Landscape analysis of healthcare workforce and resilience actions in the Sahelian context of high security challenge areas: The case of Burkina Faso.

INTRODUCTION: Access to health services is a major challenge in developing countries in general, particularly those affected by insecurity. The availability of sufficient quantity and quality of equitably distributed healthcare workforce is a major obstacle, yet it is an essential pillar of an effective and efficient national health system. Burkina Faso, similar to other countries in the Sahel, has been affected by an unprecedented security crisis that has severely tested the functionality of health facilities and the availability of healthcare workforce. OBJECTIVE: To describe the landscape of healthcare workforce and to analyse the actions taken by the government and other stakeholders to improve the resilience of the system and the retention of healthcare workers in the context of major security challenges. METHODS: This is a transversal, descriptive and analytical study carried out in Burkina Faso in 2023 through a documentary review, analyses of databases collected from health districts and regional directorates, focus groups and a national triangulation workshop with key informants. RESULTS: The study shows that, with the closure and minimal functioning of certain health facilities in security-challenged areas, healthcare workforceare concentrated in the urban areas of regional and district capitals, to the detriment of rural areas. Some staff become in an irregular situation regarding the administration. To strengthen resilience to the crisis, the main solutions have been implemented: (i) enhancing the community platform with the recruitment of 15,000 community-based health volunteers, (ii) delegating tasks to community health agents, (iii) simplified approaches, (iv) advanced health posts and mobile clinics, (v) redeployment to the most stable structures, (vi) thinking about legislation in crisis situations. CONCLUSION: Community resilience through the delegation of tasks to community-based health workers and strengthening of the community health platform has helped ensure the continuity of care in insecure areas. However, the optimization of innovative and attractive strategies will further improve the retention and return of healthcare workers in rural areas affected.

[Urinary tract infections in a pediatric setting: Bacterial ecology and antibiotic susceptibility at the Pediatric Teaching Hospital Charles-de-Gaulle in Ouagadougou (Burkina Faso)]. / Infections du tractus urinaire en milieu pédiatrique : écologie bactérienne et sensibilité aux antibiotiques au Centre hospitalier universitaire pédiatrique Charles-de-Gaulle de Ouagadougou (Burkina Faso).

INTRODUCTION: Urinary tract infection is the second most common bacterial infection in children, after respiratory tract infection. The objective of this work was to study the bacterial ecology and antibiotic susceptibility of germs isolated during childhood urinary tract infections at the Paediatric University Hospital Charles-de-Gaulle in Ouagadougou. PATIENTS AND METHOD: This was a descriptive retrospective study covering the period from July 1st, 2010 to June 30, 2015, including 141 children from 0 to 15 years old hospitalized in the medical paediatrics department for a urinary tract infection. RESULTS: The hospital frequency of urinary tract infection was 0.7%. The mean age of the patients was 43.1 months. Female patients accounted for 57.4%, a sex-ratio of 0.7. Gram-negative bacilli were often involved (67.4%) with Escherichia Coli and Klebsiella in 35.5% and 22% of cases respectively. The main Gram-positive bacteria were staphylococci (15.5%), enterococci (11.3%) and streptococci (5.6%). Enterobacteriaceae isolated were sensitive to netilmicin (80%), chloramphenicol (76.4%), and furan (82.6%). All strains of staphylococcus were susceptible to furan, gentamicin, chloramphenicol and cefixime. In 66.7% of cases, the isolated strains of staphylococcus were resistant to amoxicillin. CONCLUSION: Urinary tract infection is a common problem in pediatrics. Its management must be early and adequate based on knowledge of the bacterial ecology in order to reduce the risk of long-term renal complications.

[Hemoglobinuria in children hospitalized in Ouagadougou: short term inpatient care and prognosis]. / Hémoglobinurie chez l'enfant à Ouagadougou: prise en charge hospitalière et pronostic à court terme.

INTRODUCTION: The purpose of this study was to analyze the epidemiological, diagnostic, therapeutic and evolutionary features of hemoglobinuria in children hospitalized in the Pediatric University Hospital Charles de Gaulle, Ouagadougou. METHODS: We conducted a cross-sectional descriptive study over the period 01st July-31st December 2014. All children aged 0-15 years hospitalized in the Department of Medical Pediatrics of the Pediatric University Hospital Charles de Gaulle and diagnosed with macroscopic hemoglobinuria during the study period were enrolled. RESULTS: Thirty-eight patients were included in the study. Hospitalization rate for hemoglobinuria was 1.9%. The average age of patients was 80.8 ± 44.1 months (ranging from 21 to 168). The study involved 23 boys (60.5%) and 15 girls (39.5%). The major clinical signs were: fever (86.8%), dark urines like « coca cola ¼ (86.8%), pallor (63.2%), hepatomegaly (50%). Glomerular filtration flow was less than 80 mL/min/1.73m2 in 23 patients (69.7%); 21 patients had Glucose-6-phosphate dehydrogenase (G6PD) deficiency. The main suspected causes of hemoglobinuria were: severe malaria, bacterial and viral infections, G6PD deficiency, biliary haemoglobinuric fever. Treatments included: artemisinin derivatives, antibiotics and antipyretics. One patient underwent dialysis. CONCLUSION: Hemoglobinuria is a symptom mainly causing diagnostic problems in our context. It is a severe disorder which can result in acute renal failure (ARF).

[Risk factors for death from severe malaria in children at the Charles de Gaulle pediatric hospital of Ouagadougou (Burkina Faso)]. / Facteurs de risque de décès au cours du paludisme grave chez l'enfant au Centre hospitalier universitaire pédiatrique Charles de Gaulle de Ouagadougou (Burkina Faso).

To determine the risk factors for death from severe malaria in children in Burkina Faso, we conducted a retrospective case-control study covering a period of 24 months from January 2004 through December 2005, at the Charles de Gaulle Pediatric Hospital in Ouagadougou. Cases (n=72) were defined as all children hospitalized for and dying of confirmed severe malaria. The control subjects (n=72), matched for age, sex and date of hospitalization; were children hospitalized for confirmed severe malaria who were discharged after recovery. Risk factors assessed included: place of residence, socioeconomic level, self-medication, promptness of hospitalization, nutritional status, temperature and parasitemia. Case and control children were compared with pairwise tests. Low socioeconomic level (OR=5.4), late care (OR=15.5), poor nutritional status (OR=7.9) and a parasitemia greater than or equal to 5% (OR=2.8) were associated with a significant increase in the risk of death. In contrast, the malaria deaths were not associated with place of residence (OR=0.5), self-medication (OR=1) or fever of 41 degrees C or higher (OR=1.1). These results show the need for more health education to encourage early care-seeking in the event of fever, community-based interventions, and strengthening of the technical support centers for health facilities, as part of a national poverty reduction program.