Blahima Konaté

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.

The state of the research for health environment in the ministries of health of the Economic Community of the West African States (ECOWAS)

BackgroundAn assessment of the state of the Research for Health (R4H) environment can provide relevant information about what aspects of national health research systems needs strengthening, so that research output can be relevant to meet national priorities for decision-making. There is limited information on the state of the R4H environment in the Economic Community of West African States (ECOWAS). This article describes the state of the R4H environment within the Ministries of Health of the ECOWAS member states and outlines of some possibilities to strengthen health research activities within the ECOWAS region.MethodsInformation on the national-level R4H environment (governance and management; existence of a national policy; strategic and research priorities documents; ethics committees; research funds; coordination structures; monitoring and evaluation systems; networking and capacity building opportunities) was collected from the Ministries of Health research units in 14 ECOWAS countries using self-administered questionnaires. A workshop was held where country report presentations and group discussions were used to review and validate responses. Data from the discussions was transcribed using Nvivo, and strengths, weaknesses, opportunities and threats (SWOT) analysis of the functioning of the units was done using Robert Preziosi’s organisational diagnosis tool.ResultsThe findings indicate that as of January 2011, 50% of ECOWAS countries had established directorates for health research with defined terms of reference. The existing funding mechanisms were inadequate to support the research structures within and outside the MoHs, and for building the capacity of researchers. Networking and monitoring activities were weak and only 7% of the directors of research units were trained in research management. The majority (85.7%) of countries had broader national health policies, and 57% of the countries had some form of policy or strategic document for research development. Half of the countries had developed national research priorities.ConclusionsThese results call for urgent action to improve the research environment in the Ministries of Health in the West African sub-region.

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 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.

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.