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Introduction: the health information system (HIS) in Burkina Faso has improved significantly in recent years. In order to suggest further improvements, we specifically assessed the HIS performance indicators of the epidemic surveillance system from the perspectives of the stakeholders., Methods: we conducted a mixed methods study to assess the performance through timeliness and completeness indicators, strengths, and weaknesses of the HIS in Burkina Faso with specific focus on epidemic surveillance in the health districts of Dandé and Tenkodogo for the period of 2016 to 2019., Results: fewer than 35% of health districts were able to report at least 90% completeness of community reports since 2017. In 2018, four districts did not exceed 1% completeness of community reports. Some concerns remain related to a need of local support and inter-sectoral collaboration. The technical and organizational factors affect process and performance of the system directly or indirectly through behavioral determinants., Conclusion: the ability to measure the performance of all health facilities and to share all community reports online are challenges for the health system in Burkina Faso. New technologies, training-sensitization, and the involvement of actors with influence on social or behavioral change could help to ensure dynamic performance, if perceptions of actors are taken into account., Competing Interests: The authors declare no competing interests., (Copyright: Cheick Omar Diallo et al.)

Background: Digital health interventions (DHIs) have increased exponentially all over the world. Furthermore, the interest in the sustainability of digital health interventions is growing significantly. However, a systematic synthesis of digital health intervention sustainability challenges is lacking. This systematic review aimed to identify the barriers and facilitators for the sustainability of digital health intervention in low and middle-income countries., Methods: Three electronic databases (PubMed, Embase and Web of Science) were searched. Two independent reviewers selected eligible publications based on inclusion and exclusion criteria. Data were extracted and quality assessed by four team members. Qualitative, quantitative or mixed studies conducted in low and middle-income countries and published from January 2000 to May 2022 were included., Results: The sustainability of digital health interventions is very complex and multidimensional. Successful sustainability of digital health interventions depends on interdependent complex factors that influence the implementation and scale-up level in the short, middle and long term. Barriers identified among others are associated with infrastructure, equipment, internet, electricity and the DHIs. As for the facilitators, they are more focused on the strong commitment and involvement of relevant stakeholders: Government, institutional, sectoral, stakeholders' support, collaborative networks with implementing partners, improved satisfaction, convenience, privacy, confidentiality and trust in clients, experience and confidence in using the system, motivation and competence of staff. All stakeholders play an essential role in the process of sustainability. Digital technology can have long term impacts on health workers, patients, and the health system, by improving data management for decision-making, the standard of healthcare service delivery and boosting attendance at health facilities and using services. Therefore, management changes with effective monitoring and evaluation before, during, and after DHIs are essential., Conclusion: The sustainability of digital health interventions is crucial to maintain good quality healthcare, especially in low and middle-income countries. Considering potential barriers and facilitators for the sustainability of digital health interventions should inform all stakeholders, from their planning until their scaling up. Besides, it would be appropriate at the health facilities level to consolidate facilitators and efficiently manage barriers with the participation of all stakeholders., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Kaboré, Ngangue, Soubeiga, Barro, Pilabré, Bationo, Pafadnam, Drabo, Hien and Savadogo.)

Background: Health information systems (HIS) in most developing countries face many challenges. In view of the recurrent weaknesses in preparedness and response during the management of epidemics, we have examined the organization and functioning of the health information system in Burkina Faso., Methods: We conducted a cross-sectional study from January 1, 2020 to March 31, 2020 including a review of HIS documents, key informant interviews and direct observations. The study was conducted at the public primary health care (PHC) and community level of Bama and Soumagou, in the rural health districts of Dandé and Tenkodogo. Study participants included community-based health workers (CBHWs) and health workers in the PHC areas, community-based organization animators (CBOAs), CBO monitoring-evaluation officers and members of the District management team (DMT)., Results: While reporting forms used in all health facilities are standardized, they are not necessarily well understood at community level and at the health centers. Reports prepared by CBHWs are often delayed by the head nurse at the primary health care service. Case definitions of epidemic diseases are not always well understood by community-based health workers and front-line health workers., Conclusion: The health information system in Burkina Faso can be improved using simple strategies. There is a need to hold regular training/refresher sessions for agents involved in surveillance and to ensure the development of simplified case definitions for emerging diseases and/or diseases of public health interest for community use. Furthermore, existing epidemic management committees need to be revitalized., (© 2022. The Author(s).)

Introduction: hepatitis B is a severe disease that can be prevented by vaccination. However, few healthcare professionals, a group at high risk of contamination, are vaccinated against this disease in Burkina Faso. We conducted a study of healthcare professional students to evaluate their knowledge and factors associated with their propensity toward Hepatitis B vaccine., Methods: we conducted a cross-sectional, descriptive and explanatory study of 410 healthcare professional students of the National School of Public Health of Ouagadougou, Burkina Faso. Data were collected from 26 to 1 June 2020. Participants were randomly selected and were given a self-administered questionnaire., Results: less than one third of healthcare professional students were fully vaccinated against hepatitis B. A small proportion of healthcare professional students were aware of the three modes of transmission (46.6%), risks of exposure in the healthcare setting (31.2%) and disease complications (26.6%). Multivariate logistic regression showed that healthcare professional students´ awareness of the risks of exposure in the healthcare setting and complications of the disease were statistically associated with hepatitis B vaccination., Conclusion: strengthening the knowledge of healthcare professional students is necessary to improve vaccination coverage in this risk group., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Pengdewendé Maurice Sawadogo et al.)

Objectives: With the phase-out of the polio campaigns, Burkina Faso has developed a new strategy for routine community-based vitamin A supplementation (VAS) by institutionalising community-based health workers (CBHW) to sustain the gain of two decades of successful programming. Formative research was conducted soon after the strategy was introduced to solicit feedback on the acceptability of the new approach by the implementing actors while identifying the main implementation challenges for improving its effectiveness and sustainability., Design: This qualitative study was conducted in 2018 through (i) document review, (ii) individual interviews with key informants at the central, regional and district levels, and (iii) focus groups with CBHW and caregivers., Setting: Data collection was carried out at six levels of sites covering the entire country and selected based on VAS coverage rates with the community routine. A total of six health districts were selected., Participants: We conducted 46 individual interviews with health workers and 20 focus groups with 59 CBHW and 108 caregivers., Results: The study showed good acceptability of the strategy by all stakeholders. In the first 2 years of implementation, the national coverage of VAS was maintained at a high level (above 90 %) and there was a reduction in operational costs. The main challenges included delayed CBHW remuneration and weak communication and supervision., Conclusions: The acceptability of the community-based routine VAS was good and was perceived to have a high potential for sustainability. Addressing identified challenges will allow us to better manage the expectations of community stakeholders and maintain the initial results.

Objectives: To identify the drivers and challenges of successful nutrition programme implementation in a multisectoral, community-level approach to improve infant and young child feeding (IYCF) practices in northern Burkina Faso., Design: A qualitative study was conducted in 2019 through (i) individual interviews with key informants from five different sectors (health, agriculture, environment, livestock and education) and association staff, agents and community leaders and (ii) focus groups with mothers of children under the age of 2 years., Setting: Three health districts in the northern region of Burkina Faso implemented a multisectoral community nutrition programme to improve IYCF practices., Participants: Forty-seven implementing actors and twenty-four beneficiary mothers., Results: Factors influencing successful implementation include community participation; sector commitment and involvement; the existence of nutrition champions; capacity building; the integration of interventions; micronutrient powder distribution; the introduction of nutrition-sensitive interventions, such as the promotion of the consumption of orange-fleshed sweet potatoes; improved food production and small livestock rearing and the effective coordination of actors and complementary funding. The main challenges of the implementation of multisectorality are low participation among nutrition-sensitive sectors, a tendency for siloed work among sectors, scheduling conflicts, high actor mobility, differences in the target population by sector, a lack of technical skills among community workers, insufficient financial resources, low geographic convergence and coverage of beneficiaries, a lack of a multisectoral monitoring mechanism and accountability and insecurity., Conclusions: Strengthening sector participation, identifying a common targeting strategy and mobilising financial resources have the potential to significantly reduce barriers and improve the quality of implementation.

Background: The presence of diarrheagenic Escherichia coli (DEC) in drinking water, is a grave public health problem. This study was aimed at characterization of diarrheagenic Escherichia coli isolated from drinking water and faecal samples from diarrheic patients in Ouagadougou, Burkina Faso., Materials and Methods: A total of 242 water samples consisting of 182 potable sachets and 60 from boreholes were collected in the period between October 2018 and April 2019 in the city of Ouagadougou. Faecal samples were also collected from 201 diarrheic patients visiting National Public Health Laboratory for a biological diagnosis by coproculture. The presence of virulence genes associated with DEC was determined by 16-plex polymerase chain reaction from bacteria culture., Results: From drinking water, we found 17% (42/242) Escherichia coli isolates in which 1% (2/242) DEC were detected. Among analyzed samples (182 sachet water versus 60 borehole water), the two DEC (01 ETEC and 01 EPEC) were detected in sachet water. DEC were detected in 20% (40/201) of patients. Enteroaggregative Escherichia coli (EAEC) were mostly detected in 10% followed by Enteropathogenic Escherichia coli (EPEC) in 4%, Enteroinvasive Escherichia coli (EIEC) in 2%, and Shiga toxin-producing Escherichia coli (STEC) 0.5%. However, Enterotoxigenic Escherichia coli (ETEC) was not detected alone, but in co-infections with EAEC., Conclusion: The present study documented the prevalence of Escherichia coli pathovars associated in patients with diarrhea, and shows that drinking water might be a source of DEC transmission in human., Competing Interests: Conflict of interest: None., (Copyright: © 2021 Afr. J. Infect. Diseases.)

Introduction: Malnutrition is a multifactorial problem, and multisectoral planning is an indispensable tool. The objective of this study was (a) to evaluate the extent to which nutrition is integrated into policies and (b) to describe the process used by the government of Burkina Faso to reform its policy frameworks and multisectoral nutrition planning., Methods: This was a qualitative study, and data were collected in two key steps: first, through a policy overview conducted in 2015 and, second, in November 2017, through a document review and individual stakeholder interviews with 32 key actors involved in national nutrition planning., Results: The extent to which nutrition is integrated into development policies varied from one sector to another. Since 2014, Burkina Faso has initiated nutrition planning through a multisectoral approach involving six sectors. This process was implemented in three key stages. Progress includes revision of national nutrition policy towards multisectoral perspective, formulation of a consensual and quality multisectoral nutrition strategic plan, creation of nutrition budget line, and establishment of nutrition technical secretariat., Conclusion: To improve the anchoring of multisectoral coordination bodies at the supra-ministerial level, mobilizing resources and promoting sector accountability are key next steps that would contribute to the success of the implementation., (© 2019 John Wiley & Sons, Ltd.)

'Four' types of decentralization are distinguished in health care: deconcentration when the shift in authority is to regional or district offices; devolution when the shift is to state, provincial or municipal governments; delegation when semi-autonomous agencies are granted new powers; and privatization when ownership is granted to private entities. This article systematically reviews the experiences of local governments of Sub-Saharan African countries with the provision of health services during and after decentralization reforms. The article highlights the achievements, challenges and issues associated with decentralization. The review shows that most countries have mainly focused on the process by enacting numerous policies, regulations and standards with mixed outcomes for health services delivery. Decentralization in general, and resource transfer from the central to local governments in particular, are a highly political issue that influences the health reform strategy on decentralization. The literature shows the complexity of implementing decentralization schemes which strongly impact the health service organization and delivery. The theory of decision space applied in a comparative analysis found that some functions, particularly financing, remain under the control of the central state. Despite the numerous challenges, this review identifies some good practices in resources transfer, key determinants being the type of decentralization and the government's will to make legislative and administrative changes required for the effectiveness of decentralization. The literature search, even though systematic, resulted in a limited number of relevant publications with evidence on the link between decentralization and health services delivery. This is a largely unexplored research area, especially the use of financial resources by local governments, the factors that drive local decision-making processes and the effects of decentralization on health care sector performance., (© The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

One of the current strategies to prevent malaria in pregnancy is intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP). However, in order for pregnant women to receive an adequate number of SP doses, they should attend a health facility on a regular basis. In addition, SP resistance may decrease IPTp-SP efficacy. New or additional interventions for preventing malaria during pregnancy are therefore warranted. Because it is known that community health workers (CHWs) can diagnose and treat malaria in children, in this study screening and treatment of malaria in pregnancy by CHWs was evaluated as an addition to the regular IPTp-SP program. CHWs used rapid diagnostic tests (RDTs) for screening and artemether-lumefantrine was given in case of a positive RDT. Overall, CHWs were able to conduct RDTs with a sensitivity of 81.5% (95% confidence interval [CI] 67.9-90.2) and high specificity of 92.1% (95% CI 89.9-93.9) compared with microscopy. After a positive RDT, 79.1% of women received artemether-lumefantrine. When treatment was not given, this was largely due to the woman being already under treatment. Almost all treated women finished the full course of artemether-lumefantrine (96.4%). In conclusion, CHWs are capable of performing RDTs with high specificity and acceptable sensitivity, the latter being dependent on the limit of detection of RDTs. Furthermore, CHWs showed excellent adherence to test results and treatment guidelines, suggesting they can be deployed for screen and treat approaches of malaria in pregnancy.

These results suggest approaches to encourage the development of care provider skills, standardized practices and rational prescription to help improve medication use in the elderly..

Introduction: The global initiative for poliomyelitis eradication can only remain relevant if survey systems are regularly assessed. In order to identify shortcomings and to propose improvement, the data collection and transmission during case investigation were assessed in the Banfora health district in Burkina Faso., Methods: The survey targeted six (6) primary health centres, the district laboratory and the national laboratory, all involved in the poliomyelitis surveillance system. Data from registers, forms documenting suspected cases, stool sample forms and weekly reports were collected by means of a data grid. Data from actors involved in the poliomyelitis case investigation system were collected by means of an individual questionnaire., Results: The reactivity of investigating suspected cases was satisfactory with a median alert questionnaire notification time of 18 hours. The completeness of the reporting system was satisfactory. Nevertheless, the promptness of data management by primary heath centres and the national laboratory remained unsatisfactory. Evaluation of data management revealed logistic and organization shortcomings., Conclusion: The overall efficacy of the poliomyelitis surveillance could be improved by using management tools for laboratory supplies, collecting data related to the homes of suspected cases and implementing a cold chain maintenance plan.

Introduction: Assessment of patient satisfaction is an essential tool for continuing improvement of health services., Objective: In order to more clearly define what has been achieved and what remains to be achieved, from the patient's perspective, the level of satisfaction of AIDS patients managed at Dafra district hospital was assessed., Methods: This cross-sectional study was based on data from Individual interviews conducted with patients on ARV therapy forat least six months on 1st April2014. Erin's multiattribute modelwas used to identify the content of the data collection., Results: Patients were relatively satisfied with the comfort and the fact that some of their expectations were taken into account, such as nutritional support,free drug prescriptions and measurement of body temperature and blood pressure. However, they expressed complaints concerning the promptness of services, the courtesy of healthcare providers, confidentiality and questioned the skills ofhealthcare providers., Conclusion: The provision of good quality health care for AIDS patients in the Dafra health district requires permanent review of healthcare provider practices. Improvements are needed in terms of promptness of services, courtesy and confidentiality. Health care teams must take the sociocultural background of healthcare providers into account in order to develop, test and evaluate appropriate solutions.

Introduction: There is a lack of organizational knowledge concerning optimal management by the health care system for patients with chronic health conditions in sub-Saharan Africa. The objective of this study was to describe the quality of chronic patient care at first-line heath facilities in Bobo-Dioulasso, Burkina Faso., Methods: We conducted a cross-sectional study in six health facilities in Bobo-Dioulasso from October to November 2013. The chronic care model was used as a reference to describe the care of hypertensive patients. A score was calculated for each item in the model, and the strengths and weaknesses of health care organization were identified, Results: The overall level of support for the management of hypertensive patients was "basic" for all surveyed structures: median score and IQR 3.7 (3.4, 4.4). The level of support was basic for primary health facilities (median score 4.4), district hospitals (median score 4.1) and the University health center (median score 5.4). The relationship with the community and support to decision-making were identified as weak components of the model., Conclusions: To improve the quality of chronic patient care in first-line health facilities in Burkina Faso, efforts must be made to strengthen clinical governance and partnership with the community.

Introduction: Malaria prevention constitutes a key strategy to control this disease in Burkina Faso., Methods: A cross-sectional study conducted in July and August 2011, assessed malaria prevention practices of populations of peri-urban zones of the Bogodogo and Boulmiougou health districts of the city of Ouagadougou., Results: A total of 180 household heads, 192 mothers of children under the age of 5 years and 30 pregnant women were surveyed. For 86.7% household heads, 92% of mothers of children under the age of five years and 96.5% of pregnant women, mosquito bites represented the main mode of transmission of malaria. The majority of survey subjects reported a preference for mosquito coils rather than mosquito nets on the night preceding the survey., Discussion: The content of malaria prevention communication must take into account sociodemographic realities and lifestyles of population groups, such as those living in peri-urban regions.

In theory, the removal of user fees puts health services within reach of everyone, including the very poor. When Burkina Faso adopted the DOTS strategy for the control of tuberculosis, the intention was to provide free tuberculosis care. In 2007-2008, interviews were used to collect information from 242 smear-positive patients with pulmonary tuberculosis who were enrolled in the national tuberculosis control programme in six rural districts. The median direct costs associated with tuberculosis were estimated at 101 United States dollars (US$) per patient. These costs represented 23% of the mean annual income of a patient's household. During the course of their care, three quarters of the interviewed patients apparently faced "catastrophic" health expenditure. Inadequacies in the health system and policies appeared to be responsible for nearly half of the direct costs (US$ 45 per patient). Although the households of patients developed coping strategies, these had far-reaching, adverse effects on the quality of lives of the households' members and the socioeconomic stability of the households. Each tuberculosis patient lost a median of 45 days of work as a result of the illness. For a population living on or below the poverty line, every failure in health-care delivery increases the risk of "catastrophic" health expenditure, exacerbates socioeconomic inequalities, and reduces the probability of adequate treatment and cure. In Burkina Faso, a policy of "free" care for tuberculosis patients has not met with complete success. These observations should help define post-2015 global strategies for tuberculosis care, prevention and control.

In developing countries, few data are available on healthcare-associated infections. In Burkina Faso, there has been a failure to take into account risk management and patient safety in the quality assurance program. The main objective of our study was to carry out an assessment of healthcare-associated infection in a first level hospital. We conducted a cross-sectional study in June 2011 in the care units of Ziniaré District Hospital (Ziniaré, Burkina Faso). The hospital has been divided in three components: i) hospital population (care providers, in-patients and patients' guardians); ii) healthcare and services organization; iii) hospital environment. We included: care providers of the clinical services, hospital in-patients and patients' guardians, hospitalization infrastructure and nursing units, and all the documents relating to standards and protocols. Data collection has been done by direct observation, interviews and biological samples taken at different settings. In hospital population, care providers and patients' guardians represented a high source of infection: adherence to hygiene practice on the part of care providers was low (12/19), and no patients' guardian experienced good conditions of staying in the hospital. In healthcare and services organization, healthcare waste management represented a high-risk source of infection. In hospital environment, hygiene level of the infrastructure in the hospital rooms was low (6.67%). Prevalence of isolated bacteria was 71.8%. Urinary-tract catheters infections were the most significant in our sample, followed by surgical-site infections. In total, 56.26% (9/19) of germs were -Lactamase producers (ESBL). They were represented by Escherichia coli and Klebsiella pneumoniae. Our analysis identified clearly healthcare-associated infection as a problem in Ziniaré district hospital. Hence, a national program of quality assurance in the hospitals should now integrate the risk infectious management of healthcare-associated infections., Competing Interests: Conflict of interests: authors declare that they received financial assistance from the CUD through the EDULINK project in Benin and Burkina Faso.

The purpose of this study was to evaluate the implementation of a treatment protocol based on artemisinin-based combination therapy for the treatment of uncomplicated malaria in rural areas. Population and methods. A descriptive and comparative study was conducted in the rural health district of Houndé (Burkina Faso). The study involved health care providers, managers of essential drug depots and health centers, and patients receiving a prescription for an antimalarial drug. The data were entered and analyzed using the Epi Info 3.3.1 software package. The Chi-square test was used to compare proportions at the 0.05 level. A total of 130 prescribers and 30 managers of essential drug depots were interviewed in 28 health centers. In addition, 165 prescriptions including an antimalarial drug were collected. Of the 130 prescribers surveyed, 84.6% knew about the new treatment guidelines for uncomplicated malaria. The study found that 64.8% of the prescriptions were for ACTs, while quinine accounted for 35.2% of the prescriptions. Artesunate-amodiaquine combination therapy accounted for 98.1% of the prescriptions for antimalarial drug combination therapy. 82.4% of the prescriptions were adequate, with significantly more adequate prescriptions in clinics than in maternity hospitals (p = 0.009). Children under 5 years of age were treated better than other age groups (p < 0.001). In 89.7% of drug depots, there was evidence of a shortage of artemisinin-based combination drugs at least once in the two months before the study, most notably in the case of artesunate-amodiaquine therapy. The results highlight the importance of continuing training for treatment providers and of strict procedures for managing stocks of artemisinin-based combination drugs.

In Burkina Faso, the management of TB/HIV co-infection presents a challenge for policy-makers and the health-care system, with its psychological, sociocultural and biomedical issues. The purpose of this paper is to describe the concerns caused by this co-infection and propose a management strategy for these patients. These findings result from a qualitative socio-anthropological study during a public health project in three health districts from 2006 to 2008 and from the observation of care practices in health centres. Patients face a double burden: the negative social image of both diseases and complicated difficult treatment. They deal with problems of social integration, with their social relations impaired by humiliation and marginalisation. The painful experience of daily doses of antiretroviral and anti-TB drugs creates bitterness against drugs, aggravated sometimes by apparently capricious care. In addition to economic insecurity, these chronically ill patients face social stigma and marginalisation, all damaging to their self-esteem.

There is increasing evidence demonstrating the importance of healthcare systems for improvement of chronic illness care. The aims of this study were to develop a comprehensive assessment of the health services capacity to provide tuberculosis (TB) and human immunodeficiency virus (HIV) care but also to enhance patient empowerment, social network and community support. A cross-sectional study was conducted from 1 to 31 of August 2007 in 3 districts of Burkina Faso. We used a step-by-step model and the assessment of chronic illness care (ACIC) scale to assess capacities of 24 first line health centres (FLHC) and 3 district hospitals (DH) for providing TB and HIV/AIDS care. Data for the step-by-step model were extracted from medical records of 75 TB and 66 HIV patients. The ACIC scale was completed by health professionals, 6 medical doctors and 18 nurses, working at the DH level and at the FLHC level, respectively. The biological test for confirmation was free of charge for all the TB patients but only for 10.6% (7/66) HIV cases. Up to the time of the survey, 5 TB (6.6%) and 18 HIV + patients (27.3%) have been hospitalised for care at least once, 64 TB (85.3%) had been declared cured and 38 HIV (54.5%) were under antiretroviral treatment. Health care process organisation for TB and HIV care had distinct areas of weaknesses. From a maximum ACIC score of 11, the overall score for TB care ranged between 1.9 and 4.9 with a median of 3.7 and for HIV care between 2.1 and 6.7 with a median of 4.1. This study provides an illustration of assessing the HIV and TB care combining data from the routine information system and from the chronic illness care assessment tool, to encompass both disease control and patient health perspective. It provides to health managers arguments for clear conclusions and sufficient data for action.

To investigate the sector of food sold in the streets of Bobo-Dioulasso and identify relevant information for action, a survey on knowledge and practices of street food vendors and consumers was conducted in June 2005. Data have been collected in 928 street food selling posts. Structured questionnaires were used to collect data from 874 street vendors and 2474 consumers. Street food sites are concentrated in places where administration and trade activities are usually running. The street food seller is a married and illiterate woman of 32 years old. Cereals (48.5%), meat (33.9%), milk (9.6%) and fruits (4.4%) are the basic consumables. The street food consumer is a non married man, 27 years old working in profit-making activity. Consumers use many criteria to choose the place to eat, at times or permanently. The street food sector represents a source of income and induces change in household eating habits. Street food in Bobo-Dioulasso needs to be better organised, by using an holistic approach that involves all the actors.

Setting: In West Africa, national tuberculosis programmes (NTPs) face many problems due to the low performance of health care delivery systems and patients' social and cultural environment., Objective: To improve the case management of TB in Burkina Faso., Design: Using the operational research process as a tool, TB case management was decentralised from the district hospital to eight primary health care centres in 2003., Results: Twelve months after decentralisation, the quality of case detection remained satisfactory. The delay between the identification of TB suspects with chronic cough and the confirmation of TB was reduced from 13 to 6 days. The detection rate of TB suspects during the study (30%) was twice as high as for 2001 and 2002 (15%). However, the detection rate for smear-positive TB cases decreased from 32.3% in 2001 and 2002 to 6.5% during the year of the study., Conclusion: Sufficient time and commitment are essential to obtain a case management system that is decentralised and effective. Efforts therefore need to continue to obtain more information and better results.