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.

Enabling environment and challenges for UN joint programming to strengthen nutrition: A multi-country survey in Burkina Faso, Mali, and Senegal.

The United Nations plays an important role in supporting governments to implement nutrition policies and accelerate progress. The development of a common UN nutrition agenda and joint programming are two crucial aspects to improve complementarities and synergies to maximize the nutritional impact. The objective was to identify the success factors and challenges during the planning process of the UN common nutrition agenda in three different contexts. This is a qualitative study, conducted in Burkina Faso, Mali and Senegal between 2016 and 2018. The data was collected using an orientation kit developed by the UN Network which includes an inventory of UN nutrition actions, individual interviews, and consensus workshops. A total of 32 nutrition focal points from UN agencies participated in the study. In all countries, UN nutrition interventions were concentrated in areas with the highest number of stunted. Most of these actions were aligned with the priorities of nutrition policies and were complementary. Governance actions were mainly oriented towards sector governance. Key success of joint nutrition programming by UN includes commitment of country director and technicians, functional UN Network, participation of field-level stakeholders and strengthening of information between UN agencies. Certain prerequisites such as the existence of nutrition policy, stakeholder and action mapping, inventory of UN nutrition actions, situation analysis contributed to the formulation of a common nutrition agenda at country level. Among the challenges, we note effective implementation of joint programs to strengthen complementarity; diversity of beneficiary targeting strategies between sectors; low mobilization of resources; lack of coordination intra and inter agencies; understaffing; strengthening partnership and multisectoral accountability; ownership of the common nutrition agenda by all agencies. The development of common nutrition agenda and joint programs would maximize the nutritional impact in the country level.

Sahel terrorist crisis and development priorities: case of financial allocations for the control of non-communicable diseases in Burkina Faso.

In Africa, nearly 46% of all mortality will be attributed to non-communicable diseases (NCDs) by 2030. While the cost of inaction far exceeds the cost of action against NCDs, global funding for the prevention and control of NCDs is minimal. The objective of this was to explore the Ministry of Health budget allocations for NCDs from 2010 to 2020 as well as the effect of the terrorism crisis on these allocations. The methodology was based on the budget tracking tool developed by the Scaling Up Nutrition Movement. Twenty-nine budget lines related to the prevention and/or control of NCDs have been identified. About 29.9 million USD were allocated to the fight against NCDs with an absorption rate of more than 98%.There is an upward trend of allocated budget characterized by an exponential increase from the development of the national integrated strategic plan for the fight against NCDs (2016-2020). In 2017, an increase of 184% compared to 2016 was observed. However, the efforts were challenged by the emergence of the terrorist threat which triggered in January 2016, leading to a drastic reduction in allocations for NCDs in favor likely of defense and security priorities as well as addressing the needs of internally displaced persons. A trend analysis suggests that the NCDs budget significantly decrease as the country global terrorist index increase. Further analysis is needed to better understand the implication on NCD incidence, and identify advocacy opportunities for mitigating the negative impact of the terrorist treat on NCDs and other development issues.

An overview of governance of noncommunicable diseases (NCDs) in West African countries.

Noncommunicable diseases (NCDs) account for over 50% of total premature mortality in most low- and middle-income countries (LMICs). However, responses to the fight against NCDs are yet to be efficient in most of these countries. There is little published data on how this response is structured from a governance perspective in the context of global health systems. This study explored from existing research, the state of the governance in the fight against NCDs in the ECOWAS region. It consists of a review of articles published in peer-reviewed journals between 2010 and 2020 on ECOWAS countries. Of three hundred thirty-three (333) articles initially identified, eight (8) publications were included in these studies. There is a serious lack of information on the governance of NCDs in French-speaking countries such as Burkina Faso where no article has been identified. Of the 8 studies meeting the inclusion criteria, none has addressed the coherence of policies and programs. Seven (7) publications provided information on the component national NCDs policies, strategies and action plans, four (4) studies on the component of actors, interventions and the multisectoral coordination mechanism, five (5) on the issue of budget allocations and financing of NCD prevention and control interventions. Political commitment and government leadership has been discussed in three (3) publications. While some studies have provided information on the components of governance, it is important to remember that most of the studies were literature reviews and not empirical studies, which does not allow a better understanding of the situation of governance in each country. Designing an empirical study to answer some questions related to the governance of NCDs in the selected countries is necessary.

Analysis of the nutritional composition and organization of school meals in the province of Kadiogo in Burkina Faso: challenges and prospects.

Background: In the face of food shortages and precariousness, school meals are an effective means of encouraging pupils to attend and stay in school, and of combating nutritional deficiencies. Unfortunately, there are bottlenecks to be identified and resolved. Objective: Analyzing the composition of meals served to school-age children in primary schools in the province of Kadiogo, while assessing the opinion of school staff on these meals (Burkina Faso). Methods: A descriptive cross-sectional survey about school meals was carried out during the period from April to May 2019 among school stakeholders in primary schools in five (05) municipalities of the province of Kadiogo. Results: Insufficient quantity and quality of rations served were recorded in primary schools. The endogenous initiative canteens represented 46.4% of the registered canteens. The promotion of Health-Hygiene-Nutrition (H-H-N) activities in schools encountered difficulties in covering the sanitary needs of school-aged children because unavailability of socio-sanitary infrastructures. School meals consisted of starchy foods and legumes in rural schools and more diversified meals consisting of fruits and vegetables as well as meat and fish in urban schools. In rural municipalities, school meals were insufficient in quantity and quality, while in the urban municipality, macronutrient intakes were in excess with micronutrient intakes largely deficient. Conclusion: Despite the shortcomings, school officials specified that school meals cover lunch rations, increase school enrolment, and improve school-aged children' learning capacity.

Field-based assessment of the design of lysimeters for landfill final cover seepage control.

Lysimeters are considered the most appropriate instrument for assessing percolations rates through landfill final covers. Their design, however, must take into consideration the unsaturated nature of water seepage, otherwise they may act as a sink or cause flow avoidance. The aim of this study was to investigate whether using a simple approach to lysimeter design produces reliable seepage control data. Two different design methods were compared using a three-year field database of suction and seepage data collected from large-scale lysimeters installed at the St-Nicephore landfill in Canada. The first, or control, whose side walls were as high as the thickness of the cover material, was inspired from lysimeters installed during the Alternative Cover Assessment Program (ACAP; USA). The second lysimeter was designed based on the proposed simple design methodology, which focuses on the unsaturated flow and hydraulic properties of the materials to determine the optimal wall height. Analysis of the database did not show any indication of significant preferential flow, or alteration of the flow regime by the second lysimeter, which collected as much percolation as the control one (less than 5% difference). The linear method has not been tested for extreme climatic conditions and the wall heights calculated using this method may be very high when designed for very fine-grained soil covers.

Acceptance and challenges of the introduction of the routine community-based vitamin A supplementation strategy: the case of Burkina Faso.

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.

Determinants of the practice of exclusive breastfeeding in Guinea: evidence from 2018 Guinean demographic and health survey.

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

Discontinuation of healthcare and factors associated to mortality among severe acute malnourished children under five years in healthcare and nutritional care settings.

BACKGROUND AND AIMS: Even if under-five children mortality tends to decrease considerably in developed countries, it remains a major concern in Sub-Saharan Africa. The purpose of the present study is to assess causes of healthcare discontinuation and factors associated with mortality among severe acute malnourished children under five years old in the health district of Gorom-Gorom in Burkina Faso. METHODS: A descriptive retrospective study on healthcare discontinuation and deaths of severely acute malnourished children under five years old who registered from July to December 2018, in the health district of Gorom-Gorom in Burkina Faso. RESULTS: A total of 377 records of children suffering from severe acute malnutrition were exploited. Children of age range 6-23 months were the most predominantly malnourished. Healthcare discontinuation was observed at rates around 24.4%.Deaths were recorded in 9.72% of children hospitalized in the CRNE and around 1% in children in the ambulatory care management. The severe acute malnutrition co-morbidity factors included oral candidiasis [OR = 14.8; (95%CI 1.128-194.285)], dehydration [OR = 11.46; (95%CI 1.085-121.038)] and malaria [OR = 8.32; (95%CI 1.915-36.191)]. CONCLUSION: The risk of death of severe acute malnourished children is higher when the disease is associated with complications.

Facilitating factors and challenges of the implementation of multisectoral nutrition programmes at the community level to improve optimal infant and young child feeding practices: a qualitative study in Burkina Faso.

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.

Policy overview of the multisectoral nutrition planning process: The progress, challenges, and lessons learned from Burkina Faso.

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.

[Prevalence and factors associated with stunting among schoolchildren in Dori in the Sahel region of Burkina Faso]. / Prévalence et facteurs associés au retard de croissance chez des écoliers à Dori, Burkina Faso.

OBJECTIVES: To study the factors associated with stunted physical growth in primary school children and adolescents in the Burkina Faso Sahel. MATERIALS AND METHODS: This was a secondary analysis of the data from the survey conducted by the Directorate of Nutrition in June 2016 in 13 primary schools. The baseline study was conducted from May 15 to 24, 2016. This secondary analysis of the database took place from March to August 2017. The study participants were made up of male and female students from public primary schools and who were beneficiaries of the school canteens of the Dori municipality at the time of the survey. Logistic regression was used to identify the factors associated with a 5% significance level. RESULTS: The analysis involved a sample of 568 students aged 5 to 15 years. Girls accounted for 52% of students. The prevalence of stunting was 32.92% (95% CI [29-36%]), it was 28.93% (95 % CI [23.84-34.62%]) among boys and 36.61 % (95% CI [31.28-42.28%]) in girls. Among primary students, age (ORa = 4.38, P = 0.00), anemia (ORa = 0.24, P = 0.01) and latrine use (ORa = 0.58 with P = 0.02) were the factors statistically associated with stunting (P < 0.05). CONCLUSIONS: The prevalence of stunting among primary school students in the commune of Dori remains high. Associated factors were age, anemia and latrine use. Promotion of latrine use in households and prevention of anemia in children under 5 years of age would be necessary for the reduction of stunting among adolescents.

Mapping Nutrition Interventions, a Key Analytical Tool for Informing the Multisectoral Planning Process: Example From Burkina Faso.

BACKGROUND: The government of Burkina Faso, along with the United Nations Network for Nutrition (UNN), activity REACH (Renewed Efforts Against Child Hunger and undernutrition) partnership, conducted a mapping of nutrition interventions and stakeholders to identify the best approaches for scaling up priority nutrition interventions and to strengthen a multisectoral response to fight malnutrition. OBJECTIVE: The objectives include describing the process used to map a set of country-prioritized nutrition interventions and to describe how the results contributed to the multisectoral nutrition planning process in Burkina Faso. METHODS: The mapping exercise was designed as a cross-sectional study using the Excel-based Scaling Up Nutrition Planning and Monitoring Tool (SUN PMT) to collect, store, and analyze data. RESULTS: The results present different analyses produced by the SUN PMT for 29 prioritized nutrition interventions. The analyses include the distribution of nutrition stakeholders for each intervention, the calculation of geographic and population coverage for each intervention, and the utilization of delivery mechanisms to reach beneficiaries. CONCLUSIONS: The mapping of key nutrition interventions and stakeholders supporting those interventions in Burkina Faso was an important tool in the multisectoral planning process. The exercise made it possible to identify gaps and needs; launch a discussion on nutrition planning and the scaling up of interventions; and mobilize sectors and development partners around nutrition.

[The use of psychoactive substances among street teenagers in Ouagadougou]. / Usage de substances psychoactives chez les adolescents des rues à Ouagadougou.

Objectives: To study the determinants of psychoactive substance use among street teenagers living in Ouagadougou.Methods: Qualitative and quantitative cross-sectional study with street teenagers living on the Zogona campus in Ouagadougou, in September 2012. A focus group was then formed with eight members of the group.Results: The median age was 16 years (range: 12 to 20 years). The various psychotropic agents were tobacco, alcohol, gasoline, glue sniffing and cannabis. Seventeen of the 31 teenagers had already been admitted to a rehabilitation centre and none of them attended school at the time of data collection. However, 12 street teenagers had previously attended school. The main reasons for the presence of these teenagers in the street were "poverty in the family", "death of the parents", "Koranic school". The main reasons reported by the teenagers for substance use were "to give oneself courage", "to relieve hunger", "to be like the others", "to be accepted by the group", "to protect oneself from the cold". The main determinants of substance abuse were social exclusion, group membership, and group identification.Conclusion: Psychoactive substance use is an integral part of the life of street teenagers and is a major obstacle to social integration.

[Vulnerability of male prisoners to HIV /AIDS in Ouagadougou/ Burkina Faso]. / La vulnérabilité des détenus hommes face au VIH/sida à Ouagadougou (Burkina Faso).

OBJECTIVE: To evaluate the vulnerability of male prisoners to HIV, risk behaviour and access to prevention. METHODS: This cross-sectional descriptive study was conducted in july and August 2012 in Ouagadougou Prison in Burkina Faso. Two trained investigators collected data by means of individual interviews in the prison visiting room using a questionnaire administered to male inmates 18 years and older, imprisoned for more than three months. Two focus groups were conducted with prison guards and healthcare personnel. RESULTS: A total of165 male prisoners were interviewed. The mean prison sentence was 19 months, the median age of the inmates was 28years and 45% of them were illiterate. About4% of male prisoners reported having had homosexual relations during their imprisonment. However, data indicate underreporting and denial of homosexual behaviour by prisoners. 49% of prisoners shared razors or razorblades in prison. None of the interviewees reported injected drug use or tattoos in prison. The majority (84%) of prisoners had a good knowledge of HIVjAIDS and 6% were aware of the risk of sexually transmitted infections. Only 5% of prisoners had had a screening test during their stay in prison. CONCLUSION: Prison conditions, homosexual behaviour and absence of condoms in prison accentuate the vulnerability of prisoners to HIV j AIDS. Implementation of a prevention programme and management HIV-positive prisoners would help to reduce significantly the risk of HIV transmission in prison.