, F1 Platinum, F1 Mongal, FBT3 and FBT4 gave the best net yields of 25.85; 25.47; 20.6 and 20.34 tonnes.ha-1. On the other hand, some accessions (CRA66 and BF-Okitsu), which are less sensitive to the pathogen, gave derisory yields. In view of the results obtained, market gardeners in the city of Bobo-Dioulasso can be advised of INERA varieties FBT3 and FBT4 and the F1 Platinum and F1 Mongal hybrids for their good behavior in terms of resistance to the disease and/or of correct yield in infected soils.Keywords: Burkina Faso, R. solanacearum, tomato, varietal resistanc

How do supply- and demand-side interventions influence equity in healthcare utilisation? Evidence from maternal healthcare in Senegal

The launch of the Millennium Development Goals in 2000, followed by the Sustainable Development Goals in 2015, and the increasing focus on achieving universal health coverage has led to numerous interventions on both supply- and demand-sides of health systems in low- and middle-income countries. While tremendous progress has been achieved, inequities in access to healthcare persist, leading to calls for a closer examination of the equity implications of these interventions. This paper examines the equity implications of two such interventions in the context of maternal healthcare in Senegal. The first intervention on the supply-side focuses on improving the availability of maternal health services while the second intervention, on the demand-side, abolished user fees for facility deliveries. Using three rounds of Demographic Health Surveys covering the period 1992 to 2010 and employing three measures of socioeconomic status (SES) based on household wealth, mothers' education and rural/urban residence – we find that although both interventions increase utilisation of maternal health services, the rich benefit more from the supply-side intervention, thereby increasing inequity, while the poor benefit more from the demand-side intervention i.e. reducing inequity. Both interventions positively influence facility deliveries in rural areas although the increase in facility deliveries after the demand-side intervention is more than the increase after the supply-side intervention. There is no significant difference in utilisation based on mothers’ education. Since people from different SES categories are likely to respond differently to interventions on the supply- and demand-side of the health system, policymakers involved in the design of health programmes should pay closer attention to concerns of inequity and elite capture that may unintentionally result from these interventions

New Antenatal Model in Africa and India (NAMAI) study: implementation research to improve antenatal care using WHO recommendations

Background: In 2020, an estimated 287 000 women died globally from pregnancy‐related causes and 2 million babies were stillborn. Many of these outcomes can be prevented by quality healthcare during pregnancy and childbirth. Within the continuum of maternal health, antenatal care (ANC) is a key moment in terms of contact with the health system, yet it remains an underutilized platform. This paper describes the protocol for a study conducted in collaboration with Ministries of Health and country research partners that aims to employ implementation science to systematically introduce and test the applicability of the adapted WHO ANC package in selected sites across four countries. Methods: Study design is a mixed methods stepped-wedge cluster randomized implementation trial with a nested cohort component (in India and Burkina Faso). The intervention is composed of two layers: (i) the country- (or state)-specific ANC package, including evidence-based interventions to improve maternal and newborn health outcomes, and (ii) the co-interventions (or implementation strategies) to help delivery and uptake of the adapted ANC package. Using COM-B model, co-interventions support behaviour change among health workers and pregnant women by (1) training health workers on the adapted ANC package and ultrasound (except in India), (2) providing supplies, (3) conducting mentoring and supervision and (4) implementing community mobilization strategies. In Rwanda and Zambia, a fifth strategy includes a digital health intervention. Qualitative data will be gathered from health workers, women and their families, to gauge acceptability of the adapted ANC package and its components, as well as experience of care. The implementation of the adapted ANC package of interventions, and their related costs, will be documented to understand to what extent the co-interventions were performed as intended, allowing for iteration. Discussion: Results from this study aim to build the global evidence base on how to implement quality ANC across different settings and inform pathways to scale, which will ultimately lead to stronger health systems with better maternal and perinatal outcomes. On the basis of the study results, governments will be able to adopt and plan for national scale-up, aiming to improve ANC nationally. This evidence will inform global guidance. Trial registration number: ISRCTN, ISRCTN16610902. Registered 27 May 2022. https://www.isrctn.com/ISRCTN16610902

Les jachères à Andropogon gayanus en savane soudanienne dans l'ouest du Burkina Faso : flore, structure, déterminants et fonction dans l'écosystème = Die brachen mit Andropogon gayanus in der savanne der sudanzone imwesten von Burkina Faso : flora, struktur, determinanten und funktion im ökosystem

Un stade dominé par l'herbe pérenne #Andropogon gayanus apparaît constamment dans les successions postculturales en Afrique soudanienne. Une importante variabilité floristique locale peut cependant y être reconnue avec 12 groupements et 38 faciès floristiques dans la région de Bondoukuy. Cette variabilité, que l'on peut décrire comme hiérarchisée sur trois niveaux presque parfaitement emboîtés, s'organise principalement en fonction des trois principaux types de sols de la région (ferrallitiques, ferrugineux tropicaux lessivés hydromorphes, ferrugineux tropicauxnon hydromorphes), les pratiques relatives à la phase de culture (durée de culture, rotations) n'ayant que peu d'influence. La signification fonctionnelle du stade à #Andropogon gayanus sans la dynamique des écosystèmes anthropisés soudaniens, son caractère indicateur d'anthropisation et sa persistence sans les paysages du futur sont discutés. (Résumé d'auteur