Development of Monitoring and Evaluation Systems in Four National Programs Addressing Mother and Child Health in Cote d'Ivoire: Qualitative Analysis of the Emergence and Formulation Process.

Background: 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.

Impact of mobile phone intervention on intermittent preventive treatment of malaria during pregnancy in Burkina Faso : A pragmatic randomized trial.

PURPOSE: Intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP) coverage remains far below the desirable goal of at least three doses before delivery. This study evaluates an innovative intervention using mobile phones as a means of increasing coverage for the third dose of IPTp-SP. METHODS: This study in Burkina Faso was designed as an open-label, pragmatic, two-arm, randomised trial. Pregnant women who attended antenatal clinic (ANC) visits were included at their first ANC visit and followed until delivery. The intervention was built around the use of mobile phones as means ensuring direct tracking of pregnant women. RESULTS: Two hundred and forty-eight (248) pregnant women were included in the study. The proportion of women who received at least three doses of IPTp-SP was 54.6 %. In the intervention group, 54.1 % of women received at least three doses of IPTp-SP versus 55.1 % in the control group, a non-significant difference (adjusted odds ratio "aOR", 0.86 ; 95 % confidence interval "95 % CI", 0.49-1.51). Women in the intervention group were more likely to carry out their ANC visits in a timely manner than those in the control group (aOR, 3.21 ; 95 % CI, 1.91-5.39). CONCLUSION: While mobile phone intervention did not increase the proportion of women receiving three doses of IPTp-SP, it did help to increase the proportion of timely ANC visits. TRIAL REGISTRATION: PACTR202106905150440.

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.

Accessibility and use of HIV prevention services among people with disabilities in Burkina Faso and Niger.

ABSTRACTOur study aims to determine the predictors of access to HIV services among disabled persons in two West African countries. This was a secondary analysis from a cross-sectional study carried out in Burkina Faso, in 2017 and Niger, in 2018. People with a disability of severity 3 or 4 and aged 15-69 were included in the study. Access to HIV-related services was measured separately through three variables (access to condoms when needed, history of testing for HIV and ever attended at an HIV-related service). Factors associated with access to HIV-related services were identified using logistic regression. 1794 participants were recorded, including 973 in Burkina Faso and 821 in Niger. The ability to easily obtain a condom when needed was reported by 29.4% of respondents in Burkina Faso and 5.7% of respondents in Niger. The proportion of participants who had been tested for HIV was 32.2% in Burkina Faso and 13.6%. We observed that 5.7% and 3.5% of the participants were in contact with an HIV-related service. Only educational status was associated with access to HIV prevention services in both countries. There is a need to increase the access to HIV prevention for disabled persons in the two countries.

[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.

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

The period from conception to 24 months of age is a crucial window for nutrition interventions. Personalized maternal counseling may improve childbirth outcomes, growth, and health. We assessed the effectiveness of facility-based personalized maternal nutrition counseling (from pregnancy to 18 months after birth) in improving child growth and health in rural Burkina Faso. We conducted a paired cluster randomized controlled trial in a rural district of Burkina Faso with 12 primary health centers (clusters). Healthcare providers in the intervention centers received patient-centered communication and nutrition counseling training. Pregnant women in the third trimester living in the center catchment areas and intending to stay for the next 2 years were prospectively included. We followed 2253 mother-child pairs quarterly until the child was aged 18 months. Women were interviewed about counseling experiences, dietary practices during pregnancy, and their child's feeding practices and morbidity history. Anthropometric measurements were taken at each visit using standardized methods. The primary outcomes were the cumulative incidence of wasting, and changes in child weight-for-height z-score (WHZ). Secondary outcomes were the women's prenatal dietary practices, early breastfeeding practices, exclusive breastfeeding, timely introduction of complementary food, child's feeding frequency and dietary diversity, children's mean birth weight, endpoint prevalence of stunting, and cumulative incidence of diarrhea, fever, and acute respiratory infection. All analyses were by intention-to-treat using mixed effects models. The intervention and control arms each included six health centers. Mothers in the intervention arm had a significantly higher exposure to counseling with 11.2% for breastfeeding techniques to 75.7% for counseling on exclusive breastfeeding. Mothers of infants below 6 months of age in the intervention arm were more likely to exclusively breastfeed (54.3% vs 42.3%; Difference of Proportion (DP) 12.8%; 95% CI: 2.1, 23.6; p = 0.020) as compared to the control arm. Between 6 and 18 months of age, more children in the intervention arm benefited from the required feeding frequency (68.8% vs 53.4%; DP 14.1%; 95% CI: 9.0, 19.2; p<0.001) and a larger proportion had a minimum dietary diversity (28.6% vs 22.0%; DP 5.9%; 95% CI: 2.7, 9.2; p<0.001). Birth weight of newborns in the intervention arm was on average 84.8 g (p = 0.037) larger compared to the control arm. However, we found no significant differences in child anthropometry or morbidity between study arms. Facility-based personalized maternal nutrition counseling was associated with an improved prenatal dietary practices, Infant and Young Child Feeding practices, and child birth weight. Complementary strategies are warranted to obtain meaningful impact on child growth and morbidity. This includes strategies to ensure good coverage of facility-based services and effective nutrition/care practices in early childhood.

Factors associated with fresh stillbirths: A hospital-based, matched, case-control study in Burkina Faso.

OBJECTIVE: To determine the risk factors for fresh stillbirths in hospitals in Burkina Faso. METHODS: A hospital-based, matched (1:1), case-control study was conducted from July to August 2014 in 50 hospitals across the country. All cases of stillbirth that occurred during this period in the participating facilities were included, and an appropriate control was selected for each case from the same health facility. Cases and controls were matched for gestational age. Conditional logistic regression with robust standard errors was used to compute both unadjusted and adjusted conditional odds ratios. RESULTS: Cases were 67% less likely to have been delivered by a midwife compared with a nonmidwife attendant (ACOR=0.33; 95% CI, 0.12-0.84; P=0.02). Use of a partograph to monitor labor lowered the odds of fresh stillbirth by 82% (ACOR=0.18; 95% CI, 0.05-0.61; P=0.006). Mothers who had been transferred from another health facility were five times more likely to experience a fresh stillbirth (ACOR=5.36; 95% CI, 2.02-14.23; P<0.001). CONCLUSION: Quality and timing of intrapartum obstetric care is key to preventing fresh stillbirths. Easy to implement and available interventions, such as use of a partograph for all laboring women and improving the referral system, have the potential to save the lives of many fetuses.

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

OBJECTIVES: To explore the differential effect of a multifaceted intervention on hospital-based maternal mortality between patients with cesarean and vaginal delivery in low-resource settings. STUDY DESIGN: We reanalyzed the data from a major cluster-randomized controlled trial, QUARITE (Quality of care, Risk management and technology in obstetrics). These subgroup analyses were not pre-specified and were treated as exploratory. The intervention consisted of an initial interactive workshop and quarterly educational clinically oriented and evidence-based outreach visits focused on maternal death reviews (MDR) and best practices implementation. The trial originally recruited 191,167 patients who delivered in each of the 46 participating hospitals in Mali and Senegal, between 2007 and 2011. The primary endpoint was hospital-based maternal mortality. Subgroup-specific Odds Ratios (ORs) of maternal mortality were computed and tested for differential intervention effect using generalized linear mixed model between two subgroups (cesarean: 40,975; and vaginal delivery: 150,192). RESULTS: The test for homogeneity of intervention effects on hospital-based maternal mortality among the two delivery mode subgroups was statistically significant (p-value: 0.0201). Compared to the control, the adjusted OR of maternal mortality was 0.71 (95% CI: 0.58-0.82, p=0.0034) among women with cesarean delivery. The intervention had no significant effect among women with vaginal delivery (adjusted OR 0.87, 95% CI 0.69-1.11, p=0.6213). This differential effect was particularly marked for district hospitals. CONCLUSION: Maternal deaths reviews and on-site training on emergency obstetric care may be more effective in reducing maternal mortality among high-risk women who need a cesarean section than among low-risk women with vaginal delivery.

Treating moderate acute malnutrition in first-line health services: an effectiveness cluster-randomized trial in Burkina Faso.

BACKGROUND: Management of moderate acute malnutrition (MAM) is, currently, focused on food supplementation approaches. However, the sustainability of these strategies remains weak in low- and middle-income countries. In food-secure settings, an educational/behavioral intervention could be an alternative for improving MAM management. OBJECTIVE: This study compared the effectiveness of weekly context-appropriate child-centered counseling (CCC), with an improved corn-soy blend [corn-soy blend with added micronutrients (CSB++)] or a locally produced ready-to-use supplementary food (RUSF), in treating MAM through first-line rural health services. DESIGN: We used a cluster randomized controlled trial design with 3 arms, involving 18 rural health centers (6 by arm) and children aged 6-24 mo with uncomplicated MAM. In the first arm (CCC), trained health workers provided weekly personalized counseling to caretakers. In the 2 other arms, children received weekly either 455 g CSB++ or 350 g locally produced soy-based RUSF. Both food supplements provided ∼250 kcal/d. RESULTS: The recovery rate after 3 mo of treatment was significantly lower with CCC (57.8%) than with CSB++ (74.5%) and RUSF (74.2%) (P < 0001). Mothers' attendance at health facilities was also substantially lower in the CCC arm (P < 0001); this arm had a high defaulter rate (P < 0.003). When the analysis was adjusted for attendance, we did not find a significant difference between the 3 arms, with incidence rate ratios of 1.14 (95% CI: 0.99, 1.31) and 1.13 (95% CI: 0.98, 1.30) for the CSB++ and RUSF arms, respectively, compared with the CCC arm. CONCLUSION: Whereas supplement-based treatment of MAM was found to be more effective than the provision of CCC, we hypothesize that appropriate and specific nutrition counseling centered on children's needs, through primary health facilities, might be an alternative strategy for MAM treatment in rural food-secure areas, provided that attendance at counseling sessions by the caregiver is ensured. This trial was registered at clinicaltrials.gov as NCT01115647.

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

BACKGROUND: Health personnel retention in remote areas is a key health systems issue wordwide. To deal with this issue, since 2002 the government of Burkina Faso has implemented a staff retention policy, the regionalized health personnel recruitment policy, aimed at front-line workers such as nurses, midwives, and birth attendants. This study aimed to describe the policy's development, formulation, and implementation process for the regionalization of health worker recruitment in Burkina Faso. METHODS: We conducted a qualitative study. The unit of analysis is a single case study with several levels of analysis. This study was conducted in three remote areas in Burkina Faso for the implementation portion, and at the central level for the development portion. Indepth interviews were conducted with Ministry of Health officials in charge of human resources, regional directors, regional human resource managers, district chief medical officers, and health workers at primary health centres. In total, 46 in depth interviews were conducted (February 3 - March 16, 2011). DEVELOPMENT: The idea for this policy emerged after finding a highly uneven distribution of health personnel across urban and rural areas, the availability of a large number of health officers in the labour market, and the opportunity given to the Ministry of Health by the government to recruit personnel through a specific budget allocation. FORMULATION: The formulation consisted of a call for job applications from the Ministry of Health, which indicates the number of available posts by region.The respondents interviewed unanimously acknowledged the lack of documents governing the status of this new personnel category. IMPLEMENTATION: During the initial years of implementation (2002-2003), this policy was limited to recruiting health workers for the regions with no possibility of transfer. The possibility of job-for-job exchange was then approved for a certain time, then cancelled. Starting in 2005, a departure condition was added. Now, regionalized health workers can leave the regions after undergoing a competitive selection process. CONCLUSION: The policy was characterized by the absence of written directives and by targeting only one category of personnel. Moreover, there was no associated incentive-financial or otherwise-which poses the question of long-term viability.

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

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

Arsenic levels in tube-wells water, food, residents' urine and the prevalence of skin lesions in Yatenga province, Burkina Faso.

The aim of the present study was to evaluate the levels of arsenic in tube-well water, food and residents' urines samples in Yatenga province, Burkina Faso. The prevalence of skin lesions was evaluated as well. The study was cross-sectional in design. It was conducted during April 2009. Permanent residents of 20 villages were included in the study. Water samples were collected from 31 tube-wells located in the selected villages. Tomatoes, cabbages, and potatoes produced in the selected village were randomly sampled. Arsenic content in water, food, and residents' urine was determined by atomic absorption spectrophotometry using hydride generation method. Finally, 240 people were examined by a medical doctor for skin lesions. Arsenic concentrations from the tube-well water ranged from 1 to 124 µg/l. Arsenic concentrations of more than one-half (52%) of the water samples exceeded the WHO guideline value (10 µg/l). No trace of arsenic was found in the samples of tomatoes, cabbages, and potatoes. Variation in arsenic concentrations in the urines was correlated to arsenic concentrations in tube-well water. Clinical examinations revealed that melanosis and keratosis were respectively identified in 29.26% and 46.34% of the population. Both conditions were observed in 24.39% of the population. The frequency of skin lesions was positively associated with the arsenic concentration in tube-well water. A great majority (89.53%) of those who had skin lesions were at least 18 years old. In conclusion, chronic arsenic poisoning remains a major public health problem in the province of Yatenga (Burkina Faso).

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

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

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

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

[Individual and environmental characteristics associated with immunization of children in rural areas in Burkina Faso: a multi-level analysis]. / Les facteurs individuels et du milieu de vie associés à la vaccination complète des enfants en milieu rural au Burkina Faso: une approche multiniveau.

PROBLEM: National and international efforts to immunize children aim to remove barriers that hinder full vaccination programs and to reinforce factors promoting it. Despite Burkina Faso's participation in all international and sub-regional initiatives to protect mothers and children from vaccination-preventable communicable diseases, vaccination coverage there remains low and has grown irregularly, from 34.7% in 1993 to 29.3% in 1998 and 43.9% in 2003. The situation is even more critical in rural than in urban areas. OBJECTIVE: To analyze the contribution of individual and environmental characteristics associated with vaccination of children aged 12-23 months in rural areas in Burkina Faso. Study population and methods. Data from the 1998 DHS (Demographic and Health Survey) and the 1997 Health Ministry Statistical Yearbook were used with a multi-level approach. Analysis distinguished two levels corresponding to the data's hierarchical structure: characteristics of children and their family's environment (level 1) and the health system and social environment (level 2). The study included 805 children aged 12 to 23 months, living in 44 health districts. The dependent variable was the child's vaccination status and is dichotomous (completely vaccinated or not). Completely vaccinated children are those who have received the BCG, the three doses of DTCoq, oral polio, measles and yellow fever vaccines, according to either their vaccination cards or their mothers' statement. RESULTS: The likelihood of vaccination increased with the level of household wealth (OR [well-off/poor]=1.88; [CI: 1.15-3.06] and was strongly associated with use of health services (OR [Prenatal care and assisted delivery/none of these services]=5.64; [CI: 3.16-10.05]). Nevertheless, these 2 variables did not alone explain the differences in vaccination observed between districts. More than 37% of the variation for vaccination completeness can be attributed to differences between health districts. Resources appear to play a minor role but a 1% increase in the proportion of educated women in the district increased the odds of complete vaccination by a factor of 1.14 [CI: 1.01-1.27]. Discussion. Despite universal access to free vaccination, children from poor households are less likely to receive all their vaccines than children from well-off households. This is probably due to indirect costs that stem from vaccination; the financial barrier remains one of the most significant factors preventing complete vaccination. Previous utilization of prenatal care and institutional delivery is more related to dynamics or even interaction between individuals and the health system. In addition to their direct effects, the interrelation between population and health systems may constitute a vaccination culture that may play a major role in explaining vaccination completeness. The resources of the health system bear little relation to vaccination. They are necessary but not sufficient for good health services. The organizational dynamic of health teams, the leadership of health district supervisors and staff motivation are key elements in these processes but were not measured in this study. CONCLUSION: Adding resources to vaccination programs is always a challenge for a number of national healthcare systems. It is not, however, the only key to success. The organization of healthcare systems and the contacts and relationships they establish with their populations appear to be determinant. The local vaccination culture that results from this interaction may be a key to explaining the variations observed between the different health districts.

[Impact of water resource installations on the distribution of schistosomiasis and its intermediary hosts in Burkina Faso]. / Influences des hydro-aménagements sur la distribution des bilharzioses et de leur hôtes intermédiares au Burkina Faso.

Dams generally are a favourable biotope for the molluscs acting as intermediary hosts to schistosomiasis. The importance of the schistosomiasis endemic which follows depends on the interactions taking place between the parasites and their definitive (humans) and intermediary hosts. A preliminary sound knowledge of the prevailing epidemiological situations is therefore necessary to define an efficient programme to fight these infections. The extension of schistosomiasis following the installation of water resource facilities is significative of the part played by these hosts. In the hydroagricultural complex of Sourou, the prevalence of urinary schistosomiasis increased from 19% in 1954 to more than 70% in 1998-1999 in Guiédougou, the most ancient site. As to digestive schistosomiasis, almost unheard of until 1987, its prevalence ranged from 8% to 69% in 1998 in the villages located alongside the areas thus equipped. In the Kou Valley, the prevalence went up from 14% in 1957 to 80% in 1974 for urinary schistosomiasis and from 1.3% to 45% for intestinal schistosomiasis. The same tendencies are likely to appear in the hydraulic installations of Bagré, Ziga, and Kompienga. Dams thus constitute amplifying factors for the proliferation of species and for parasite-host interactions. All the actors (developers, populations and scientists) are faced with the challenge of finding a mean to control the development of schistosomiasis infections which are likely to seriously lessen the benefits expected from these hydraulic installations.

[Medical emergencies in the Yalgado Ouedraogo national hospital of Ouagadougou: patients' profile and assessment of care practices]. / Les urgences médicales au Centre hospitalier national Yalgado Ouédraogo de Ouagadougou: profil et prise en charge des patients.

The Emergency Department, the showcase of the hospital, must be functional at all times with sufficient resources for looking after the patients without delay. In the Medical Emergency Department of the Yalgado Ouedraogo national hospital of Ouagadougou (Burkina Faso), problems such as delays and difficulties to obtain medicine, give rise to conflicts thus causing the hospital to be a target for public criticism. The aim of this study is to establish the profile of the patients and to assess how they are taken care of. A cross-sectional survey was carried out for 21 consecutive days spread out over three months, from April 25 to June 25, 1997 and concerned all of the 551 patients consulting on those days. The self referral rate was 50.8%. Patients came mainly from the Kadiogo province (90.7%), with their own transport means (85.1%), more often at the beginning of the week (31 patients per day on average) than during week ends (21 patients per day on average, p<0.001). The age group was 15 to 93 years with a mean of 35.4 ( 14,2) years. Infectious diseases, particularly gastroenteritis (21.3%), malaria (12.1%), and pneumonia (10.2%) were the main diagnoses. The median waiting time was 8 min (from 0 to 3 h 59 min), the median therapeutic time was 56 min (from 5 min to 16 h 19 min). Patients were supplied with medicine in 14.5% of cases. Thus median medicine acquisition time was significantly reduced from 35 min to 21 min (p<0.001) when medicines were bought. Medicine acquisition time significantly contributes to increase the therapeutic delay (rs=0.31; p<0.001). The median therapeutic time was 56 min (5 min to 16 h 19 min). The diagnostic accuracy rate was 77.4%, and the satisfaction index 3.5%. Patients expenditure was 9,002 CFA francs on average, including 7,963 CFA francs for medicine. Thus access to medicine constitutes a major point of malfunction, increasing the caretaking time span as well as patients' expenditure. In addition to quickly and systematically supplying medicines to all patients, organizing the reception and providing comfortable waiting conditions must be considered in order to offer better care delivery services.

[Hospital staff use of generic essential drugs: the case of Yalgado Ouedraogo University Hospital Centre (Burkina Faso)]. / Utilisation des médicaments essentiels génériques par le personnel hospitalier: le cas du CHU Yalgado Ouédraogo (Burkina Faso).

With the institution of the primary health care strategy in 1978 and the devaluation of the CFA franc in 1994 the French-speaking countries of Africa are striving to encourage the prescription of generic essential drugs. However, their prescription rates continue to remain low in these countries, especially in the major hospitals. The aim of this study was thus to determine how prescribers at the national hospital in Ouagadougou were informed about genetric drugs and to analyse their attitudes and practices with a view to elucidating the barriers to a more widespread use of generic essential drugs in hospital practice. The study consisted of a survey of all of the qualified prescribers (n=194) at Yalgado Ouedraogo University Hospital Centre in 1998. Thirty refused to participate and 35 questionnaires were discarded because they were poorly filled out. So, the responses of 129 (66.5%) prescribers in all were analysed. More than 80% (106/129) of the prescribers were aware of the existence of generic drugs in the hospital, but only 24.8% of them considered generics to have the same efficacy as their corresponding proprietary drugs. However, 64.3% of the prescribers felt that there was a place for generic drugs in a last-resort echelon of medical care, such as the national hospital in Ouagadougou, and 85.3 % were willing to prescribe them for their patients because of their low cost. The analysis of the data and the responses to the open questions show that the main conditions that would boost the prescription of generic essential drugs by hospital staff are as follows: generic essential drugs available in appropriate dosage forms and of guaranteed quality; appropriate basic training starting in medical and nursing schools; providing the prescribers with information and further education about generic drugs; and better dispensing of these drugs by the hospital's central pharmacy.