Abdramane Berthé

The ambivalence of stigma and the double-edged sword of HIV/AIDS intervention in Burkina Faso.

This article analyses the causes of HIV stigmatisation in Burkina Faso as perceived by people living with HIV/AIDS (PLHIV) and people working in AIDS-related Community Based Organisations (CBOs). Stigmatisation continues to be a pressing issue when dealing with HIV/AIDS in Sub-Saharan Africa. The article is based on direct observation of HIV-related practices within 20 CBOs in Burkina Faso, as well as semi-structured interviews or focus group discussions with 72 PLHIV and 90 professionals and volunteers working in CBOs. PLHIV were chosen by convenience sampling among the persons who accessed CBO services and were interviewed about their life quality and experience relating to HIV. Professionals and volunteers were interviewed about their strategies, their achievements, and the problems they encountered. The research was conducted in the course of three months fieldwork between September and November 2009. Our principal findings show, firstly, that moral or social stigmatisation does not in any simple way derive from fear, ignorance or inaccurate beliefs but that it is also established and continually reinforced by official campaigns addressing HIV/AIDS. Secondly, we show that stigmatisation is a socially complex and ambiguous process. Based on these empirical findings we conclude that HIV/AIDS need no longer be approached in AIDS intervention as a sexually acquired and fatal disease. When reliable access to antiretroviral drugs is in place, AIDS becomes a chronic condition with which one can live for many years, and this makes it easier to address HIV and moral or social stigmatisation by downplaying the current focus upon sexuality and morality.

Prevalence and patterns of multimorbidity among the elderly in Burkina Faso: cross‐sectional study

To assess the prevalence and distribution patterns of multimorbidity among urban older adults in Burkina Faso.

The West African experience in establishing steering committees for better collaboration between researchers and decision-makers to increase the use of health research findings

BackgroundAware of the advantages of a project steering committee (SC) in terms of influencing the development of evidence-based health policies, the West African Health Organisation (WAHO) encouraged and supported the creation of such SCs around four research projects in four countries (Burkina Faso, Nigeria, Senegal and Sierra Leone). This study was conducted to describe the process that was used to establish these committees and its findings aim to assist other stakeholders in initiating this type of process.MethodsThis is a cross-sectional, qualitative study of the initiative’s four projects. In addition to a literature review and a review of the project documents, an interview guide was used to collect data from 14 members of the SCs, research teams, WAHO and the International Development Research Center. The respondents were selected with a view to reaching data saturation. The technique of thematic analysis by simple categorisation was used.ResultsTo set up the SCs, a research team in each country worked with health authorities to identify potential members, organise meetings with these members and sought the authorities’ approval to formalise the SCs. The SCs’ mission was to provide technical assistance to the researchers during the implementation phase and to facilitate the transfer and use of the findings. The ‘doing by learning’ approach used by each research team, combined with WAHO’s catalytic role with each country’s Ministry of Health, helped each SC manage its contextual difficulties and function effectively.ConclusionThe involvement of technical and financial partners motivated the researchers and ministries of health, who, in turn, motivated other actors to volunteer on the SCs. The ‘doing by learning’ approach made it possible to develop strategies adapted to each context to create, facilitate and operate each SC and manage its difficulties. To reproduce such an experience, a strong understanding of the local context and the involvement of strong partners are required.

The key actors maintaining elders in functional autonomy in Bobo-Dioulasso (Burkina Faso)

BackgroundGlobally, a significant increase in functional disability among the elderly is expected in the near future. It is therefore vital to begin considering how Sub-Saharan Africa countries can best start building or strengthening the care and support system for that target population. Study objectives are: 1) identify the key actors of the social system who maintain elders in functional autonomy at home in Bobo-Dioulasso (Burkina Faso) and 2) to describe the functional status of older people living at home.MethodsWe conducted a longitudinal descriptive study among the elderly aged 60 and above (351). Their functional status was evaluated using the Functional Autonomy Measurement System (SMAF). Data analysis was done using the statistical software package STATA (SE11).ResultsIn Bobo-Dioulasso, 68% of seniors have good functional capacity or a slight incapacity and 32% have moderate to severe incapacities. Older people die before (3%) or during (14%) moderate to severe disabilities. This would mean that the quality of medical and/or social care is not good for maintaining functional autonomy of older people with moderate to severe disabilities. Two main groups of people contribute to maintain elders in functional autonomy: the elderly themselves and their family. Community, private or public structures for maintaining elders in functional autonomy are non-existent. The social system for maintaining elders in functional autonomy is incomplete and failing. In case of functional handicap at home, the elders die. But stakeholders are not conscious of this situation; they believe that this system is good for maintaining elders in functional autonomy.ConclusionIt is likely that the absence of formal care and support structure likely shortens the lifespan of severely disabled older people. Stakeholders have not yet looked at this possibility. The stakeholders should seriously think about: 1) how to establish the third level of actors who can fulfill the needs to maintain elders in functional autonomy that are not satisfied by others (family members or the older individuals themselves), and 2) how to reinforce the role of each actor and the collaboration between the different groups of people of this system.

Plaintes des patients: une opportunité pour améliorer la qualité des soins des personnes âgées avec des multimorbidités au Burkina Faso

Introduction Peu de données existent sur les plaintes des patients pour identifier des pistes d’amélioration de la qualité de soins des personnes âgées avec des multimorbidités. L’objectif de cette étude était d’analyser les plaintes des personnes âgées qui présentent des multimorbidités dans les formations sanitaires à Bobo-Dioulasso, Burkina Faso. Méthodes Nous avons réalisé une étude transversale dans les formations sanitaires de la ville de Bobo-Dioulasso de novembre 2013 à février 2014. Les personnes âgées de 60 ans ou plus, avec au moins une pathologie chronique vues en ambulatoire ou en hospitalisation pendant la période d’étude ont été inclues. Des entretiens qualitatifs ont été réalisés à l’aide d’un questionnaire semi-structuré. Une analyse du contenu a été réalisée. Résultats Nous avons noté des plaintes liées au long temps d’attente pour les soins, des conditions inadaptées de transfert des patients en hospitalisation, un manque d’échanges d’informations sur les maladies et des conditions d’hôtellerie inadaptées pour la personnes âgée venue en consultation et en hospitalisation. Conclusion Des pistes d’amélioration pourraient passer par la rénovation et l’agrandissement des salles d’attentes des formations sanitaires, la séparation des prestations des soins chroniques des soins aigus en ambulatoire et en hospitalisation, l’appui à l’autonomisation par une meilleure communication avec le patient avec l’appui d’un groupe d’entraide communautaire et l’implication des familles.

Plaidoyer pour un renforcement du système de pharmacovigilance au Burkina Faso

Large-scale deployment of new medicines has been observed over the last two decades in many Sub-Saharan Africa countries faced with major public health issues such as malaria and HIV/AIDS. However, some of these medicines may be responsible for varying degrees of toxicity, with adverse drug reactions leading to decreased compliance or even discontinuation of treatment. Pharmacovigilance systems therefore had to be set up in these countries, such as in Burkina Faso, West Africa, which initiated the organization of pharmacovigilance activities in 2008. Despite this progress, the systems in place have not yet achieved a sufficient level of performance to deal with drug-related health issues, highlighting the need for further actions. Pharmacovigilance in Burkina Faso can be strengthened at multiple levels: pre-service and in-service training of health workers; the establishment of active surveillance based on sentinel sites; informing the public and raising awareness; and strengthening national coordination.

Prises de risques chez les jeunes de Bobo Dioulasso: une analyse des facteurs associés à la précocité et au multipartenariat sexuels

INTRODUCTION Despite health education efforts, young people continue to adopt risky sexual behaviors which may have a significant impact on their health. This study aims to analyze the factors associated with sexual precocity and multiple partners among young people aged 19-24 years living in Bobo-Dioulasso. METHODS We conducted a quantitative, cross-sectional study. Survey data were collected from 573 young people aged 15-24 years in Bobo-Dioulasso (Burkina Faso) in December 2014. The respondents were selected using two stages cluster sampling. Risk factors for sexual precocity and multiple partners were analyzed using Stata 13 IC software. We used P<0.05 as the significance level. RESULTS More than half of respondents (54%) were sexually active, of whom 14% before the age of 16. Having multiple sex partners was reported by 24% of sexually active youth. Determinants of sexual precocity and multiple partners were age, sex, level of education and economic status of parents. Our data have also shown that early sexual debut was associated with multiple sexual partners (p<0.005). CONCLUSION Actions aimed to convince young people to delay sexual debut and to better assess risks are of utmost importance. Enhancing parents, teachers and carers capabilities is essential to improve the quality of their relationships with young people.

Regard des personnes âgées sur la prescription des médicaments potentiellement inappropriés dans le premier niveau de soins à Bobo-Dioulasso, Burkina Faso

BACKGROUND Little is known about the organization of primary care facilities in sub-Saharan Africa that might lead to potentially inappropriate prescribing. The aim of this study was to analyze the factors that could lead to potentially inappropriate prescribing in primary care facilities in Bobo-Dioulasso (Burkina Faso), taking into consideration the patients perspective. METHODS A cross-sectional qualitative study was conducted in primary care facilities from November 2013 to February 2014. People aged 60 years or more with at least one chronic disease were included. Individual interviews were conducted. An analysis of the thematic content of the interviews was conducted. RESULTS Our results showed that the patient referral system was insufficient. We also found many different prescribers for older people seeking care and poor communication between prescribers and patients. This caused some consequences such as the absence of review of drugs consumed before a new prescription, a lack of exchange on medication changes and repeated treatment change during hospitalization. Most of the persons who prescribed potentially inappropriate medications were nurses. CONCLUSION The poor communication between prescribers and patients is a challenge for the prevention of prescribing potentially inappropriate medications. Teamwork is an important feature of the organizational care system, strengthening it could be a way to improve rational prescription.

Functional disability in activities of daily living and instrumental or domestic activities of daily living in the elderly living at home in Bobo-Dioulasso (Burkina Faso).

In sub-Saharan Africa, various studies have been conducted on severe disability in activities of daily living, instrumental or domestic activities. These studies have reported different rates without describing the social context for understanding their results. This study was conducted in Burkina Faso to fill the gaps in scientific information on disability in these areas. We conducted a cross-sectional descriptive study in Bobo-Dioulasso among the older population, aged 60 and above. Their functional status was evaluated using the Functional Autonomy Measurement System (SMAF). Data analysis was done with the help of Stata. A systematic random sample of 351 aging adults was interviewed. Moderate to severe functional disability or the need for supervision or assistance was present in 7% in activities of daily living and 86% in instrumental or domestic activities of daily living. This need for assistance varied according to the different activities or items in each domain. The proportions of disability found in this study are higher than those of previous studies that measured the often severe disabilities. All persons with disability claimed to have stable human resources which help them to manage their disabilities. The social context instrumental or domestic activities of daily living are divided by generation and/or by sex. That explains some results. With this division, its inacceptable in some family that elders and/or old men do instrumental or domestic activities of daily living as prepare meals, do laundry, carry water to wash. The variation of this division from one family to another complicates the assessment of functional disability. To best manage elders disabilities, strategies must develop to: 1) retard the resignation of the family in care of its elderly in functional disability, 2) anticipate the preparation of formal social networks, public structures to support the elderly.