Blaise Sondo

Rates of coverage and determinants of complete vaccination of children in rural areas of Burkina Faso (1998-2003)

BackgroundBurkina Fasos immunization program has benefited regularly from national and international support. However, national immunization coverage has been irregular, decreasing from 34.7% in 1993 to 29.3% in 1998, and then increasing to 43.9% in 2003. Undoubtedly, a variety of factors contributed to this pattern. This study aims to identify both individual and systemic factors associated with complete vaccination in 1998 and 2003 and relate them to variations in national and international policies and strategies on vaccination of rural Burkinabé children aged 12-23 months.MethodsData from the 1998 and 2003 Demographic and Health Surveys and the Ministry of Healths 1997 and 2002 Statistical Yearbooks, as well as individual interviews with central and regional decision-makers and with field workers in Burkinas healthcare system, were used to carry out a multilevel study that included 805 children in 1998 and 1,360 children in 2003, aged 12-23 months, spread over 44 and 48 rural health districts respectively.ResultsIn rural areas, complete vaccination coverage went from 25.9% in 1998 to 41.2% in 2003. District resources had no significant effect on coverage and the impact of education declined over time. The factors that continued to have the greatest impact on coverage rates were poverty, with its various dimensions, and the utilization of other healthcare services. However, these factors do not explain the persistent differences in complete vaccination between districts. In 2003, despite a trend toward district homogenization, differences between health districts still accounted for a 7.4% variance in complete vaccination.ConclusionComplete vaccination coverage of children is improving in a context of worsening poverty. Education no longer represents an advantage in relation to vaccination. Continuity from prenatal care to institutional delivery creates a loyalty to healthcare services and is the most significant and stable explanatory factor associated with complete vaccination of children. Healthcare service utilization is the result of a dynamic process of interaction between communities and the healthcare system; understanding this process is the key to understanding better the factors underlying the complete vaccination of children.

The Kaya HDSS, Burkina Faso: a platform for epidemiological studies and health programme evaluation

The Kaya Health and Demographic Surveillance System (Kaya HDSS) is located in the North Central region of Burkina Faso in the Kaya health district. The main purposes of the Kaya HDSS are to study demographic, infectious and chronic disease indicators in the district, to observe changes in health over time, evaluate health programmes and to provide a basis for policy decisions and capacity building in order to enhance the health of the community. Kaya HDSS was established in late 2007 following a baseline census of the population of the HDSS area. Homes were visited every 6 months to collect demographic information and data on morbidity and mortality. A verbal autopsy questionnaire is used to collect information on the causes of death. The Kaya HDSS reached 64,480 residents in 10,587 households by the end of 2011, with an average of 6.1 ± 4.3 persons per household. The site is 70% urban and 30% rural. The population is 51.8% female. Over 55% of deaths occur outside health facilities. Malaria is the leading cause of death, primarily affecting children under 5 years of age (44%) and those 5 to 14 years old (36%). The Kaya HDSS data can be obtained by sending a request via the HDSS website (http://kaya-hdss.org/).

Impact of maternal HAART on the prevention of mother-to-child transmission of HIV: results of an 18-month follow-up study in Ouagadougou Burkina Faso.

Abstract Mother-to-child transmission remains the main cause of global pediatric HIV infections, especially in sub-Saharan Africa. Many interventions based on single-dose antiretroviral therapy have been implemented to reduce the mother-to-child transmission of HIV. In resource-limited settings, highly active antiretroviral therapy (HAART) has only been recommended for HIV-infected pregnant women requiring treatment for their own health. Here, we assessed the efficacy over 18 months of maternal HAART versus peripartum short-course antiretroviral therapy (SCART) regimens for the prevention of mother-to-child transmission (PMTCT) of HIV. We conducted a retrospective cohort study of patients from two medical centers in Ouagadougou, Burkina Faso. The PMTCT files and registers from 1 January 2003 to 31 December 2006 were obtained from routine data collected at these sites. The main assessment criterion was the rate of HIV-1 positivity in children born to HIV-positive mothers as measured with HIV-1 rapid tests at 18 months. A total of 586 pregnant HIV-1-infected women in PMTCT programs were selected. Among these women, 260 were undergoing HAART and 326 received single-dose nevirapine (91.3%) or single-dose zidovudine (8.7%) at delivery. HIV-1 serological tests were performed on 454 children at 18 months old. The rate of HIV-1 vertical transmission was 0% (0/195) in the HAART group and 4.6% (12/259) in the single-dose monotherapy group (P<0.01). Eight infants in the HAART cohort and 30 in the SCART cohort were breastfed; three in the SCART group were HIV-positive. A total of 62 children died, 19 in the HAART group and 43 in the single-dose monotherapy group. Our study confirms that HAART for mothers effectively reduces the risk of infant HIV infection while preserving the breastfeeding option for mothers.

Determinants and causes of mortality in HIV-infected patients receiving antiretroviral therapy in Burkina Faso: a five-year retrospective cohort study

Abstract In this study, we investigated the causes of death and the factors associated with mortality in a cohort of patients receiving highly active antiretroviral therapy (HAART) in Burkina Faso, an African country with limited resources. This retrospective cohort study included patients aged 15 years and older who started HAART for the first time between January 2003 and December 2008 in 14 health districts. We used survival analyses, including the Kaplan–Meier method, to examine potential predictors of death and two Cox proportional hazard models to estimate hazard ratios for death, first from baseline covariates and then from time-dependent covariates. A total of 6641 patients initiated HAART during this period; of these, 5608 were included in the analysis. By the end of the study period, 4310 of those patients were still receiving HAART, 690 had died, 207 had been transferred and 401 were lost to follow-up. The median duration of follow-up was 23.2 months [interquartile range (IQR): 12.4–36.9], and the overall incidence of mortality was 6 per 100 person-years. The clinical stage, CD4 count, body mass index (BMI), haemoglobin level, HAART regimen, gender, age, profession and year of initiation were the primary risk factors associated with death. In the multivariate analysis, BMI, clinical stage, treatment regimen and CD4 count remained significantly associated with death. The most frequent causes of death were wasting syndrome, tuberculosis and anaemia. This result highlights the already advanced stage of immunodeficiency among patients in Burkina Faso when they start HAART. Testing patients for HIV and starting antiretroviral therapy earlier are necessary to further reduce the mortality of patients living with HIV. This study provides a solid evidence base with which future evaluations of HAART in Burkina Faso can be compared.

User fees and access to ARV treatment for persons living with HIV/AIDS: implementation and challenges in Burkina Faso, a limited-resource country

Abstract Access to antiretroviral (ARV) treatment remains a crucial problem for patients living with HIV/AIDS (PLWHA) in limited-resources countries. Some African countries have adopted the principle of providing ARV free of charge, but Burkina Faso opted for a direct out-of-pocket payment at the point of care delivery, with subsidized payments and mechanisms for the poorest populations to receive these services free of charge. Our objectives were to determine the proportion of PLWHA who pay for ARV and to identify the factors associated with ARV access in Burkina Faso. A cross-sectional study was performed in 13 public health facilities, 10 Nongovernmental Organizations and association health facilities, and three faith-based health facilities. In each facility, 20 outpatients receiving ARV were interviewed during a routine clinic visit. A multivariate analysis by logistic regression was performed. Among the expected 520 patients receiving ARV, 499 (96.0%) were surveyed. The majority of patients (79%) did not pay for their ARV treatment, thereby limiting cost recovery from patient payments. In a multivariate analysis, level of education and income were associated with free access to ARV. Patients with no education more frequently received free ARV than those who had received some level of education (OR 2.7, 95% CI [1.3–5.6]). Patients without any income or with less than US

An exploratory analysis of the regionalization policy for the recruitment of health workers in Burkina Faso.

10 per month were more likely to receive free ARV (OR 2.6 [95% CI 1.3–5.2]) than those who earned more than US

Cultures locales de vaccination: le rôle central des agents de santé en milieu rural au Burkina Faso

10 per month. However, 16% of patients without any income and 21% of those without employment paid for ARV, and the costs of drugs for opportunistic infections, food, and transport remained a burden for 85%, 91%, and 74%, respectively, of those who did not pay for ARV. Free access to a minimum care package for every PLWHA would enhance access to ARV.

Insulin Growth Factor-I in Protein-Energy Malnutrition during Rehabilitation in Two Nutritional Rehabilitation Centres in Burkina Faso

AbstractBackgroundHealth personnel retention in remote areas is a key health systems issue wordwide. To deal with this issue, since 2002 the government of Burkina Faso has implemented a staff retention policy, the regionalized health personnel recruitment policy, aimed at front-line workers such as nurses, midwives, and birth attendants. This study aimed to describe the policy’s development, formulation, and implementation process for the regionalization of health worker recruitment in Burkina Faso.MethodsWe conducted a qualitative study. The unit of analysis is a single case study with several levels of analysis. This study was conducted in three remote areas in Burkina Faso for the implementation portion, and at the central level for the development portion. Indepth interviews were conducted with Ministry of Health officials in charge of human resources, regional directors, regional human resource managers, district chief medical officers, and health workers at primary health centres. In total, 46 indepth interviews were conducted (February 3 - March 16, 2011).ResultsDevelopment The idea for this policy emerged after finding a highly uneven distribution of health personnel across urban and rural areas, the availability of a large number of health officers in the labour market, and the opportunity given to the Ministry of Health by the government to recruit personnel through a specific budget allocation. Formulation The formulation consisted of a call for job applications from the Ministry of Health, which indicates the number of available posts by region.The respondents interviewed unanimously acknowledged the lack of documents governing the status of this new personnel category. Implementation During the initial years of implementation (2002-2003), this policy was limited to recruiting health workers for the regions with no possibility of transfer. The possibility of job-for-job exchange was then approved for a certain time, then cancelled. Starting in 2005, a departure condition was added. Now, regionalized health workers can leave the regions after undergoing a competitive selection process.ConclusionThe policy was characterized by the absence of written directives and by targeting only one category of personnel. Moreover, there was no associated incentive—financial or otherwise—which poses the question of long-term viability.ContexteLe maintien en poste du personnel de la santé dans des régions éloignées est un des principaux problèmes des systèmes de santé partout dans le monde. Pour tenter de régler ce problème, le gouvernement du Burkina Faso a mis en oeuvre depuis 2002 une politique de rétention du personnel dite politique de recrutement régionalisé du personnel de la santé qui concerne les agents de première ligne que sont le personnel infirmier, les sages-femmes et les accoucheuses. Le présent article a pour objectif de décrire le processus d’émergence, de formulation et de mise en oeuvre de cette politique de régionalisation du recrutement du personnel de la santé au Burkina Faso.MéthodesNous avons mené une étude qualitative. L’unité d’analyse est une étude de cas unique avec plusieurs niveaux d’analyse. L’étude a été menée dans trois régions éloignées du Burkina Faso pour la mise en oeuvre et de façon centralisée pour l’émergence. Des entrevues approfondies ont été menées avec des fonctionnaires du ministère de la Santé qui étaient ou ont été responsables des ressources humaines, des directeurs régionaux, des gestionnaires régionaux des ressources humaines, des médecins-chefs de districts et des travailleurs de la santé dans des centres de soins de santé primaires. Au total, 46 entrevues approfondies ont été menées avec des intervenants de différents groupes entre le 3 février et le 16 mars 2011.RésultatsÉmergence L’idée de cette politique a émergé à la suite du constat de la répartition très inégale entre milieux urbains et ruraux du personnel de la santé d’une part, et d’autre part de la disponibilité d’un grand nombre d’agents de santé sur le marché du travail et de la possibilité offerte au ministère de la Santé de recruter du personnel grâce à l’allocation d’un budget spécifique par le gouvernement. Formulation La formulation consistait en un appel de candidature du ministère de la Santé qui indiquait le nombre de postes disponibles par région.Les participants rencontrés sont unanimes pour reconnaitre l’inexistence de lignes directrices concernant le statut de cette nouvelle catégorie de personnel. Mise en oeuvre Au cours des premières années de sa mise en oeuvre (2002-2003), cette politique se résumait aux recrutements du personnel pour les régions sans aucune possibilité de départ. La possibilité d’effectuer une permutation poste pour poste a été acceptée un certain temps, puis a de nouveau été supprimée. À partir de 2005, une condition de départ a été ajoutée. Désormais, les agents régionalisés peuvent quitter les régions après l’admission à un concours professionnel.ConclusionsCette politique est limitée par l’absence de lignes directrices écrites et par le fait qu’elle ne s’adresse qu’à une catégorie de personnel. De plus, aucun incitatif, financier ou non, n’y a été associé, ce qui pose le problème de sa viabilité à long terme.

Effectiveness of facility-based personalized maternal nutrition counseling in improving child growth and morbidity up to 18 months: A cluster-randomized controlled trial in rural Burkina Faso

Problématique. Le Burkina Faso a utilisé différentes stratégies de vaccination auxquelles d’importantes ressources ont été allouées, cependant la couverture vaccinale est demeurée insuffisante. Au niveau périphérique du système de santé, à son interface avec la communauté, se développent des « cultures locales de vaccination ». Objectif. Analyser les composantes de ces cultures locales de vaccination : (i) l’étiologie attribuée aux maladies du programme élargi de vaccination (PEV), son acceptation et ses avantages perçus et ; (ii) les expériences de vaccination. Méthodes. Des focus groups (21) et des entretiens individuels semi-dirigés (13) ont été réalisés dans deux aires sanitaires (ayant les meilleurs et les moins bons résultats en matière de vaccination), d’un district sanitaire au Burkina Faso. Résultats. Les maladies cibles du PEV sont bien connues et sont classées parmi les maladies du « blanc », catégorie de maladies devant être traitées au centre de santé. Malgré leur recours à la médecine traditionnelle, les populations attribuent la régression de la fréquence et de la gravité des épidémies de rougeole, coqueluche et poliomyélite à la vaccination. La fièvre et la diarrhée post vaccinales peuvent être vues comme un succès ou une contre-indication de la vaccination. Les deux centres de santé appliquent les mêmes stratégies et font face aux mêmes barrières à l’accessibilité. A Yirtan, l’organisation de la vaccination est meilleure, le comité de gestion y est impliqué et l’agent de santé est plus disponible ; il accueille mieux les mères et est soucieux de s’intégrer à la communauté. On y note une meilleure mobilisation sociale. Conclusion. Le contraste de deux cultures locales de vaccination différentes, montre que le comportement de l’agent de santé en constitue la composante déterminante. Tant dans la sphère professionnelle que personnelle, il doit créer un climat de confiance avec la population qui acceptera de faire vacciner ses enfants, pour autant que le service soit disponible.

Effect of maternal death reviews and training on maternal mortality among cesarean delivery: post-hoc analysis of a cluster-randomized controlled trial

Objective. To investigate the relationship between IGF-I and the nutritional status of West-African children hospitalised for nutritional rehabilitation. Patients and methods. A cohort study was performed in two centres for nutritional rehabilitation and education (CREN) in Burkina Faso. Children were followed and the anthropometric data as well as the capillary blood samples were taken on the 7th and on the 14th days after their admission. IGF-I levels were determined from dried blood spots on filter paper on IGF-I RIA, after separation of the IGF-I from its binding proteins, using Sep-Pak chromatography. Results. A total of 59 children was included in the cohort. The IGF-I mean geometric values (SD) were 6.3 (1.4) μg/L on admission, 8.6 (1.8) μg/L at day 7 and 13.6 (2.0) μg/L at day 14. The differences between these values were statistically significant (P < .001). There is a significant correlation between the changes of IGF-I with the change of weight for height Z-score (P = .01). Conclusion. These results suggest that IGF-I can be considered as a potential marker to follow the nutritional status of children admitted in hospital for protein and energy malnutrition.