Search

The COVID-19 outbreak has spread all around the world in less than four months. However, the pattern of the epidemic was different according to the countries. We propose this paper to describe the transmission network and to estimate the serial interval and the reproductive number of the novel coronavirus disease (COVID-19) in Burkina Faso, a Sub-Saharan African country. Data from the COVID-19 response team was analyzed. Information on the 804 first detected cases were pulled together. From contact tracing information, 126 infector-infectee pairs were built. The principal infection clusters with their index cases were observed, principally the two major identified indexes in Burkina. However, the generations of infections were usually short (less than four). The serial interval was estimated to follow a gamma distribution with a shape parameter 1.04 (95% credibility interval: 0.69–1.57) and a scale parameter of 5.69 (95% credibility interval: 3.76–9.11). The basic reproductive number was estimated at 2.36 (95% confidence interval: 1.46–3.26). However, the effective reproductive number decreases very quickly, reaching a minimum value of 0.20 (95% confidence interval: 0.06–0.34). Estimated parameters are made available to monitor the outbreak in Sub-Saharan African countries. These show serial intervals like in the other continents but less infectiousness.

To analyze implementation of maternal and neonatal death surveillance and response (MNDSR) in Cameroon to determine to what extent monitoring objectives are being met and highlight the main obstacles and facilitating factors.Secondary analysis of a cross-sectional study using a qualitative method and routine data on maternal health. Semistructured interviews were conducted with participants involved in MNDSR at the central, regional, and district levels.Notification of maternal deaths has been incorporated into the Integrated Disease Surveillance and Response (IDSR) system since January 2014. However, maternal deaths are underreported in most hospitals and neonatal and community deaths are not recorded. Comprehensive review of maternal deaths does not occur in all hospitals despite training of providers in 2013 on how to conduct reviews.Implementation of MNDSR in Cameroon is insufficient. More commitment from the Ministry of Health is needed to develop an action plan and secure funding.

To identify barriers to the implementation of maternal death reviews in health districts in Burkina Faso.We conducted a multiple case study in seven health facilities chosen by contrasted purposive sampling. Sampling criteria were based on intrahospital maternal mortality rates and the location of the health facility. Data collection was conducted from April 27 to May 30, 2015, using structured and semistructured interviews and data extraction from source documents. Data were analyzed using a thematic approach.Barriers to quality maternal death reviews identified were primarily implementation conditions, including poor skills and motivation of healthcare personnel, low interest in quality of care, lack of suitable equipment, insufficient coordination and collaboration between health services, insufficient monitoring, and weakness in programming and conducting the reviews.Barriers to achieving quality maternal death reviews remain numerous at the operational level of the health system. Taking steps to remove these barriers is key to improving the quality of maternal death reviews and childbirth outcomes in Burkina Faso.

Esme Marie Laure Essis,1– 3 Wambi Maurice Evariste Yaméogo,4 Olivier Gbènamblo Sossa,5 Daouda Doukouré,1,2 Rachidatou Compaoré,4,6 Djoukou Olga Denise Kpebo,1,2,7 Marie Laurette Agbré-Yacé,1,2 Joseph Aka,1,7 Issiaka Tiembré,7,8 Blaise Sondo,4 Seni Kouanda4,6 1National Institute of Public Health, Abidjan, Cote d’Ivoire; 2Reproductive Health Research Unit of Cote d’Ivoire, Abidjan, Cote d’Ivoire; 3Doctoral School in Science, Health, and Technology, Saint Thomas Aquinas University, Ouagadougou, Burkina Faso; 4African Institute of Public Health, Saint Thomas Aquinas University, Saaba, Burkina Faso; 5Department of Economics and Management, Thomas Sankara University, Ouagadougou, Burkina Faso; 6Research Institute of Health Sciences, Ouagadougou, Burkina Faso; 7Department of Public Health, Felix Houphouët Boigny University, Abidjan, Cote d’Ivoire; 8National Institute of Public Hygiene, Abidjan, Cote d’IvoireCorrespondence: Esme Marie Laure Essis, National Institute of Public Health, Abidjan, BP V 47, Cote d’Ivoire, Tel +225 07 07 88 72 13, Fax +225 20 22 44 02, Email essismarie2007@yahoo.frBackground: Monitoring and evaluation were introduced into the management of national health programs to ensure that results were attained, and that donors’ funds were used transparently. This study aims to describe the process of the emergence and formulation of monitoring and evaluation (M&E) systems in national programs addressing maternal and child health in Cote d’Ivoire.Methods: We conducted a multilevel case study combining a qualitative investigation and a literature review. This study took place in the city of Abidjan, where in-depth interviews were conducted with twenty-four (24) former officials who served at the central level of the health system and with six (06) employees from the technical and financial partners’ agencies. A total of 31 interviews were conducted from January 10 to April 20, 2020. Data analysis was conducted according to the Kingdon conceptual framework modified by Lemieux and adapted by Ridde.Results: The introduction of M&E in national health programs was due to the will of the technical and financial partners and the political and technical decision-makers at the central level of the national health system, who were concerned with accountability and convincing results in these programs. However, its formulation through a top-down approach was sketchy and lacked content to guide its implementation and future evaluation in the absence of national expertise in M&E.Conclusion: The emergence of M&E systems in national health programs was originally endogenous and exogenous but strongly recommended by donors. Its formulation in the context of limited national expertise was marked by the absence of standards and guidelines that could codify the development of robust M&E systems.Keywords: monitoring and evaluation, emergence, formulation, health program, Africa, Cote d’Ivoire

To analyze implementation of the maternal death surveillance and response (MDSR) strategy in Chad.Secondary data analysis of results from a cross-sectional study involving semistructured interviews with decision-makers at central, regional, and district levels, health providers, and technical and financial partners, and a document review. Data collection took place from June-July 2017.Maternal death reporting was incorporated into the Integrated Disease Surveillance and Response system but did not include neonatal deaths nor maternal and neonatal deaths in communities. Underreporting of maternal deaths owing to fear of repercussions was evident, likely associated with maternal deaths reported at monthly meetings held by the country's President with stakeholders in the health sector. Maternal death reviews were only undertaken between 2015 and 2016 in four regions of Chad and ceased in mid-August 2016. Reasons include the departure of foreign obstetricians, lack of motivation among health workers, weak accountability at all levels of the health system, organizational issues, and nonimplementation of review recommendations.Strong action is needed by the Ministry of Health to revive implementation of the MDSR system.

To assess the current system of maternal death review (MDR) in Ghana and identify the achievements, challenges, and gaps that will assist in transitioning to the maternal death surveillance and response system (MDSR).A secondary analysis of data from a cross-sectional study on MDSR implementation was conducted between September and October 2018. The MDSR cycle served as an analytical framework to measure the country's performance in implementing MDSR. Common facilitating or hindering factors were also identified.The MDR system is moderately strong at regional level with timely receipt of data and regular review meetings and reports in most regions. At district level the MDR system is less well implemented, although there is evidence of good communication with regional teams in providing timely data. Communication between districts and communities about maternal deaths seemed to be poor in general. There was no MDR committee at national level and the recommendations made were poorly implemented.MDRs in Ghana were structurally sound, but recommendations were poorly implemented. Leadership at the national level needs to be developed to ensure that the current system could transition to an MDSR system.

To assess the quality of the maternal death review (MDR) cycle in selected health facilities in Burkina Faso in accordance with national standards.A multiple case study using a qualitative approach performed in five health districts and two regional hospital centers in Burkina Faso. The facilities were chosen by contrasted purposive sampling based on hospital maternal mortality rate and urban or rural location. Structured and semistructured interviews were conducted and data analyzed thematically, horizontally, and vertically.Of the seven facilities included, six performed MDR. The MDR cycle was incomplete in five facilities because the implementation of recommendations had not been assessed. All cases of maternal death lacked vital information. Case analysis was not conducted in accordance with the national standards in most of the facilities. The action plans for implementing recommendations were not commonly used.The MDR process and its various stages did not meet quality standards. Identifying the determinants leading to lack of adherence to MDR standards will contribute to optimal choice of interventions and improving good practices in health facilities.

To evaluate the capability of high-volume comprehensive emergency obstetric care (CEmOC) health facilities on the provision of comprehensive postabortion care (PAC) in Sub-Saharan Africa and to determine the frequency of women with severe abortion-related complications in high capability facilities.A cross-sectional analysis conducted across 11 countries in Sub-Saharan Africa, using facility-level information from the World Health Organization (WHO) Multi-Country Survey on Abortion-related morbidity (MCS-A) between 2017 and 2018. PAC signal functions were adapted to assess facilities' capability to deliver comprehensive PAC through infrastructure, standard comprehensive capability, and extended comprehensive capability to provide PAC. The percentage of facilities with each signal function and distribution of facilities by number of signal functions were calculated for the three capability categories. Distribution of severe abortion complications by facility capability score was assessed.Of 210 high-volume CEmOC facilities included, 47.9% (n = 100) had capability to provide all facility infrastructure signal functions, 54.4% (n = 105) for standard comprehensive PAC, reducing to 17.7% (n = 34) for extended comprehensive PAC capability. Overall, there were gaps in extended capabilities including availability of a functioning ICU (available in 37.3% of facilities) and providers 24/7 (65.5% of facilities reported an obstetrician available 24/7 dropping to 41.3% for anesthesiologists). Facilities' PAC capability varied across regions. Overall, 34.6% (n = 614) of women with severe abortion-related complications were treated in facilities with the maximum capability score for extended comprehensive PAC.Although high levels of capability to provide abortion-related care for most signal functions were evident, significant gaps that impact on the management of severe abortion-related complications remain, particularly related to extended facility capabilities including specialized human resources and ICU.

Background. Hypertension is the leading cause of cardiovascular disease, particularly in low- and middle-income countries. Improved awareness of hypertension status can significantly increase early treatment, thereby reducing cardiovascular complications and premature death. This study aimed to report the prevalence of the awareness, treatment, and control of hypertension among the adult population in Burkina Faso. Method. We performed a secondary analysis of the first national population-based survey on common risk factors of noncommunicable diseases in Burkina Faso. It was a national representative cross-sectional survey among adults aged 25–64 years. Awareness of hypertension was defined by blood pressure ≥140/90 mmHg or a prior diagnosis by a health worker or the use of any antihypertensive drugs. A modified Poisson regression model using a generalized estimating equation was used to identify factors associated with awareness of hypertension. Result. A total of 4628 people with valid blood pressure measurements were considered. Of them, 828 had hypertension. Among people with hypertension, the prevalence of awareness was 17.5% (95% CI: 14.4%–21.1%), and 47.3% (95% CI: 37.6%–57.3%) of them had taken antihypertensive medications for their hypertension. One-third (35.5% (95% CI: 23.3%–49.9%)) of those who took medications had controlled hypertension. The prevalence of awareness was significantly higher among women (21.1% (95% CI: 16.4%–26.7%)) compared with men (13.8% (95% CI: 10.4%–17.9%)) ( p = 0.019 ). The prevalence of awareness increased with increasing age and education level. Nearly one-third (29.3% (95% CI: 25.3%–33.6%)) of people with hypertension needed antihypertensive drug treatment. Conclusion. There was a poor level of awareness, treatment, and control of hypertension among adults in Burkina Faso. Effective control strategies to increase the screening of hypertension in primary care and at the community level are necessary in Burkina Faso.

Background Women delivering in health facilities in sub-Saharan Africa and their newborns do not always receive proven interventions needed to prevent and/or adequately manage severe complications. The gaps in quality of care are increasingly pointed out as major contributing factor to the high and slow declining perinatal mortality rates. The World Health Organization Safe Childbirth Checklist (WHO-SCC), as a quality improvement strategy, targets low cost and easy to perform interventions and suits well with the context of limited resource settings. In this matched-pair cluster randomized controlled trial, we assess the effectiveness of the WHO-SCC in improving healthcare providers’ adherence to best practices and ultimately improving childbirth outcomes. Methods This is a multi-country study. In each country we will carry out a matched-pair cluster randomized controlled trial whereby four pairs of regional hospitals will be randomized on a 1:1 basis to either the intervention or control group. A context specific WHO-SCC will be implemented in the intervention facilities along with trainings of healthcare providers on best childbirth practices and ongoing supportive supervisions. The standard of care will prevail in the control group. The primary outcome is a summary composite metric that combine the following poor childbirth outcomes: stillbirths, maternal deaths, early neonatal deaths, severe postpartum hemorrhage, maternal infections, early neonatal infections, prolonged obstructed labor, severe pre-eclampsia, uterine rupture in the health facility, eclampsia and maternal near miss. The occurrence of these outcomes will be ascertained in a sample of 2530 childbirth events in each country using data extraction. A secondary outcome of interest is the adherence of healthcare providers to evidence best practices. This will be measured through direct observations of a sample of 620 childbirth events in each country. Discussion Our study has the potential to provide strong evidence on the effectiveness of the WHO-SCC, a low cost and easy to implement intervention that can be easily scaled up if found effective. Trial registration The trial was registered in the Pan-African Clinical Trials Registry on 21st January 2020 under the following number: PACTR202001484669907. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9662

Background Exclusive breastfeeding is critical for infant survival and development. However, the rate of exclusive breastfeeding in the first 6 months of life is low in sub-Saharan Africa. With the current trend in breastfeeding rates in many countries including in Guinea, the World Health Assembly target of at least 50% of children aged less than 6 months being exclusively breastfeed by 2025 is likely to be compromised and lives a numerous infant that are be at risk. The objective of this study was to identify the individual and contextual determinants of the practice of Exclusive Breastfeeding (EBF) in Guinea. Method We conducted a secondary analysis of data from the 2018 Guinea Demographic and Health Survey (DHS). The study population consisted of women who gave birth between the ages of 15 and 49. Our sample consisted of women who had their last birth six (06) months prior to collection. The enumeration areas were our second level. A multilevel logistic regression was performed using Stata version 15.1 software. Three statistical models were implemented: The final model was obtained using the bottom-up step-by-step method. The intra-class correlation coefficient was calculated. Results On the 851 women included in our study, 33% reported having exclusively breastfed during the first 6 months of life of their children. After a multivariate analysis, the variables associated with exclusive breastfeeding are: children aged 2–3 months (OR = 0.53 CI95% = [0.36–0.79]) and children aged 4–5 months (OR = 0.23 IC95% = [0.14–0.36]), women in the Faranah area (OR = 2.69 IC95% = [1.21–5.94]) and those in Mamou (OR = 2.27 IC95% = [1.00–5.94]), women who gave birth in a health facility (OR = 1.94 IC95% = [1.34–2.80]) and women living in polygamous households (OR = 0.68 IC95% = [0.48–0.98]). Conclusion The practice of exclusive breastfeeding remains low in Guinea. For the achievement of Sustainable Development Goals, particularly the improvement of exclusive breastfeeding practices, the individual and contextual determinants identified in this study should be taken into consideration in policies and programmes.

A person with a disability regardless of the gender has an increased risk of sexual coercion and violence in various ways. This study aimed to analyze the prevalence and the risk factors associated with lifetime sexual violence among people with disabilities (PWDs) in Burkina Faso. We conducted a secondary analysis of a cross-sectional study carried out in Central, Central-East, Central-West and "Hauts Bassins" regions of Burkina Faso. PWDs were selected during a household survey through a two-stage random sampling technique. The prevalence of sexual violence in people disabilities was 7.4% (95%: CI 5.8-9.4). Females with disabilities were more likely than males with disabilities to report lifetime sexual violence (8.9% vs. 4.9%). The place where the person usually spends time and the disability duration were significantly associated with the occurrence of sexual violence among females with disability. There is no association between the other demographic characteristics and sexual violence among people with disability.

COVID-19 has worsened the health situation in Burkina Faso. In fact, the country has known a peak of the second wave, which began in November, and ended around January 2021. Biological diagnosis has played a key role in the management of COVID-19. The aim of this review paper is to address the practical aspects that laboratories have faced in order to meet the challenge of SARS-CoV-2 diagnosis in Burkina Faso. According to international requirements, Burkina Faso has used real-time Reverse Transcription Polymerase Chain Reaction (rRT-PCR) as the “gold standard” for the diagnosis of COVID-19. From March 9, 2020 to July 31, 2021, in Burkina Faso, laboratories involved in COVID-19 diagnosis analyzed 226,189 samples by molecular tests and 2, 352 samples by rapid antigenic tests, whose peak was in January 2021 with 35,984 samples analyzed. The daily average rate of samples analysis was 456.02 tests. The majority of the individuals requesting COVID-19 tests were travelers (62.00%), followed by contact cases (18.42%), suspected cases (7.95%), voluntary screening (7.57%), and 4.06% of other applicants consisting of health care personnel and at-risk patients. In terms of prevention, vaccines are being administered to the general population. However, some efforts must be made to provide automated sample analysis equipment and complete sequencing of SARS-CoV-2 remains among the challenges.

IntroductionCOVID-19 has led to an unprecedented increase in demand on health systems to care for people infected, necessitating the allocation of significant resources, especially medical resources, towards the response. This, compounded by the restrictions on movement instituted may have led to disruptions in the provision of essential services, including sexual and reproductive health (SRH) services. This study aims to assess the availability of contraception, comprehensive abortion care, sexually transmitted infection prevention and treatment and sexual and gender-based violence care and support services in local health facilities during COVID-19 pandemic. This is a standardised generic protocol designed for use across different global settings.Methods and analysisThis study adopts both quantitative and qualitative methods to assess health facilities’ SRH service availability and readiness, and clients’ and providers’ perceptions of the availability and readiness of these services in COVID-19-affected areas. The study has two levels: (1) perceptions of clients (and the partners) and healthcare providers, using qualitative methods, and (2) assessment of infrastructure availability and readiness to provide SRH services through reviews, facility service statistics for clients and a qualitative survey for healthcare provider perspectives. The health system assessment will use a cross-sectional panel survey design with two data collection points to capture changes in SRH services availability as a result of the COVID-19 epidemic. Data will be collected using focus group discussions, in-depth interviews and a health facility assessment survey.Ethics and disseminationEthical approval for this study was obtained from the WHO Scientific and Ethics Review Committee (protocol ID CERC.0103). Each study site is required to obtain the necessary ethical and regulatory approvals that are required in each specific country.

To evaluate the maternal death surveillance and response (MDSR) implementation process in two health districts in Burkina Faso and identify factors that have affected implementation.We conducted a case study in two health districts selected by purposive sampling according to location (rural or urban) during the period 2015-2016. Data gathering consisted of semi-structured interviews with several health personnel involved in the implementation process.Identification and notification of deaths varied depending on the facility. Maternal death review sessions were irregular, and the completion rate was lower in urban areas The community component has not yet been implemented and review of newborn deaths is not yet standard practice. Follow-up and implementation of the review recommendations were inadequate.Implementation of the MDSR system in Burkina Faso remains in progress. Improvements are needed in notification of deaths occurring at community level, monitoring and evaluation, and integration of newborn deaths into the process.

People with disability face stigmatization in most of African countries. The objective of this study was to determine the prevalence and the factors associated with stigma among people living with a disability in Niger. This is a secondary analysis of data from a cross sectional study on disability and HIV conducted in Niger from June to November 2018. People with disabilities in grades 3 and 4 identify with Washington Group Short Set of Questions, aged 15-60, were included. Factors associated with stigma were identified by a binary multilevel regression model. A total of 820 participants were included. The prevalence of stigma was 18%. People with intellectual (adjusted odds ratio [aOR]: 1.89; 95% Confidence interval [95%CI] [1.58-5.03]) and cognitive (aOR:2.82; 95%CI 1, 14-3.13]were more likely to experience stigma than other types of disabilities. People with disabilities over the age of 20 were 57% to 71% less likely to be stigmatized than people with disabilities aged 15-19. Living in the same accommodation with other people with disabilities was also a protective factor against the experience. There is a need to implement interventions to reduce the stigmatization of people with disabilities in Niger.

Introduction : Les hopitaux publics en Afrique sub-saharienne se caracterisent par une faiblesse de leurs performances. Aussi, le Burkina Faso a-t-il experimente un mode de gestion prive dans un hopital public pour ameliorer sa performance.Objectif : Evaluer la performance du CHU de Tengandogo (CHU-T) de Ouagadougou, un hopital public a mode de gestion privee.Methode : Il s’agit d’une etude transversale realisee dans le service des urgences medico-chirurgicales. Les techniques de collecte de donnees ont consiste en une revue documentaire avec une extraction de donnees quantitatives (indicateurs de performance hospitaliers) et des entretiens individuels semi-structures aupres d’informateurs cles. Les donnees ont ete collectees en avril 2017. Le cadre d’analyse couvre la continuite, l’efficacite et l’efficience des services, la securite du personnel et l’environnement de travail.Resultats : L’etude a montre que la performance du CHU-T etait entravee par la rupture frequente des medicaments et consommables medicaux, l’etat de degradation des infrastructures et des equipements, les difficultes de coordination des soins entre les services, l’etiquette « hopital pour riches » et l’absence de donnees relatives a la securite des patients et du personnel.Conclusion : Cette etude a montre que ce modele de gestion n’a pas permis d’ameliorer la performance attendue de l’hopital. D’autres facteurs devraient etre consideres pour resoudre les problemes structurels affectant la performance des hopitaux en Afrique.

Introduction: The HbsAg prevalence in Burkina Faso was 9.1%. We aimed at describing the therapeutic features and the clinical outcome for the patients taking antiretroviral treatment. Materials and Methods: We implemented a cross-sectional study from January 1st, 2004 to December 31st, 2015. Patients aged more than 15 years with positive hepatitis B surface antigen for over six months and positive hepatitis B e-antigen were included. Results: We analyzed the data of 148 participants for a sex ratio of 3; sixty-three patients including 49 men (77.8%) were on treatment. and 81.5% had inflammatory activity greater than one. Under tenofovir, the normalization of ALT was observed in 42 (84%) patients while HBV-DNA became undetectable in 24/33 patients. HBeAg negativation was observed in 16/25 (64%) patients after seven years of treatment. With lamivudine, 2/9 patients had a complete virologic response and six had a normalization of their ALT. Two and 9 patients lost HBeAg after 7 and 9 years of treatment, respectively. Overall 63% and 27% of the patients were in the high or low-adherence group, respectively. In the low-adherence group, all patients had normal or abnormal ALT, but detectable HBV DNA. Ten patients taking lamivudine developed resistance including primary resistance in three patients. No resistance has been observed with tenofovir. Conclusion: The management of the viral hepatitis B includes often a long follow up period without any medication. When antiviral is indicated, the adherence to the treatment is crucial to a long-term control of the virus. In our setting, the low purchase power of the patients may jeopardize their therapeutic future and there is a need to support this group of patients with free-of-charge medicines as it is provided for the HIV infected people.

Background: Quality assurance in labor and delivery is needed. The method must be simple and consistent, and be of universal value. The 10-Group Classification System is a simple method providing a common starting point for further detailed analysis within which all perinatal events and outcomes can be measured and compared. Objective: The purpose of this study was to analyze cesarean section (CS) rates using the classification system of Robson’s ten groups and to identify the main contributors to the overall CS rate in Burkina Faso’s regional and university hospitals. Materials and Method: A cross-sectional study with retrospective collection was carried out. All women who gave birth between July 1, 2017 and June 30, 2018, in the Regional Hospital Centres (RHC) and University Hospital Centres (UHC) of Burkina Faso were classified according to the Robson ten-group method. The overall CS rates and in each Robson group were calculated, as well as the contribution of each group to the overall CS rate. Results: The CS rate was 26.5% (8543 out of 32,240 deliveries) during the study period. nulliparous women with single term pregnancy in cephalic presentation during spontaneous labour (group 1), multiparous women with single pregnancy in cephalic presentation, gestational age ≥37SA, spontaneous labour (group 3) and multiparous women with previous CS (group 5) were the main contributors (67.7%) to the overall CS rate. In addition, we observed a variation in CS rates between different hospitals, especially among women with full-term pregnancies in cephalic presentation without previous CS (groups 1 to 4), showing large differences in emergency obstetric and neonatal care across the country. Conclusions: Women in groups 1, 3 and 5 were the most important contributors to the overall CS rate in Burkina Faso. It appears that efforts to reduce the overall rate of CS should focus on vaginal delivery on the scarred uterus, reduction of CS rates in nulliparous women with full-term pregnancy in cephalic presentation (groups 1) and proper monitoring of multiparous women with full-term pregnancy in spontaneous labour (group 3).

To evaluate the implementation of the maternal and neonatal death surveillance and response (MNDSR) system at county level in Liberia.Secondary analysis of data from a cross-sectional study carried out in March 2016, using both quantitative and qualitative methods to collect data in five counties based on set criteria. Three health facilities were selected in each county through the Health Management Information System (HMIS) by random sampling. The evaluation was also carried out in one catchment community per health facility and at the county referral hospital. Primary data were collected through individual interviews and a review of MNDSR tools and structure. Data were analyzed using thematic analysis.Implementation of the MNDSR system was very low in the five counties. Only two out of the five counties were currently conducting MNDSR. MNDSR guidelines and standard operating procedures were not available at the county level. Only 12 (23.5%) health facilities had a maternal and neonatal death review committee. Less than a quarter of the assessed community members could correctly give the definition of a maternal or neonatal death.The MNDSR system is weak in Liberia, at county, health facility, and community levels. Strong national commitment is needed in collaboration with diverse partners for successful implementation of the system.

The co-occurrence of cardiovascular risk factors is usually associated with a higher risk of cardiovascular disease (CVD) or cancer. This study aimed to determine the prevalence of the co-occurrence and its determinants and to identify the clustering profiles of lifestyle risk factors among the adult population in Burkina Faso. Among 4692 participants, 4377 adults from the first STEPS survey conducted in Burkina Faso were considered in this analysis. Four lifestyle risk factors (smoking, alcohol consumption, inadequate fruit and vegetable intake and low physical activity) were analysed. The clustering was evaluated using the observed/expected (O/E) ratio approach. To identify the determinants of co-occurrence, we performed a modified Poisson regression. The prevalence of the co-occurrence of two or more cardiovascular lifestyle risk factors was 46.4% (95% CI: 43.1–49.7). The main determinants of the co-occurrence were being male (adjusted prevalence ratio (aPR): 1.27 (95% CI: 1.16–1.38)), advanced age (55–64 years old: aPR: 1.45 (95% CI: 1.31–1.60)) and a high level of education (aPR: 1.29 (95% CI: 1.09–1.52)). The clustering profile for lifestyle risk factors was tobacco consumption combined with alcohol consumption (O/E: 2.77 (95% CI: 2.12–3.56)), and concurrent involvement in all four lifestyle risk factors (O/E = 1.51 (95% CI: 1.19–1.89)). This first population-based report on the co-occurrence of lifestyle risk factors calls for action to tailor health-promoting interventions to increase healthy lifestyle behaviors. The identified CVD-risk clustering should be considered as an important step in this strategy development in Burkina Faso.

Many studies have shown the HIV vulnerability of people with disabilities (PWD). This vulnerability is supported by risky sexual behaviours, which need to be well described. The objective of this study is to identify predictors of sexual behaviours at risk of HIV infection among PWD in Burkina Faso. We conducted a population-based cross-sectional study on disability and HIV in four regions in Burkina Faso. PWD were selected through a probabilistic method. The Washington Group Short questionnaire was used to identify PWD. Five sexual risk behaviours were considered in this analysis (having multiple sex partners, starting sex at an early age, having had sex with a nonregular partner, sex in return for payment and condomless sex). A composite variable was created and called "risky sexual behaviour (RSB)", which was defined in three categories (low risk, moderate risk and high risk) based on the co-occurrence of the individual sexual risk behaviours. Generalized structural equation was used to identify the predictors of RSB withincome possession as a mediator. A total of 973 PWD were included in this study. The proportion of PWD who were engaged in at least two risky sexual behaviours was 9.5% (95%CI: 6.5-13.8), those with one risky sexual behaviour represented 42.8% (95%CI: 39.4-46.3) and less than half ( 47.7% (95%CI: 43.3-52.1)) werenot engaged in risky sexual behaviour. The prevalence of HIV increased with the level of risky sexual behaviour. Age, education level and type of disability have a significant direct effect on RSB. Indeed, the oddof engaging in sexual risk behaviour was low among PWD who attended at least secondary school compared to those who were not schooled (adjusted odds ratio (aOR): 0.62 (95%CI: 0.41-0.92). The indirect effect of sex on RSB mediating by income possession was significant. Indeed, women with income have a low oddof engaging in RSB compared to men (aOR: 0.83 [95%CI: 0.71-0.98]). Our results confirm a certain ambivalence in the sexuality of people with disabilities. Hence, there is a need for a particular focus on risky sexual behaviour to enable the development of an effective HIV strategy in this group.

This study aimed to determine the prevalence and risk factors of HIV infection among people with disabilities (PWDs) in Burkina Faso. We carried out a cross-sectional study on level 3 and/or 4 disabled people. Identification of PWDs aged 15-69 years was done in households using the Washington Group (WG) Short questionnaire, following by HIV behavioural survey and HIV testing. Multi-level binary logistics Bayesian analysis was done to identify factor associated with HIV. In total, 973 PWDs were included in this study. HIV prevalence was 4.6% (3.3-6.1%). Independent factors associated with HIV infection were aged 35-44 years old (AOR: 8.93; 95% CrI: 3.57-18.89), had visual or hearing impairments (AOR: 6.38; 95%CrI: 1.95-15.44), no income (AOR:6.11; 95% CrI: 2.49-12.48), and had casual sex partners (AOR: 6.28; 95% CrI: 3.27-11.13). HIV prevalence is high compared to the general population. These data suggest a need for comprehensive and specific HIV prevention among people with disabilities, including awareness for safer sexual behaviours.

The aim of this work was to report for the first time the prevalence of HIV infection among people with disabilities (PWDs) in Niger. The Washington Group Short questionnaire was used to identify people with disabilities during a household survey. Blood samples for HIV testing were collected using the Dried Blood Sampling (DBS) method. HIV testing was performed according to the Niger national HIV testing guideline. A total of 21,979 persons aged 15-69 years were screened, of them 2237 (10.17%) had disabilities and 949 participants (4.32%) had severe disabilities (level 3 or 4). Finally, 821 participants agreed to participate in the HIV testing. Female persons with disabilities accounted for the majority (52.25%). People with physical impairment were mostly represented (39.27%) followed by those with visual impairment (38.66%). At least one-third had multiple impairs (36.91%). HIV prevalence among person with disabilities was 0.66% (95% CI: 0.33-1.30). There is no difference between HIV prevalence and type of disabilities or socio-demographic characteristics. Hence, there is a need to consider them in the development and implementation of an effective HIV strategy.

Previous studies on HIV and disability have reported the vulnerability of people with disabilities (PWDs) to HIV and the need to include them in HIV prevention programs. However, in Mali, data on HIV among this population is scarce. This study aims to estimate HIV prevalence and risk factors among people with disabilities in Mali. We conducted a household-based cross-sectional study in six regions of Mali. The Washington Group (WG) short questionnaire was used to identify PWDs in the household. A total of 1051 PWDs were included in the study. The prevalence of HIV infection among people with disabilities in Mali was 2.38% (25/1051), with a 95% confidence interval (CI) of 1.58%-3.44%. HIV prevalence was higher in women (3.31% [95%CI: 2.14-4.88]) than in men (0.78% [95%CI: 0.22-2.06]). People with visual or intellectual functional limitations were the most affected, with 3.93% (95%CI: 2.22-6.44) and 2.67% (95%CI: 0.56-8.28), respectively. Multivariate analysis shows that age, sex, type of disability and sexual violence are the risk factors for HIV infection among people with disabilities in Mali. These results suggest that HIV strategies should include people with disabilities in order to achieve the target of ending the HIV/AIDS epidemic by 2030 in Mali.

Background: Chronic renal failure is a serious pathology requiring renal dialysis. The number of patients under dialysis has increased considerably in the world and particularly in sub-Saharan Africa. Dialysis is a very expensive care. This is the reason why this study on the costs of dialysis management was initiated in Burkina Faso. The study objective is to determine the direct medical and non-medical costs of managing chronic renal failure among patients undergoing dialysis in Ouagadougou in 2020.Methods: An analytical cross-sectional study was conducted. Data were collected in the hemodialysis department of three public university hospitals in Ouagadougou, Burkina Faso. All dialysis patients with chronic renal failure were included in the study. Linear regression was used to investigate the determinants of the direct medical and non-medical cost of hemodialysis. Results: A total of 290 patients participated in this study, including children, adults, and the elderly with extremes of 12 and 82 years. Almost half of the patients (47.5%) had no income. The average monthly total direct cost across all patients was 75842 CFA or US$134.41.The average direct medical cost was 51315 CFA or US$90.94 and the average direct non-medical cost was 24 527 CFA or US$43.47. Most of the patients (45.2%) funded their hemodialysis by their own source. The multivariate analysis showed that the presence of an accompanying person during treatment, residing in a rural area, ambulatory care, use of personal cars, and treatment at the dialysis center of Yalgado Teaching Hospital were associated with higher direct costs.Conclusion: The average cost of dialysis services borne by the patient and his/her family is very high in Burkina Faso since itis 2.1 times higher than the inter-professional minimum wage in the country (34664 CFA or 61.4 $US). It appears that the precariousness of the means of subsistence strongly increases with the occurrence of chronic renal failure requiring dialysis. Thus, to alleviate the expenses borne by patients undergoing dialysis, it would be important to extend the state subsidy package to the costs of drugs and to promote health insurance to ensure equitable care for these patients.

This study used in-depth interviews with a diverse sample of women with disabilities in Burkina Faso to explore how discrimination based on gender and disability intersects and influences exposure to violence, as well as the impact of such discrimination on social participation, a theme barely studied in West Africa. The study thematically analysed the narratives of 35 women with disabilities - including mental, physical, auditory and visual - (age range = 15-53), rural and urban that were collected through four focus groups and eight case stories of rape survivors. As presented in the statements of the women surveyed, the combination of stereotypes and prejudices linked to disability and unequal gender relations make these women predominantly vulnerable to gender-based violence, especially sexual violence. This increased vulnerability to sexual assault emphasises the processes of social exclusion these women experience, at all levels of society, which for most of them results in limited social participation. The findings of this study showed the need for policies related to women's empowerment and inclusion of people with disabilities to adopt an intersectional approach, to better consider the specific issues of women with disabilities.

Background The World Health Organization Safe Childbirth Checklist tool was specifically designed for developing countries such as sub-Saharan African countries, to ensure safety and security of the couple mother and newborn around the time of childbirth. However, the implementation of the Safe Childbirth Checklist tool requires a good knowledge of the context setting to face challenges. Our study objectives were (1) to assess the acceptability of the WHO SCC tool and (2) to identify conditions and strategies for a better introduction and use of the WHO SSC tool. Methods This was a pilot multi-country study conducted from January to March 2019 in Burkina Faso and Côte d’Ivoire, respectively, in the health regions of central-North and Agnéby-Tiassa-Mé. In each health region, 5 health facilities of different levels within the health system pyramid were selected through a purposive sampling. The study was conducted in 2 phases: 38 healthcare providers and 15 managers were first trained to use the Safe Childbirth Checklist tool; secondly, the trained providers were allowed to use the tool in real-life conditions for 2 weeks. Then, semi-structured interviews were conducted among healthcare providers and managers. The topics covered by the interview guides were acceptability of the tool, barriers and facilitators to its use, as well as strategies for better introduction and use within the healthcare system. Analysis was carried out using the Nvivo 12 software. Results Respondents reported an overall good acceptance of using the tool. However, they suggested minor content adaptation. The design of the tool and increased workload were the main barriers to its use. Potential facilitators to its introduction were managers’ commitment, healthcare providers’ motivation, and the availability of supplies. The best strategies for optimal use were its attachment to existing tool such as partograph or/and its display in the maternity ward. Conclusions The findings showed that the implementation of the Safe Childbirth Checklist tool is acceptable in Burkina Faso and Côte d’Ivoire. These findings are important and will help to design a trial aiming at assessing the effectiveness of the tool WHO SCC tool in these two countries.

Almost all sub-Saharan countries have adopted cost-reduction policies to facilitate access to health care. However, several studies underline the reimbursement delays experienced by health facilities, which lead to deficient implementation of these policies. In April 2016, for its free care policy, Burkina Faso shifted from fee-for-service (FFS) paid retrospectively to FFS paid prospectively. This study tested the hypothesis that this new method of payment would be associated with an increase in direct medical expenditures (expenses covered by the policies) associated with deliveries. This paired pre-post study used data from two cross-sectional national surveys. Observations were paired according to the health facility and the type of delivery. We used a combined approach (state and household perspectives) to capture all direct medical expenses (delivery fees, drugs and supplies costs, paraclinical exam costs and hospitalization fees). A Wilcoxon signed-rank test was used to test the hypothesis that the 2016 distribution of direct medical expenditures was greater than that for 2014. A total of 279 pairs of normal deliveries, 66 dystocia deliveries and 48 caesareans were analysed. The direct medical expenditure medians were USD 4.97 [interquartile range (IQR): 4.30–6.02], 22.10 [IQR: 15.59–29.32] and 103.58 [IQR: 85.13–113.88] in 2014 vs USD 5.55 [IQR: 4.55–6.88], 23.90 [IQR: 17.55–48.81] and 141.54 [IQR: 104.10–172.02] in 2016 for normal, dystocia and caesarean deliveries, respectively. Except for dystocia (P = 0.128) and medical centres (P = 0.240), the 2016 direct medical expenditures were higher than the 2014 expenses, regardless of the type of delivery and level of care. The 2016 expenditures were higher than the 2014 expenditures, regardless of the components considered. In the context of cost-reduction policies in sub-Saharan countries, greater attention must be paid to the provider payment method and cost-control measures because these elements may generate an increase in medical expenditures, which threatens the sustainability of these policies.