Adama Faye

Developing a tool to measure satisfaction among health professionals in sub-Saharan Africa

BackgroundIn sub-Saharan Africa, lack of motivation and job dissatisfaction have been cited as causes of poor healthcare quality and outcomes. Measurement of health workers’ satisfaction adapted to sub-Saharan African working conditions and cultures is a challenge. The objective of this study was to develop a valid and reliable instrument to measure satisfaction among health professionals in the sub-Saharan African context.MethodsA survey was conducted in Senegal and Mali in 2011 among 962 care providers (doctors, midwives, nurses and technicians) practicing in 46 hospitals (capital, regional and district). The participation rate was very high: 97% (937/962). After exploratory factor analysis (EFA), construct validity was assessed through confirmatory factor analysis (CFA). The discriminant validity of our subscales was evaluated by comparing the average variance extracted (AVE) for each of the constructs with the squared interconstruct correlation (SIC), and finally for criterion validity, each subscale was tested with two hypotheses. Two dimensions of reliability were assessed: internal consistency with Cronbach’s alpha subscales and stability over time using a test-retest process.ResultsEight dimensions of satisfaction encompassing 24 items were identified and validated using a process that combined psychometric analyses and expert opinions: continuing education, salary and benefits, management style, tasks, work environment, workload, moral satisfaction and job stability. All eight dimensions demonstrated significant discriminant validity. The final model showed good performance, with a root mean square error of approximation (RMSEA) of 0.0508 (90% CI: 0.0448 to 0.0569) and a comparative fit index (CFI) of 0.9415. The concurrent criterion validity of the eight dimensions was good. Reliability was assessed based on internal consistency, which was good for all dimensions but one (moral satisfaction < 0.70). Test-retest showed satisfactory temporal stability (intra class coefficient range: 0.60 to 0.91).ConclusionsJob satisfaction is a complex construct; this study provides a multidimensional instrument whose content, construct and criterion validities were verified to ensure its suitability for the sub-Saharan African context. When using these subscales in further studies, the variability of the reliability of the subscales should be taken in to account for calculating the sample sizes. The instrument will be useful in evaluative studies which will help guide interventions aimed at improving both the quality of care and its effectiveness.

[Access to intermittent preventive treatment (IPt) in a situation of abolition of user's fee: role of economic welfare].

In Senegal, the free distribution of sulfadoxine pyrimethamine during antenatal care is recommended to remove the disparity in the context of intermittent preventive treatment against malaria. The objective of this study was thus to identify factors influencing access to treatment in a situation of abolition of user fees. It was a cross-sectional and analytical study. It covered a sample of 1906 women aged 15-49 years randomly selected during the national survey on malaria in Senegal. Data were collected during a personal interview. The economic well-being was measured from the characteristics of housing and durable goods. The multivariate analysis was performed using logistic regression. The average age was 27.94 ± 5.34, 64.27% resided in rural area and 71.8% had received no schooling. Among the surveyed women, 23% were in the poorest quintile, while 16.3% were in the richest. Intermittent preventive treatment was performed in 49.3%. IPt were made more in urban areas (OR 1.45 95% [1.17 to 1.72]). It increased with the level of education with an OR of 1.5 and 1.68 in primary and secondary. The completion of the IPt increased with economic welfare. The OR ranged from 1.44 to 2.95 in the second quintile to the richest. Free medication does not necessarily benefit poor people. Other accompanying measures must be developed to facilitate the distribution of drugs particularly at community level with the involvement of people.

Accès au traitement préventif intermittent (TPI) dans une situation de gratuité : rôle du bien-être économique

In Senegal, the free distribution of sulfadoxine pyrimethamine during antenatal care is recommended to remove the disparity in the context of intermittent preventive treatment against malaria. The objective of this study was thus to identify factors influencing access to treatment in a situation of abolition of user fees. It was a cross-sectional and analytical study. It covered a sample of 1906 women aged 15-49 years randomly selected during the national survey on malaria in Senegal. Data were collected during a personal interview. The economic well-being was measured from the characteristics of housing and durable goods. The multivariate analysis was performed using logistic regression. The average age was 27.94 ± 5.34, 64.27% resided in rural area and 71.8% had received no schooling. Among the surveyed women, 23% were in the poorest quintile, while 16.3% were in the richest. Intermittent preventive treatment was performed in 49.3%. IPt were made more in urban areas (OR 1.45 95% [1.17 to 1.72]). It increased with the level of education with an OR of 1.5 and 1.68 in primary and secondary. The completion of the IPt increased with economic welfare. The OR ranged from 1.44 to 2.95 in the second quintile to the richest. Free medication does not necessarily benefit poor people. Other accompanying measures must be developed to facilitate the distribution of drugs particularly at community level with the involvement of people.

Study of determinants of unprotected sex in sailors of the Senegalese merchant navy

Sailors are a mobile population travelling a lot and therefore being often exposed to casual sex. The aim of this study is to analyze the determinants of unprotected sex among sailors in Senegal. A descriptive and analytical study was conducted among sailors of the merchant navy. Data on knowledge, attitudes and practices were collected during a personal interview. A multivariate analysis was performed using a multiple logistic regression. A total of 400 sailors were interviewed, 57.9% had casual sex of whom 23.7% were not protected. Sexual intercourse without protection was more common among the uneducated (OR = 2.29 [1.23 to 5.99]) and married (OR = 2.29 [1.23-5.99]). Sailors who thought that using condom reduces pleasure during sexual intercourse (OR = 2.5 [1.2-5.1]) and those who consumed alcohol (OR = 5.4 [2.07-14.2]) were less protected during casual sex. Sexual contact is one of the main modes of transmission of HIV / AIDS. Sailors often have unprotected sex. Interventions using specific ways must be performed taking into account the mobility of these men who are often uneducated.

Social inequality and antenatal care: Impact of economic welfare on pregnancy monitoring in Senegal

AIM To explore the links between antenatal care (ANC) non-attendance and economic welfare. METHOD AND SUBJECT: This was a cross-sectional, descriptive and analytical study of women aged 15 to 49 years living in Senegal in 2005. Data were from the Demography and Health Survey using a two-stage random sampling procedure. Participants were classed by quintile using an economic well-being score based on housing characteristics and ownership of sustainable goods. The quality of ANC was determined from the number of visits, the qualification of the person delivering care, and content (counseling, weight, height and blood pressure measurements). Logistic regression was used for data analysis. RESULTS A total of 6927 women were surveyed. Mean age was 28.15 years (±2.6); 20.3% were primiparous; 61.2% resided in rural areas; 70.0% had received no education. Each of the first four economic quintiles included about 20% (19.2% to 21.5%) of the participants while 16.9% were in the fifth (richest) quintile. A total of 457 women (6.6%) did not undergo any ANC visit. ANC non-attendance increased with parity, decreased with education level and was higher in rural areas than in urban areas, OR=7.2 (95% CI [5.1-10.1]). It decreased with increasing economic well-being: OR=0.6 [0.47-0.75] 2nd quintile vs. 1st, OR=0.02 [0.01-0.05] 5th quintile vs. 1st, p<0.05 overall. CONCLUSION Economic welfare plays a major role in determining use of ANC. The only way to solve health problems is to reduce inequalities. The solution to this problem is beyond the scope of health but concerns an overall economic program involving the entire community, including policy-makers.

Assessment of General Public’s Knowledge and Opinions towards Antibiotic Use and Bacterial Resistance: A Cross-Sectional Study in an Urban Setting, Rufisque, Senegal

Background: Bacterial resistance is a major public health problem worldwide. One solution to this scourge is to sensitize the general public on rational use of antibiotics. Our goal was to assess people’s knowledge and opinions about antibiotic use and bacterial resistance in an urban setting. Method: We performed a cross-sectional study. A convenience sampling was done. A questionnaire was administered to 400 persons during face-to-face interviews. Results: Most respondents thought that antibiotics are effective against colds/flu (69.8%), cough (72.3%) and sore throat (64.4%). At the same time, 42.8% stated that antibiotic therapy can be stopped as soon as the symptoms disappear. Only 8.8% and 41.8% of people knew that handwashing and vaccination prevented bacterial resistance. Globally, 7% of people had a good knowledge. Socio-demographic variables were not associated with the level of knowledge. The main sources of information were entourage and pharmacy staff. Regarding the opinions, 78.3% of surveyed participants the people thought that that people overuse antibiotics. Additionally, 28% said that they have no role to play against bacterial resistance. Conclusion: People living in an urban setting had a low knowledge about antibiotic use and bacterial resistance. There is a need to implement awareness campaigns. Further studies on population practices toward antibiotic use are necessary.

Community-Based Maternal and Neonatal Health Services in Kolda and Sedhiou Districts of Senegal

INTRODUCTION : A recent assessment of the Millennium Development Goals has shown significant gaps in most developing countries, particularly with regard to the decline in maternal and infant mortality. Unaccess to health services is a major obstacle to reducing maternal and infant mortality. To support the Ministry of Health and Social Action in the implementation of its Strategic Plan for Reproductive Health (2012-2015), the NGO Micronutriment Initiative has developed a project based on Community-based Maternal and Neonatal Health services (CBMNH), which will be implemented at the level of the Kolda region. The general objective of this study is to carry out a situational analysis of maternal and neonatal health in the health districts of Kolda and Sedhiou to help the implementation and the evaluation of the project. METHOD : It was a descriptive and analytical cross-sectional survey. The study included women who gave birth between February 2013 and January 2014. The sampling was random at two degrees. The sample size was 471 women for each of the two health districts. The data collected during an individual interview focused on prenatal consultation (PNC), delivery, postnatal consultation (PONC) and exclusive breastfeeding (EBF). The quantitative analysis of the data consisted of the estimation of the main indicators, the comparison of the indicators between the health district of Sedhiou and the health intervention district of Kolda. Multivariate analysis identified factors associated with PNC, delivery, and EBF. RESULTS : In total, 965 women were interviewed. The results of the study show that the average duration of PNC1 ranged from 3.41 months in Sedhiou to 3.82 months in Kolda. The proportion of women with full PNC was 38.8% and 54.9% respectively in Kolda and Sedhiou. The proportion of women who took iron-folic acid for at least 90 days ranged from 78.8% (Sedhiou) to 71.7% (Kolda). The delivery was carried out by trained staff in 61.0% and 57.4% respectively in Kolda and Sedhiou. The EBF was initiated in the first hour in 47.0% (Kolda) and 52.6% (Sedhiou). The results of the multivariate analysis showed that the early use of PNC services was related to low household income (0.65 [0.50-0.86]), proximity to the health facility (1.93 [1.34-2.78]) and multiparity (1.4 [1.05-1.87]). Completion of all PNC was associated with household income and early PNC1 (3.65 [2.58-5.18]). With regard to iron-folic acid intake, it was more common in women who achieved early PNC1 (2.19 [1.58-3.04]) and all PNC (3.58 [2.22- 5.77]). The delivery by trained personnel was related to the proximity of the structure (2.43 [1.75-3.37]), but also to the preparation of the delivery. Women who knew the period of the MBF (1.37 [1.04-1.81]) and the protective role of the EBF (1.71 [1.28-2.27]) started their children early at the EBF. CONCLUSION : The results of the study show that the use of reproductive health services was linked to environmental, economic, cultural and structural factors. Improving the accessibility of these services requires joint action by the government, NGOs, community actors and the involvement of the population. This will be done through the construction, equipping and rehabilitation of health facilities, strengthening the knowledge of providers, community actors, women and support groups.

Evaluation of secondary school teachers’ knowledge on screening for breast cancer in Benin

Aims: breast cancer is a public health problem in Africa. the objective of this study is to assess the knowledge of secondary school teachers on screening for breast cancers and to determine the associated factors. Methods: this is a crosssectional, descriptive and analytical study. A stratified three-stage sampling allowed us to draw 405 secondary school teachers working in a public institution from the Atlantic to benin during the 2013–2014 school year. the data were collected on an individual interview in schools. the knowledge was considered good if the teacher knew about: mammography, its frequency of realization and its target. A logistic regression was performed. results: the mean age was 35.2 years (8.5). the male teachers accounted for 82.77%. Half of the teachers (49.90%) had good knowledge about breast cancer screening. Factors related to knowledge about breast cancer screening among high school teachers are: level of information (Or adjusted = 11.54 [6.62–20.11]), history of breast cancer in (adjusted Or = 4.75 [1.39–10.21]) and females (adjusted Or = 2.64 [1.29–5.42]). conclusion: the study shows insufficient information on breast cancer in benin. It is essential to raise this Adama Faye1, Sèlomè Julie Emma Azanman-Doumenou1, Khadim Niang1, Anta Tal-Tal1 Affiliation: 1Institute of Health and Development, BP16390 Dakar-Fann, UCAD, Dakar, Sénégal. Corresponding Author: Adama Faye, Institute of Health and Development, BP16390 Dakar-Fann, UCAD, Dakar, Sénégal; Email: adama.faye@ucad.edu.sn Received: 27 June 2017 Accepted: 06 July 2017 Published: 29 July 2017 level by establishing a national cancer control program.

Determinants of women’s satisfaction during their delivery in the health structures of Pikine in Dakar: A transversal study

Aims: This article presents the results of a study aimed at assessing the satisfaction of women during childbirth in the health structures of the department of Pikine in the region of Dakar Senegal and identifying the determinants of this satisfaction. Methods: This cross-sectional survey carried out in 2015 involved 318 women who gave birth. An adapted version of the Satisfaction Questionnaire for Obstetric Care and Postpartum Immediate Care (SSOPPI) was used. Factors on the quality of the system in the structures, the socio-demographic and psychological characteristics of the mothers Thierno Souleymane Ball Anne1, Ibrahima Seck2, Massamba Diouf3, Adama Faye4, Marie BA5, Anta Tal Dia4 Affiliations: 1M&E Technical Advisor, The Challenge Initiative, IntraHealth International, Senegal Office; 2First Technical Advisor of the Minister of Health and Social Action of Senegal; 3Department of Odontology, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University of Dakar; 4Director of Studies at the Institute of Health and Development (ISED), Public Health Service, Institute of Health and Development, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University Dakar; 5Head of Advocacy and External Relations, Coordination Unit for the Ouagadougou Partnership, IntraHealth International, Senegal Office. Corresponding Author: Thierno Souleymane Ball Anne, Dakar, Senegal, BP 5328 Dakar Fann; Email: tanne@intrahealth.org Received: 09 May 2017 Accepted: 06 July 2017 Published: 22 August 2017 were used as exposure variables. Results: The two-thirds of the sample having a satisfaction score greater than 7.92 for satisfaction scores ranging from 1 to 10. Childbirth in a Mbao structure as well as the lack of appropriate premises, human resources or equipment in the structures (quality of the system) are negatively associated with satisfaction with respectively adjusted odd ratio (OR) of 0.39 [0.22–0.67] and 0.46 [0.23–0.90]. Conversely, childbirth in a Pikine (district) health facility is positively associated with satisfaction with adjusted OR of 3.15 [1.76–5.70]. Similarly, childbirth in a health post is associated with satisfaction with adjusted OR of 1.70 [1.00–2.91]. Conclusion: The sociodemographic and psychological characteristics of the mothers were not associated with their satisfaction. Characteristics related to childbirth structure were significantly associated with the satisfaction of mothers.

Socioeconomic Adversities During Life Course and Menopause Onset in a Developing Country

Background: The age of natural menopause varies considerably between countries and within countries. This variation is related to socio-economic conditions. The objective is to assess the effect of socioeconomic conditions on the age of the natural menopause in postmenopausal women aged 40 to 80 years. Method: A cross-sectional study was conducted involving women aged 40–80 years living in Burkina Faso in 2014. The cluster sampling in two stages has been carried out. The dependent variable was the age at menopause and the independent variables were the current socioeconomic and childhood conditions, the health and nutrition conditions during childhood and the gynaeco-obstetric history. The analysis was performed by a multivariate Cox model. Results: A total of 600 women aged 40 to 80 years were interviewed. The average age at menopause was 47.10 years (± 4.98). Socio-economic factors associated with menopausal age are: marital status, place of residence and parents’ home status, the education level and the womens transport means. The risk of having a premature menopause is higher in women who cumulate at least four socioeconomic disadvantages (HR=2.67 [1.90, 3.75] 95%) compared to those who do not. Conclusion: the socio-economic difficulties during childhood and adulthood are linked to the age of natural menopause. It is crucial to raise the level of education, and improve the living conditions of the population.