Access to Opioids in Palliative Care in Low-and Middle-Income Countries : The Case of Burkina-Faso -How Can Blockchain and Internet of Things Assist? –

Background: People requesting palliative care or suffering from pain are subjected to adhere to opioid-based treatment in order to alleviate their pain. Commonly, access to opioids is strictly controlled. Access to Healthcare delivery services remains challenging in Low-and Middle-Income Countries (LMIC). In Burkina-Faso (BF), a Sub-Saharan African (SSA) country, patients requiring palliative care (PC) are especially facing poor access to pain drugs such as morphine. Facing poor access to pain-alleviating medicine can severely impact the daily quality of life (QoL). On one hand, patients are experiencing poor opioids access. On another hand opioids abuse, leading to drug addiction is noticed. The question arising here is how can they face poor access and at the same time abuse the given drug? One plausible answer is the counterfeit chain, which provides illegal drugs. Beyond the counterfeit issues faced, the public health care system is also facing, amongst others, prescription falsification, fraud in the distribution, and stock shortage. Method & Design:  Mixed-Method-Design was applied to this study. National stipulations, regulations, and the state-of-the-art in the field of palliative care in BF were investigated and analyzed. Based on the investigation‘s outcomes and following the paradigm of design science research, and information system based improvement solution is proposed to tackle the poor access to opioids, improve the supply and distribution chain as well as to efficiently monitor the consumption of opioids in BF, and prevent patients from any health issues, drug addiction, and death. Objectives: The main objectives are to fight against opioid addiction, counterfeits, a stock shortage, and prevent related health safety issues. The main aim is to enable the traceability of any opioids prescription, secure the supply and distribution, and thus early detect any fraud in the system. This editorial paper would, therefore, focus on investigating the reasons underlying the poor access to opioids in palliative care in BF and make suggestions for improvement. A blockchain (BC) and the Internet of Things (IoT) based system to secure and improve opioids supply, distribution, and prescription will be proposed. Results: The contribution analysis reveals the potential of the proposed model to assist in many ways to improve access to opioids and to secure this access. The model could contribute to preventing drug abuse, overprescription, supporting off-label-use of opioids and thus providing a knowledge database for off-label use of opioids. This model shows promise to deliver accurate data and information about the exact opioid’s needs and consumption atlas. This will assist to better distribute the product in the entire country. A proof-of-concept of the proposed model is required. This is ongoing and will be presented in a forthcoming paper. Conclusion: This editorial paper investigates access to opioids in Burkina Faso. It pointed out by analyzing out the computer science perspectives the different causes of the crisis. A contextualized model is provided. A test in situ needs to be performed

Inhospital Outcome of Elderly Patients in an Intensive Care Unit in a Sub-Saharan Hospital

People living more and more longer and elderly is growing and that requires change in health system including geriatric care to be innovative. The aim of this study was to analyze causes and prognosis of older patients admitted in an intensive care unit (ICU) in Sub-Sahara area. A retrospective study over 5 years of patients aged 65 years and above admitted in ICU of Yalgado Ouedraogo was carried out. Of the 2116 patients admitted in ICU, 237 (11.2%) were older. The mean age was 71.7 ± 6.1 years. Males were predominant (sex ratio = 2.4). Medical history was present in 80.6%. The Charlson mean score was 4.8 ± 1.8. Patients with coma represented 42%. Ambulatory Simplified Acute Physiologic Score (ASAPS) up to 8 was recorded in 49%. Medical diseases (60%) like nervous system (37.9%) were reported. Stroke and general surgery were the main affection. Globally treatment was based on fluid management and oxygen supply. During ICU stay, complications occurred in 37.5% like acute respiratory distress syndrome (ARDS) in 10.5%. The mean length of stay was 5.3 ± 7.4 days. The elderly mortality was 73%; those 90% died within 7 days. In multivariate analysis, shock (odds ratio: OR = 2.2, p = 0.002), severe brain trauma (OR = 9.6, p = 0.002), coma (OR 5.8 p < 0.003), surgical condition (OR = 4.2, p = 0.003), ASAPS ≥ 8 (OR = 4.3, p = 0.001), complication occurring (OR = 5.2, p = 0.001), and stroke (OR = 3.7, p = 0.001) were independent risk factors of death. Elderly patients are frequently admitted in ICU with high mortality

Cancellation of elective surgical procedures in the university teaching hospital center Yalgado Ouedraogo in Burkina Faso: incidence, reasons and proposals for improvement

Background: Cancellation of scheduled surgery leads to operating theatre under-occupancy and is recognised as a major cause of emotional trauma to patients and their families. This study aimed to assess the incidence of elective surgery cancellation in order to make proposals for healthcare improvement.Methods: A prospective study was undertaken on cancellation of scheduled surgery in the general surgery service. Cancellation is considered to have occurred when planned surgery did not take place on the day it was scheduled and recognised as ‘final’ when it was no longer considered at a later date. Cancellations were classed as ‘avoidable’ or ‘unavoidable’.Results: A total of 103 surgeries were scheduled for patients with an average age of 41.1 years. Abdominal surgery (36.9%) dominated and 63.1% (n = 65) of the operations were scheduled. Some 36.9% (n = 38) of interventions were delayed, of which 9.7% (n = 10) were definitively cancelled and 27.2% (n = 28) were carried forward. Half of the cancellations (47.4%) were related to equipment and 31.6% related to patient factors. Hospital-related cancellation accounted for 63.9%. Cancellation was avoidable in 68.5% of cases. A financial cause was relevant for 16.6% (n = 6) and 2.6% of cancellations were due to a ‘long preceding intervention’.Conclusion: The impact of cancellation is high and better organisation and communication between relevant role players within the operating theatre should reduce unnecessary cancellation.Keywords: cancellation, elective surgery, operating theatr

Severe pre-eclampsia in the gynecology and obstetrics department of the CHR of Koudougou: epidemiological, clinical, therapeutic and prognostic aspects

Background: To study the epidemiological, clinical, therapeutic and prognostic aspects of severe pre-eclampsia in the gynecology and obstetrics department of the CHR of Koudougou.Methods: descriptive cross-sectional study with prospective collection from January 1 to December 31, 2018. The variables studied focused on clinical socio-demographic characteristics, treatment and prognosis. The women admitted to the department and meeting the criteria for severe pre-eclampsia were included, more than 20 weeks of amenorrhea with an increase in blood pressure, presence of albumin in the urine and signs of clinical or biological seriousness.Results: Severe pre-eclampsia represented 2.3% of admissions and 3% of deliveries. The clinical profile was that of a young housewife (51.2%), married (72.4%), nulliparous (44.1%) with a pregnancy in the 3rd trimester. Symptoms were dominated by headache (53.5%) and diastolic blood pressure ≥110 mmHg (66.9%), with albuminuria greater than two crosses and hyperuricemia. Magnesium sulfate and clonidine were the most commonly prescribed anticonvulsant and antihypertensive drug, respectively. Cesarean section was performed in 53% of cases.Maternal complications were noted in 57.5% of cases without death. However, the fetus took a heavy toll with 50.7% morbidity and 14% perinatal mortality.Conclusions: Severe pre-eclampsia is responsible for heavy morbidity - perinatal mortality. Improving maternal and fetal prognosis will require compliance with treatment protocols and greater accessibility of care at all levels of the health pyramid.

Incidence and outcome of severe ante-partum hemorrhage at the Teaching Hospital Yalgado Ouédraogo in Burkina Faso

Abstract Background Hemorrhage is the main cause of maternal death during pregnancy. This study aims to evaluate incidence and outcomes of Severe Ante Partum Hemorrhage (SAPH) during the third trimester of pregnancy prior to delivery. Methods Analytical cross-sectional study with prospective data collection during 12 months in Yalgado Ouedraogo Hospital, Ouagadougou, Burkina Faso. In this context SAPH is specifically referring to Ante Partum Hemorrhage (APH) and Intra Partum Hemorrhage (IPH) in the 3rd trimester. Postpartum Hemorrhage (PPH) was not included. Results During our study 7,469 women were admitted in obstetrics and 122 cases of SAPH were recorded. SAPH represented 1.6% (n = 122) of hospitalizations causes and 14.5% (n = 1083) of hemorrhages during pregnancy. Mean age was 27.8 ± 6.9 years, mean parity 2.8 ± 1.3 and mean duration of pregnancy was 37 Weeks Amenorrhea (WA). Evacuation from other facilities was the main mode of admission (91.8%, n = 112) and blood transfusion was the essence of resuscitation. Complications were observed in 80.3% (n = 98). During the study, 118 maternal deaths were reported of which 15.6% (n = 19) related to SAPH. Among SAPH cases who died (n = 19) majority (n = 16) had severe anemia (n = 16; 82.6%, p = 0.004). Ten women (8.19%) were admitted in Intensive Care Unit (ICU). Fifteen premature births (12.3%) and 22 perinatal deaths (18.1%) were recorded. Evacuation (p = 0.04), critical clinical condition during admission (p = 0.004), and Uterine Rupture (UR) (p = 0.002) were associated with poor outcome. The Retroplacental Hemorrhage (RPH) (40.9%) was the most common cause of fetal death (p = 0.005) and was associated with High Blood Pressure (HBP) and pre-eclampsia. Conclusion APH is a complication associated with significant maternal and fetal morbidity and mortality