Predictors of contraceptive method discontinuation among adolescent and young women in three West African countries (Burkina Faso, Mali, and Niger).

BACKGROUND: The effective use of contraception among adolescents and young women can reduce the risk of unintended pregnancies. However, the prevalence of contraceptive use remains low in this age group. The objective of this study was to estimate the rate of contraceptive method discontinuation among adolescents and young women and to identify its associated factors in Burkina Faso, Mali, and Niger. METHOD: This was a secondary analysis of data from Demographic and Health Surveys of Burkina Faso (2010), Mali (2012-2013), and Niger (2012). The dependent variable was the time to discontinuation of contraceptive methods. Independent variables were represented by sociodemographic, socioeconomic, and cultural characteristics. Mixed-effects survival analysis with proportional hazards was used to identify the predictors. RESULTS: A total of 2,264 adolescents and young women aged 15 to 24 years were included in this analysis, comprising 1,100 in Burkina Faso, 491 in Mali, and 673 in Niger. Over the last five years, the overall contraceptive discontinuation rate was 68.7% (50.1% in Burkina Faso, 59.6% in Mali, and 96.8% in Niger). At the individual level, in Burkina Faso, occupation (aHR = 0.33), number of living children (aHR = 2.17), marital status (aHR = 2.93), and region (aHR = 0.54) were associated with contraceptive discontinuation. Except for education and marital status, we found the same factors in Mali. In Niger, a women's education level (aHR = 1.47) and her partner (aHR = 0.52) were associated with discontinuation. At the community level, the region of origin was associated with discontinuation of contraceptive methods. CONCLUSION: Most adolescents and young women experienced at least one episode of discontinuation. Discontinuation of contraceptive methods is associated with the level of education, occupation, number of children, marital status, and desire for children with the spouse. Promotion of contraceptive interventions should target adolescents, young women, and their partners, as well as those with a low education level or in a union.

Prevalence and Factors Associated with Late First Antenatal Care Visit in Kaya Health District, Burkina Faso.

Early first antenatal consultation during pregnancy is important to identify women at risk of complications and to increase the probability of institutional delivery, with skilled birth attendants. However, most women in developing countries begin their antenatal visits after the first trimester. The purpose of this study was to estimate the extent of this phenomenon and to identify its main associated factors. We conducted a secondary data analysis using Kaya Health and Demographic Surveillance System Data (Kaya HDSS), which was collected between February 1 , 2013 and January 31 , 2014. This study included 704 women of reproductive age who permanently reside on Kaya HDSS area. The dependent variable was the time until the first antenatal consultation. The factors associated with late first antenatal consultation were identified by logistic regression. The prevalence of late first antenatal consultation was 62.93%. The multivariate analysis demonstrated that women of age 25 and over (OR=1.77; p=0.002), multiparity (OR=1.72; p=0.036), the women's lack of education (OR=2.72; p=0.001) and the household's poor socio- economic level (very low: OR=2.89; p <0.001) were factors associated with late first antenatal consultation. Sanitary education, community implication and free healthcare for mothers and children can contribute in reducing this phenomenon in our context.

Repeat Ivermectin Mass Drug Administrations for Malaria Control II: Protocol for a Double-blind, Cluster-Randomized, Placebo-Controlled Trial for the Integrated Control of Malaria.

BACKGROUND: The gains made against malaria have stagnated since 2015, threatened further by increasing resistance to insecticides and antimalarials. Improvement in malaria control necessitates a multipronged strategy, which includes the development of novel tools. One such tool is mass drug administration (MDA) with endectocides, primarily ivermectin, which has shown promise in reducing malaria transmission through lethal and sublethal impacts on the mosquito vector. OBJECTIVE: The primary objective of the study is to assess the impact of repeated ivermectin MDA on malaria incidence in children aged ≤10 years. METHODS: Repeat Ivermectin MDA for Malaria Control II is a double-blind, placebo-controlled, cluster-randomized, and parallel-group trial conducted in a setting with intense seasonal malaria transmission in Southwest Burkina Faso. The study included 14 discrete villages: 7 (50%) randomized to receive standard measures (seasonal malaria chemoprevention [SMC] and bed net use for children aged 3 to 59 months) and placebo, and 7 (50%) randomized to receive standard measures and monthly ivermectin MDA at 300 µg/kg for 3 consecutive days, provided under supervision to all eligible village inhabitants, over 2 successive rainy seasons. Nonpregnant individuals >90 cm in height were eligible for ivermectin MDA, and cotreatment with ivermectin and SMC was not permitted. The primary outcome is malaria incidence in children aged ≤10 years, as assessed by active case surveillance. The secondary safety outcome of repeated ivermectin MDA was assessed through active and passive adverse event monitoring. RESULTS: The trial intervention was conducted from July to November in 2019 and 2020, with additional sampling of humans and mosquitoes occurring through February 2022 to assess postintervention changes in transmission patterns. Additional human and entomological assessments were performed over the 2 years in a subset of households from 6 cross-sectional villages. A subset of individuals underwent additional sampling in 2020 to characterize ivermectin pharmacokinetics and pharmacodynamics. Analysis and unblinding will commence once the database has been completed, cleaned, and locked. CONCLUSIONS: Our trial represents the first study to directly assess the impact of a novel approach for malaria control, ivermectin MDA as a mosquitocidal agent, layered into existing standard-of-care interventions. The study was designed to leverage the current SMC deployment infrastructure and will provide evidence regarding the additional benefit of ivermectin MDA in reducing malaria incidence in children. TRIAL REGISTRATIONS: ClinicalTrials.gov NCT03967054; https://clinicaltrials.gov/ct2/show/NCT03967054 and Pan African Clinical Trials Registry PACT201907479787308; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=8219. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41197.

Spatio-temporal analysis and prediction of malaria cases using remote sensing meteorological data in Diébougou health district, Burkina Faso, 2016-2017.

Malaria control and prevention programs are more efficient and cost-effective when they target hotspots or select the best periods of year to implement interventions. This study aimed to identify the spatial distribution of malaria hotspots at the village level in Diébougou health district, Burkina Faso, and to model the temporal dynamics of malaria cases as a function of meteorological conditions and of the distance between villages and health centres (HCs). Case data for 27 villages were collected in 13 HCs. Meteorological data were obtained through remote sensing. Two synthetic meteorological indicators (SMIs) were created to summarize meteorological variables. Spatial hotspots were detected using the Kulldorf scanning method. A General Additive Model was used to determine the time lag between cases and SMIs and to evaluate the effect of SMIs and distance to HC on the temporal evolution of malaria cases. The multivariate model was fitted with data from the epidemic year to predict the number of cases in the following outbreak. Overall, the incidence rate in the area was 429.13 cases per 1000 person-year with important spatial and temporal heterogeneities. Four spatial hotspots, involving 7 of the 27 villages, were detected, for an incidence rate of 854.02 cases per 1000 person-year. The hotspot with the highest risk (relative risk = 4.06) consisted of a single village, with an incidence rate of 1750.75 cases per 1000 person-years. The multivariate analysis found greater variability in incidence between HCs than between villages linked to the same HC. The time lag that generated the better predictions of cases was 9 weeks for SMI1 (positively correlated with precipitation variables) and 16 weeks for SMI2 (positively correlated with temperature variables. The prediction followed the overall pattern of the time series of reported cases and predicted the onset of the following outbreak with a precision of less than 3 weeks. This analysis of malaria cases in Diébougou health district, Burkina Faso, provides a powerful prospective method for identifying and predicting high-risk areas and high-transmission periods that could be targeted in future malaria control and prevention campaigns.

[Acceptability and satisfaction with pregnancy and newborn diagnostic assessment (PANDA) system providing prenatal care in Burkina Faso]. / Acceptabilité et satisfaction de l'utilisation du système Pregnancy and Newborn Diagnostic Assessment (PANDA) pour les soins prénatals au Burkina Faso.

INTRODUCTION: mobile health technologies are increasingly being used as innovative solutions to improve antenatal care in Primary Care Services (PCSs). This study assessed the acceptability and satisfaction with PANDA system used in PCSs in Burkina Faso. METHODS: we conducted a cross-sectional mixed-methods study of 35 users of PCSs and 35 health workers in the Koupela Health District, in the Central East region of Burkina Faso in September 2017. Interviews and 4 focus groups were conducted among PCSs users and semi-structured interviews among health-care professionals. Quantitative data analysis was carried out using the SPSS software and qualitative data analysis using a thematic analysis with NVivo 10. RESULTS: PANDA system was very well accepted and appreciated by users and healthcare providers. Factors influencing customer satisfaction included the improvement of interactions with health care providers and the access to better quality care at lower cost. Health care providers appreciated the relevance of PANDA system as well as service improvements, follow-up and monitoring of pregnant women. CONCLUSION: in primary health-care system in Burkina Faso, PANDA system is very well accepted and appreciated by both health care providers and users of prenatal care services.

Anopheles bionomics, insecticide resistance and malaria transmission in southwest Burkina Faso: A pre-intervention study.

BACKGROUND: Twenty-seven villages were selected in southwest Burkina Faso to implement new vector control strategies in addition to long lasting insecticidal nets (LLINs) through a Randomized Controlled Trial (RCT). We conducted entomological surveys in the villages during the dry cold season (January 2017), dry hot season (March 2017) and rainy season (June 2017) to describe malaria vectors bionomics, insecticide resistance and transmission prior to this trial. METHODS: We carried out hourly catches (from 17:00 to 09:00) inside and outside 4 houses in each village using the Human Landing Catch technique. Mosquitoes were identified using morphological taxonomic keys. Specimens belonging to the Anopheles gambiae complex and Anopheles funestus group were identified using molecular techniques as well as detection of Plasmodium falciparum infection and insecticide resistance target-site mutations. RESULTS: Eight Anopheles species were detected in the area. Anopheles funestus s.s was the main vector during the dry cold season. It was replaced by Anopheles coluzzii during the dry hot season whereas An. coluzzii and An. gambiae s.s. were the dominant species during the rainy season. Species composition of the Anopheles population varied significantly among seasons. All insecticide resistance mechanisms (kdr-w, kdr-e and ace-1 target site mutations) investigated were found in each members of the An. gambiae complex but at different frequencies. We observed early and late biting phenotypes in the main malaria vector species. Entomological inoculation rates were 2.61, 2.67 and 11.25 infected bites per human per month during dry cold season, dry hot season and rainy season, respectively. CONCLUSION: The entomological indicators of malaria transmission were high despite the universal coverage with LLINs. We detected early and late biting phenotypes in the main malaria vector species as well as physiological insecticide resistance mechanisms. These data will be used to evaluate the impact of complementary tools to LLINs in an upcoming RCT.

Anopheles bionomics, insecticide resistance mechanisms, and malaria transmission in the Korhogo area, northern Côte d'Ivoire: a pre-intervention study.

A better understanding of malaria transmission at a local scale is essential for developing and implementing effective control strategies. In the framework of a randomized controlled trial (RCT), we aimed to provide an updated description of malaria transmission in the Korhogo area, northern Côte d'Ivoire, and to obtain baseline data for the trial. We performed human landing collections (HLCs) in 26 villages in the Korhogo area during the rainy season (September-October 2016, April-May 2017) and the dry season (November-December 2016, February-March 2017). We used PCR techniques to ascertain the species of the Anopheles gambiae complex, Plasmodium falciparum sporozoite infection, and insecticide resistance mechanisms in a subset of Anopheles vectors. Anopheles gambiae s.l. was the predominant malaria vector in the Korhogo area. Overall, more vectors were collected outdoors than indoors (p < 0.001). Of the 774 An. gambiae s.l. tested in the laboratory, 89.65% were An. gambiae s.s. and 10.35% were An. coluzzii. The frequencies of the kdr allele were very high in An. gambiae s.s. but the ace-1 allele was found at moderate frequencies. An unprotected individual living in the Korhogo area received an average of 9.04, 0.63, 0.06 and 0.12 infected bites per night in September-October, November-December, February-March, and April-May, respectively. These results demonstrate that the intensity of malaria transmission is extremely high in the Korhogo area, especially during the rainy season. Malaria control in highly endemic areas such as Korhogo needs to be strengthened with complementary tools in order to reduce the burden of the disease.

A case-control study of risk factors for maternal mortality in Burkina Faso in 2014.

OBJECTIVE: To analyze the factors associated with maternal mortality in hospitals in Burkina Faso in the context of emergency obstetric neonatal care. METHODS: A case-control study was conducted in 812 health facilities in the public and private sectors, involving all categories of health facility in the 13 regions of Burkina Faso. The study population included all women with obstetric complications from May 2013 to April 2014. For any identified case of maternal death, a control counterpart (living woman) was matched according to the obstetric complication. Conditional logistic regression was used to assess factors associated with maternal mortality. RESULTS: The analysis focused on a total of 1128 women (564 cases and 564 controls). Place of residence (P=0.011), the referral for care (P<0.001), maternal age (P<0.001), state of consciousness of the mother (P<0.001), and the presence of a fever (P<0.001) were significantly associated with the occurrence of maternal death. In multivariate analysis, maternal age (OR 1.45; 95% CI, 0.95-2.20; P<0.001), coma (OR 1.44; 95% CI, 0.16-0.2; P=0.010), and presence of fever (OR 1.67; 95% CI, 1.21-2.28; P<0.001) were risk factors related to maternal death. CONCLUSION: The determined factors demonstrate that the survival of women is closely linked to their health.