Prevalence and risk factors of violence among persons with disabilities in Burkina Faso.

This study aimed to analyse factors associated with violence against people with disabilities in Burkina Faso. This is a secondary analysis of data from cross-sectional study among people with disability with Grade 3-4 between 15 and 65 years of age. The prevalence of violence was 13.9%. Persons with physical or multiple disabilities were more likely to suffer violence, while people with physical, intellectual, or multiple disabilities were less likely to suffer violence than those with visual disabilities. Additionally, those between 34 and 55 years were less likely to suffer violence than those over 55. Monogamous and polygamous people with disabilities were 1.9 and 4.3 times, respectively, more likely to be victims of violence than single people. People without formal education were 1.47 times more likely to experience violence than those with education; those living in a family or alone in a housing unit were 2.79 and 12.61 times, respectively, more likely to experience violence than those living with others in a housing unit. Findings suggest that violence is common against all persons with disabilities, but that some factors make violence more likely. There is a need for a policy against violence among people with disability.

Prevalence and factors associated with stigma among people with disabilities in Niger in 2018: a multi-level analysis.

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.

Low prevalence of high blood pressure in pregnant women in Burkina Faso: a cross-sectional study.

BACKGROUND: High blood pressure (HBP) during pregnancy causes maternal and fetal mortality. Studies regarding its prevalence and associated factors in frontline level health care settings are scarce. We thus aimed to evaluate the prevalence of HBP and its associated factors among pregnant women at the first level of the health care system in Burkina Faso. METHODS: This cross-sectional study was conducted in six health facilities between December 2018 and March 2019. HBP was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Multivariable logistic regression analysis was performed to identify factors associated with HBP. RESULTS: A total of 1027 pregnant women were included. The overall prevalence of HBP was 1.4% (14/1027; 95% confidence interval [CI] 0.7-2.3), with 1.6% (7/590; 95% CI 0.8-3.3) in rural and 1.2% (7/437; 95% CI 0.6- 2.5) in semi-urban areas. The prevalence was 0.7% (3/440; 95% CI 0.2-2.1) among women in the first, 1.5% (7/452; 95% CI 0.7-3.2) in the second and 3% (4/135; 95% CI 1.1-7.7) in the third trimester. In the multivariable analysis, pregnancy trimester, maternal age, household income, occupation, parity, and residential area were not associated with HBP during pregnancy. CONCLUSION: The prevalence of HBP among pregnant women at the first level of health system care is significantly lower compared to prevalence's from hospital studies. Public health surveillance, primary prevention activities, early screening, and treatment of HDP should be reinforced in all health facilities to reduce the burden of adverse pregnancy outcomes in Burkina Faso.

Determinants of childbirth care quality along the care continuum in limited resource settings: A structural equation modeling analysis of cross-sectional data from Burkina Faso and Côte d'Ivoire.

INTRODUCTION: Despite the important increase in in-facility births, perinatal mortality rates have remained high and slow to decrease in many developing countries. This situation is attributed to poor childbirth care quality. The reason why women delivering in health facilities do not always receive care of an adequate standard is unclear. We assessed the determinants of childbirth care quality along the care continuum by means of different approaches. METHODS: A health facility-based cross-sectional study with a direct observation of health care workers' practices while caring for mother-newborn pairs was carried out in Burkina Faso and Côte d'Ivoire. The performance of a set of essential best practices (EBPs) was assessed in each birth event at the admission, prepushing and immediate postpartum stages. A quality score, in the form of the additive sum of EBPs effectively delivered, was computed for each stage. We used negative binomial regression models and a structural equation modeling analysis to assess the determinants of care quality at each stage and the relationships of the quality delivered at the different stages, respectively. RESULTS: A total of 532 and 627 mother-newborn pairs were evaluated in Burkina Faso and Côte d'Ivoire, respectively. In both countries, delivery care quality varied significantly at all stages between health districts. Predelivery care quality was consistently higher in referral hospitals than in primary health care facilities (incident rate ratio (IRR) = 1.02, p < 0.05, and IRR = 1.10, p < 0.05, respectively, for Burkina Faso and Côte d'Ivoire). Quality at admission was poorer among nurses than among midwives in Burkina Faso (IRR = 0.81, p < 0.001). Quality at the admission and predelivery stages was positively correlated with immediate postpartum care quality (ß = 0.48, p < 0.001, and ß = 0.29, p < 0.001, respectively). CONCLUSION: Quality improvement strategies must target both providers and health facilities, and different inputs are needed depending on the stage in the care continuum.

Effectiveness of the World Health Organization Safe Childbirth Checklist (WHO-SCC) in preventing poor childbirth outcomes: a study protocol for a matched-pair cluster randomized control trial.

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.

Yam Daabo interventions' effects on postpartum family planning use in Burkina Faso at 24 months after childbirth.

INTRODUCTION: After testing the interventions for improving the prevalence of contraceptive use, very few studies have measured the long-term effects thereafter the end of the implementation. This study aimed to measure Yam Daabo interventions' effects on contraceptive use in Burkina Faso at twelve months after completion of the intervention. METHODS: Yam Daabo was a two-group, multi-intervention, single-blind, cluster randomized controlled trial. Interventions comprised refresher training for the provider, a counseling tool, supportive supervision, availability of contraceptive services 7 days a week, client appointment cards, and invitation letters for partners. We used generalized linear mixed-effects models (log Poisson) to compare the modern contraceptive prevalence at 12 months post-intervention in the two groups. We collected data between September and November 2018. We conducted an intention-to-treat analysis and adjusted the prevalence ratios on cluster effects and unbalanced baseline characteristics. RESULTS: Twelve months after the completion of the Yam Daabo trial, we interviewed 87.4% (485 out of 555 women with available data at 12 months, that is, 247/276 in the intervention group (89.5%) and 238/279 in the control group (85.3%). No difference was observed in the use of hormonal contraceptive methods between the intervention and control groups (adjusted prevalence ratio = 1.21; 95% confidence interval [CI] = [0.91-1.61], p = 0.191). By contrast, women in the intervention group were more likely to use long-acting reversible contraceptives (LARC) than those in the control group (adjusted prevalence ratio = 1.35; 95% CI = [1.08-1.69], p = 0.008). CONCLUSION: Twelve months after completion of the intervention, we found no significant difference in hormonal contraceptive use between women in the intervention and their control group counterparts. However, women in the intervention group were significantly more likely to use long-acting reversible contraceptives than those in the control group. TRIAL REGISTRATION: The trial registration number at the Pan African Clinical Trials Registry is PACTR201609001784334 . The date of the first registration is 27/09/2016.

Seroprevalence and factors associated with IgG anti-DENV positivity in blood donors in Burkina Faso during the 2016 dengue outbreak and implications for blood supply.

OBJECTIVES: Our study aimed to update the seroprevalence and factors associated with anti-dengue virus (DENV) antibody positivity among blood donors and to discuss their implications for blood supply. BACKGROUND: Questions on the potential transmission of DENV by transfusion increased after the documentation of the risk of transmission of the West Nile virus. This risk was estimated after transfusion of DENV RNA-positive blood units of up to 37.5%. In Burkina Faso, very few studies on DENV in blood donors have been conducted. As a result, there were no reliable data on DENV to allow the implementation of appropriate measures to control the risk of transmission of the dengue virus by blood transfusion. METHODS: We conducted a 4-week cross-sectional study from December 4 to 30, 2016. Blood donors of both genders, aged 18-60 years, accepted for blood donation after medical selection were consecutively enrolled. RESULTS: Our study included a total of 1007 blood donors, in which donors living in urban areas represented 78.2%. The mean age was 26.1 ± 8.1 years. After adjustment in a multiple regression logistic model, the odds of having IgG anti-DENV increased as age increased. The odds of DENV was 53% lower in rural areas (OR = 0.47; P = .000) compared to urban settings and 42% lower in mobile sites (OR = 0.58; P = .03) compared to fixed ones. CONCLUSION: Our study provides new and useful insights for future research on the risk of TT-DENV throughout blood transfusion.

Task sharing for family planning services, Burkina Faso.

PROBLEM: In Burkina Faso, the coverage of services for family planning is low due to shortage of qualified health staff and limited access to services. APPROACH: Following the launch of the Ouagadougou Partnership, an alliance to catalyse the expansion of family planning services, the health ministry created a consortium of family planning stakeholders in 2011. The consortium adopted a collaborative framework to implement a pilot project for task sharing in family planning at community and primary health-care centre levels in two rural districts. Stakeholders were responsible for their areas of expertise. These areas included advocacy; monitoring and evaluation; and capacity development of community health workers (CHWs) to offer oral and injectable contraceptives to new users and of auxiliary nurses and auxiliary midwives to provide implants and intrauterine devices. The health ministry implemented supportive supervision cascades involving relevant planning and service levels. LOCAL SETTING: In Burkina Faso, only 15% (2563/17 087) of married women used modern contraceptives in 2010. RELEVANT CHANGES: Adoption of new policies and clinical care standards expanded task sharing roles in family planning. The consortium trained a total of 79 CHWs and 124 auxiliary nurses and midwives. Between January 2017 and December 2018, CHWs provided injectables to 3698 new users, and auxiliary nurses or midwives provided 726 intrauterine devices and 2574 implants to new users. No safety issues were reported. LESSONS LEARNT: The pilot project was feasible and safe, however, financial constraints are hindering scale-up efforts. Supportive supervision cascades were critical in ensuring success.

Distribution of ABO and RHD blood group antigens in blood donors in Burkina Faso.

Geographical distribution of ABO and RHD antigens is important for blood transfusion services and population genetics studies. There are few data on this topic in Burkina Faso, a multi-ethnic country. Our study aims at reporting phenotypic and allelic frequencies of ABO and RHD blood groups among voluntary blood donors from various ethnical regions of Burkina Faso. We conducted a cross-sectional study including 81,486 blood donors. ABO allelic frequencies were determined using the Bernstein method. Differences in phenotypic distribution of blood groups were assessed using the chi-square test; a p value <0.05 being considered as statistically significant. We noticed that O+>B+>A+>AB+>O->B->A->AB- in our population. Phenotypic frequencies of blood groups A, B, O and AB were respectively 22.54%, 28.56%, 43.30% and 5.60%. RHD+was 92.24%. The allelic frequencies of A, B, O and D were respectively 0.1524; 0.1887; 0.6590 and 0.7214. We noticed statistical differences (p < 0.05) between these administrative regions which corresponded roughly to some natural ethnic areas. Indeed, the phenotype O was more frequent in the Central-west, Central and East regions corresponding to "Mossi," "Gourounsi," "Gourmantché" areas while the phenotype A and AB were more reported in "Boucle du mouhoun" and "Hauts-Bassins" regions where we have "Bwaba" and "Bobo." The phenotype O negative was less frequent in "Bwaba." Our study provides interesting information to blood services that will allow them to better refine their donor recruitment strategies.

Tobacco use and associated risk factors in Burkina Faso: results from a population-based cross-sectional survey.

BACKGROUND: Tobacco is a leading preventable cause of non-communicable diseases (NCDs). Studies characterizing the prevalence of tobacco use in low-income countries are lacking. This study describes the prevalence of tobacco use in Burkina Faso and its associated factors. METHODS: Data from the 2013 Burkina Faso World Health Organization (WHO) Stepwise approach to Surveillance (STEPS) were analyzed. The prevalence of any tobacco product use, cigarette smoking, and other tobacco use was calculated. Logistic regression analyses identified factors associated with tobacco use. Overall, 4691 people were included in this analysis. RESULTS: The prevalence of any tobacco use was 19.8% (95% CI: 18.4-21.2). Tobacco use was higher for men (29.2% [27.0-31.5]) than women (11.8% [10.3-13.4]). The prevalence of smoked tobacco was 11.3% (10.3-12.4), with a significantly higher prevalence among men (24.5% [22.1-27.0]) than women (0.1% [0.01-0.3]). The overall prevalence of other tobacco use was 8.9% (7.4-10.7), with lower values for men (5.6% [4.1-7.2]) compared to women (11.7% [9.4-14.1]). Tobacco smoking among men was significantly associated with an increased age and alcohol consumption. The analysis of risk factors for other tobacco use stratified by gender showed that age, education, residence, and alcohol consumption were significantly associated with consumption for women, and age and alcohol consumption for men. CONCLUSION: Tobacco use is common in Burkina Faso. To effectively reduce tobacco use in Burkina Faso, a comprehensive tobacco control program should consider associated factors, such as gender, age, and alcohol consumption.

Participatory action research to identify a package of interventions to promote postpartum family planning in Burkina Faso and the Democratic Republic of Congo.

BACKGROUND: The YAM DAABO study ("your choice" in Mooré) takes place in Burkina Faso and the Democratic Republic of Congo. It has the objective to identify a package of postpartum family planning (PPFP) interventions to strengthen primary healthcare services and determine its effectiveness on contraceptive uptake during the first year postpartum. This article presents the process of identifying the PPFP interventions and its detailed contents. METHODS: Based on participatory action research principles, we adopted an inclusive process with two complementary approaches: a bottom-up formative approach and a circular reflective approach, both of which involved a wide range of stakeholders. For the bottom-up component, we worked in each country in three formative sites and used qualitative methods to identify barriers and catalysts to PPFP uptake. The results informed the package design which occurred during the circular reflective approach - a research workshop gathering service providers, members of both country research teams, and the WHO coordination team. RESULTS: As barriers and catalysts were found to be similar in both countries and with the view to scaling up our strategy to other comparable settings, we identified a common package of six low-cost, low-technology, and easily-scalable interventions that addressed the main service delivery obstacles related to PPFP: (1) refresher training of service providers, (2) regularly scheduled and strengthened supportive supervision of service providers, (3) enhanced availability of services 7 days a week, (4) a counseling tool, (5) appointment cards for women, and (6) invitation letters for partners. CONCLUSIONS: Our research strategy assumes that postpartum contraceptive uptake can be increased by supporting providers, enhancing the availability of services, and engaging women and their partners. The package does not promote any modern contraceptive method over another but prioritizes the importance of women's right to information and choice regarding postpartum fertility options. The effectiveness of the package will be studied in the experimental phase. If found to be effective, this intervention package may be relevant to and scalable in other parts of Burkina Faso and the DRC, and possibly other Sub-Saharan countries. TRIAL REGISTRATION: Retrospectively registered in the Pan African Clinical Trials Registry ( PACTR201609001784334 , 27 September 2016).

Diabetes and abnormal glucose regulation in the adult population of Burkina Faso: prevalence and predictors.

BACKGROUND: The prevalence of diabetes mellitus (DM) is reportedly growing fast in sub-Saharan Africa. There is however a scarcity of epidemiologic data on DM in Burkina Faso. We carried out a secondary analysis of the first survey conducted in Burkina Faso on a nationally representative sample following the World Health Organization (WHO) Stepwise approach to risk factors Surveillance (STEPS) for non-communicable diseases (NCDs) with the aims of identifying the prevalence of NCDs and the prevalence of common risk factors for NCDs. We report here on the prevalence of diabetes and overall abnormal glucose regulation (AGR) and their associated risk factors. METHODS: In the primary study 4800 individuals were randomly sampled using a stratified multistage clusters sampling process. We used fasting capillary whole blood glucose level to define three glucose regulation statuses using WHO's cut-off levels: normal, diabetes and overall abnormal glucose regulation (impaired fasting glucose and diabetes). Appropriate statistical techniques for the analysis of survey data were used to identify the factors associated with diabetes and abnormal glucose regulation fitting a logistic regression model. Analyses were carried out using Stata Version 14 software. RESULTS: The prevalence of DM and AGR were respectively 5.8% (95% CI: 5-6.7) and 9% (95% CI: 8-10.1). Significant risk factors for DM include age (OR = 1.9; P = 0.009 for the age group of 55-64), obesity (OR: 2.6; P = 0.001), former smoke (OR:2; P = 0.03), second-hand smoke (OR = 1.7; P = 0.006) and total cholesterol level (OR: 2.1; P = 0.024). The same predictors were also found significantly associated with AGR. In addition, having an history family diabetes was protective against AGR (OR = 0.5; P = 0.032). CONCLUSION: Diabetes is no longer a rare disease in the adult active population of Burkina Faso. Its burden is significant in both rural and urban areas. Health policies that promote healthy life style are needed to give precedence to the prevention in a context of an under-resourced country.

[Indoor air pollution and acute respiratory infection prevalence in infants in Ouagadougou.] / Pollution de l'air intérieur et prévalence des infections respiratoires aiguës chez les enfants à Ouagadougou.

In Burkina Faso, women and their young children are the most exposed to the effects of indoor air pollution. This study investigated the risk factors associated with air pollution during meal cooking in the occurrence of Acute Respiratory Infections (ARI) in children under 5 years of age. This is a cross-sectional study that took place in two sectors of the city of Ouagadougou (sectors 15 and 17) in Burkina Faso. The study involved 608 households. The data was collected using an interview guide and an observation grid. The data was entered with Epi data 3.1 software and analyzed with Stata / SE 12.0. The associations between the variables were expressed in Odds Ratio (OR) and their confidence intervals were estimated at 95%. The prevalence of ARI was 3.5% in children under 5 years of age. In bivariate analysis, with low-standing habitats, the use of traditional and / or improved stoves, appeared to be a risk factor for ARI. In multivariate analysis, only the use of the combination ? improved stoves + wood ? was found to be significantly associated with ARI in the last 2 weeks before the study (OR = 14.703, 95% CI: 1.156 -186.887). This requires strengthening the promotion of the use of gas and conducting studies on the effectiveness of improved stoves in reducing exposure to pollutants.

Clinical outreach refresher trainings in crisis settings (S-CORT): clinical management of sexual violence survivors and manual vacuum aspiration in Burkina Faso, Nepal, and South Sudan.

During the early humanitarian response to a crisis, there is limited time to train health providers in the life-saving clinical services of the Minimum Initial Services Package (MISP) for Reproductive Health. The Training Partnership Initiative of the Inter-agency Working Group on Reproductive Health in Crises developed the S-CORT model (Sexual and reproductive health Clinical Outreach Refresher Training) for service providers operating in acute humanitarian settings and needing to rapidly refresh their knowledge and skills. Through qualitative research, this study aimed to determine the operational enablers and barriers related to the implementation of two S-CORT modules: clinical management of sexual violence survivors (CMoSVS) and manual vacuum aspiration (MVA). Across three participating countries (Burkina Faso, Nepal, and South Sudan), 135 health staff attended the CMoSVS refresher training and 94 the MVA refresher training. Results from the focus group discussions and in-depth interviews suggest that the S-CORT approach is respectful of human rights and quality of care principles. Furthermore, it is potentially effective in enhancing the knowledge and skills of existing trained service providers, strengthening their capacity, and changing their attitudes towards abortion-related services, for example. The S-CORT is a promising model for implementation in the acute phase of an emergency upon stabilisation of the security situation. The model can also be integrated into broader post-crisis capacity development efforts. Future operational research should emphasise not only an assessment of new modules' contents, but whether implementing this refresher training model in remote outreach settings is feasible, effective, and efficient.

Prevalence and factors associated with hypertension in Burkina Faso: a countrywide cross-sectional study.

BACKGROUND: High blood pressure (HBP) is an increasing public health issue for developing countries. HBP is an important contributing factor to many non-communicable diseases that were until very recently thought to be rare in developing countries. There is not enough evidence on its burden and risk factors in Africa. We report in this study on the prevalence and factors associated with HBP in the adult and active population of Burkina Faso from a nationally representative sample. METHODS: We conducted a secondary analysis of data from the World Health Organization (WHO) Stepwise approach to Surveillance(STEPS) survey on the prevalence of major risk factors for non-communicable diseases in Burkina Faso. This survey was conducted between September 26 and November 18, 2013 and involved a nationally representative sample of 4,800 adults aged 25 to 64 years. The risk factors were identified using a binary logistic regression in STATA Version 13.1 software. RESULTS: The analysis was conducted on a sample of 4629 participants of whom 72.18% lived in rural areas. The overall prevalence of hypertension in Burkina Faso was 18% (95% CI: 16.19%-19.96%). In urban areas the prevalence was 24.81% (95% CI 20.21%-30.07%) and 15.37% (95% CI 13.67%-17.24%) in rural areas. Increased Body Mass Index (BMI) and older age were consistently associated with higher odds of HBP in both residential areas. In addition, being of male sex, fat intake, family history of HBP and low level of HDL cholesterol were significantly associated with increased odds of HBP in rural residents. CONCLUSION: The prevalence of hypertension is high in Burkina Faso with roughly one person in five affected. There is a predominant burden in urban areas with prevalence of ten-point percent higher compared to rural area. Modifiable risk factors should be targeted with appropriate and effective strategies to curb the rising burden of hypertension and its consequences.

Inadequate programming, insufficient communication and non-compliance with the basic principles of maternal death audits in health districts in Burkina Faso: a qualitative study.

BACKGROUND: Implementation of quality maternal death audits requires good programming, good communication and compliance with core principles. Studies on compliance with core principles in the conduct of maternal death audits (MDAs) exist but were conducted in urban areas, at the 2nd or 3rd level of the healthcare system, in experimental situations, or in a context of skills-building projects or technical platforms with an emphasis on the review of "near miss". This study aims to fill the gap of evidence on the implementation of MDAs in rural settings, at the first level of care and in the routine care situation in Burkina Faso. METHODS: We conducted a multiple-case study, with seven cases (health districts) chosen by contrasted purposive sampling using four criteria: (i) the intra-hospital maternal mortality rates for 2013, (ii) rural versus urban location, (iii) proofs of regular conduct of maternal death audits (MDAs) as per routine health information system, and (iv) the use of district hospital versus regional hospital for reference when the first mentioned does not exist. A review of audit records and structured and semi-structured interviews with staff involved in MDAs were conducted. The survey was conducted from 27 April to 30 May of 2015. RESULTS: The results showed that maternal death audits (MDAs) were irregularly scheduled, mostly driven by critical events. Overall, preparing sessions, communication and the conduct of MDAs were most of the time inadequate. Confidentiality was globally respected during the clinical audit sessions. The principle of "no name, no shame, and no blame" was differently applied and anonymity was rarely preserved. CONCLUSION: Programming, communication, and compliance with the basic principles in the conduct of maternal death audits were inadequate as compared to the national standards. Identifying determinants of such shortcomings may help guide interventions to improve the quality of clinical audits. RESUME: La mise en œuvre d'audits de décès maternels de qualité nécessite une bonne programmation, une bonne communication et le respect des principes fondamentaux. Des études sur le respect des principes fondamentaux existent mais ont été menées dans les zones urbaines, le 2ème ou 3ème niveau du système de santé, dans des situations expérimentales, un contexte de projets de renforcement des compétences ou de plates-formes techniques, en mettant l'accent sur la revue des «near miss¼. Cette étude vise à combler le manque d'information sur la programmation et le respect des principes fondamentaux concernant le milieu rural, le niveau du système de santé qui est. le district sanitaire et la situation de routine au Burkina Faso. MéTHODOLOGIE: Nous avons mené une étude de cas multiple dans 7 établissements de santé sélectionnés par échantillonnage raisonné contrasté selon 4 critères: milieu urbain ou rural, taux de mortalité maternelle dans les établissements de santé en 2013 (les données de l'année 2014 n'étant pas complètes à la rédaction du protocole), la déclaration des audits de décès maternels dans le système de surveillance nationale, le recours ou non par le district choisi à un centre hospitalier régional pour les soins complémentaires de premier niveau (normalement offerts à l'hôpital de district s'il existe). Une revue des dossiers d'audits, ainsi que des entretiens directifs, semi-directifs auprès du personnel impliqué dans les soins de maternité ont été réalisés. L'enquête s'est. déroulée du 27 Avril au 30 Mai 2015. RéSULTATS: Les résultats montrent que les revues des décès maternels ont été irrégulièrement programmées, de façon espacée et très souvent au gré des évènements. La préparation, la conduite des séances et la communication après les séances ont été défaillantes. La confidentialité au sein du groupe d'auditeurs a été respectée tandis que le niveau de respect du principe de « no name, no shame, no blame ¼ a varié d'une structure à une autre. Enfin, l'anonymat a été le moins respecté. CONCLUSION: La programmation, la communication et le respect des principes fondamentaux ont connu des défaillances par rapport aux normes mais de façon variable d'une structure à une autre. L'identification des déterminants de ces insuffisances pourront aider à l'orientation des interventions visant l'amélioration de l'activité des audits de décès maternels au niveau district de santé.

Getting Up to Date with What Works: A Systematic Review on the Effectiveness and Safety of Task Sharing of Modern Methods in Family Planning Services.

Objective: This systematic review was conducted to provide up-to-date evidence on the safety and effectiveness of task sharing in the delivery of modern contraceptives. Study Design. The review followed the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. We searched Medline, Embase, Cochrane CENTRAL, and Google Scholar for peer-reviewed studies that reported on effectiveness and/or safety outcomes of task sharing of any modern contraceptive method. Only Cochrane Effective Practice of Organizations of Care (EPOC) study designs were eligible, and quality assessment of the evidence was performed using the Cochrane risk of bias (RoB) tools. Meta-analyses, where possible, were carried out using Stata, and certainty of the evidence for outcomes was assessed using the Grading of Recommendations Assessment, Development, and Evaluation tool (GRADE). Results: Six studies met the inclusion criteria: five reported on self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) compared to administered by trained health providers; and one assessed tubal ligation performed by associate clinicians compared to advanced-level associate clinicians. Self-injection improved contraceptive continuation, with no increase in unintended pregnancy and no difference in side effects compared to provider administered. In tubal ligation, the rate of adverse events, time to complete procedure, and participant satisfaction were similar among associate clinicians and advanced clinicians. Conclusion: The evidence suggests that self-injection of DMPA-SC and tubal ligation performed by associate clinicians are safe and effective. These findings should be complemented with the evidence on the feasibility and acceptability of task sharing of these methods. The review protocol was registered with PROSPERO CRD42021283336.

Maternal and neonatal death surveillance and response in Liberia: An assessment of the implementation process in five counties.

OBJECTIVE: To evaluate the implementation of the maternal and neonatal death surveillance and response (MNDSR) system at county level in Liberia. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Evaluation of the quality of maternal death review cycles in Burkina Faso.

OBJECTIVE: To assess the quality of the maternal death review (MDR) cycle in selected health facilities in Burkina Faso in accordance with national standards. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Assessment of the maternal death surveillance and response implementation process in Burkina Faso.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.