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There is growing consensus in the family planning community around the need for novel measures of autonomy. Existing literature highlights the tension between efforts to pursue contraceptive targets and maximize uptake on the one hand, and efforts to promote quality, person-centeredness, and contraceptive autonomy on the other hand. Here, we pilot a novel measure of contraceptive autonomy, measuring it at two Health and Demographic Surveillance System sites in Burkina Faso. We conducted a population-based survey with 3,929 women of reproductive age, testing an array of new survey items within the three subdomains of informed choice, full choice, and free choice. In addition to providing tentative estimates of the prevalence of contraceptive autonomy and its subdomains in our sample of Burkinabè women, we critically examine which parts of the proposed methodology worked well, what challenges/limitations we encountered, and what next steps might be for refining, improving, and validating the indicator. We demonstrate that contraceptive autonomy can be measured at the population level but a number of complex measurement challenges remain. Rather than a final validated tool, we consider this a step on a long road toward a more person-centered measurement agenda for the global family planning community.
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Anticoncepcionais , Serviços de Planejamento Familiar , Humanos , Feminino , Burkina Faso , Inquéritos e Questionários , Comportamento Contraceptivo , AnticoncepçãoRESUMO
Unmet need for contraception is a widely used but frequently misunderstood indicator. Although calculated from measures of pregnancy intention and current contraceptive use, unmet need is commonly used as a proxy measure for (1) lack of access to contraception and (2) desire to use it. Using data from a survey in Burkina Faso, we examine the extent to which unmet need corresponds with and diverges from these two concepts, calculating sensitivity, specificity, and positive/negative predictive values. Among women assigned conventional unmet need, 67 percent report no desire to use contraception and 61 percent report access to a broad range of affordable contraceptives. Results show unmet need has low sensitivity and specificity in differentiating those who lack access and/or who desire to use a method from those who do not. These findings suggest that unmet need is of limited utility to inform family planning programs and may be leading stakeholders to overestimate the proportion of women in need of expanded family planning services. We conclude that more direct measures are feasible at the population level, rendering the proxy measure of unmet need unnecessary. Where access to and/or desire for contraception are the true outcomes of interest, more direct measures should be used.
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Comportamento Contraceptivo , Anticoncepção , Gravidez , Humanos , Feminino , Serviços de Planejamento Familiar , Anticoncepcionais , Acessibilidade aos Serviços de SaúdeRESUMO
The adolescent birth rate (ABR) is an important indicator of maternal health, adolescent sexual health, and gender equity; it remains high in sub-Saharan Africa. While Demographic and Health Surveys (DHS) are the main source of ABR estimates, Health and Demographic Surveillance Systems (HDSS) also produce ABRs. Studies are lacking, however, to assess the ease of access and accuracy of HDSS ABR measures. In this paper, we use birth and exposure data from 10 HDSS in six African countries to compute local ABRs and compare these rates to DHS regional rates where the HDSS sites are located, standardizing by education and place of residence. In rural HDSS sites, the ABR measure is on average 44 percent lower than the DHS measure, after controlling for education and place of residence. Strong temporary migration of childless young women out of rural areas and different capacities in capturing temporarily absent women in the DHS and HDSS could explain this discrepancy. Further comparisons based on more strictly similar populations and measures seem warranted.
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Coeficiente de Natalidade/tendências , Gravidez na Adolescência/estatística & dados numéricos , População Rural/tendências , Adolescente , Adulto , África Subsaariana/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Gravidez , Fatores Socioeconômicos , Adulto JovemRESUMO
Ramadan exposure in utero can be regarded as a natural experiment with which to study how nutritional conditions in utero influence susceptibility to disease later in life. We analyzed data from rural Burkina Faso on 41,025 children born between 1993 and 2012, of whom 25,093 were born to Muslim mothers. Ramadan exposure was assigned on the basis of overlap between Ramadan dates and gestation, creating 7 exclusive categories. We used proportional hazards regression with difference-in-differences analysis to estimate the association between Ramadan exposure at different gestational ages and mortality among children under 5 years of age. Under-5 mortality was 32 deaths per 1,000 child-years. Under-5 mortality among Muslims was 15% higher than that among non-Muslims (P < 0.001). In the difference-in-differences analysis, the occurrence of Ramadan during conception or the first or second trimester was associated with higher under-5 mortality rates among Muslims only. The mortality rates of children born to Muslim mothers were 33%, 29%, and 22% higher when Ramadan occurred during conception, the first trimester, and the second trimester, respectively, compared with children of non-Muslim mothers born at the same time (P = 0.01, P < 0.001, and P = 0.007). Having a Muslim mother was not associated with mortality when the child was not exposed to Ramadan, born during Ramadan, or exposed during the third trimester. Observance of Ramadan during early pregnancy can have detrimental consequences for the future health of the unborn child.
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Mortalidade da Criança/etnologia , Jejum/efeitos adversos , Islamismo , Fenômenos Fisiológicos da Nutrição Materna , Efeitos Tardios da Exposição Pré-Natal/mortalidade , Burkina Faso/epidemiologia , Pré-Escolar , Estudos de Coortes , Demografia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Gravidez , Efeitos Tardios da Exposição Pré-Natal/etnologia , Modelos de Riscos Proporcionais , Análise de Regressão , População Rural/estatística & dados numéricosRESUMO
BACKGROUND: Vector and malaria parasite's rising resistance against pyrethroid-impregnated bed nets and antimalarial drugs highlight the need for additional control measures. Larviciding against malaria vectors is experiencing a renaissance with the availability of environmentally friendly and target species-specific larvicides. In this study, we analyse the perception and acceptability of spraying surface water collections with the biological larvicide Bacillus thuringiensis israelensis in a single health district in Burkina Faso. METHODS: A total of 12 focus group discussions and 12 key informant interviews were performed in 10 rural villages provided with coverage of various larvicide treatments (all breeding sites treated, the most productive breeding sites treated, and untreated control). RESULTS: Respondents' knowledge about the major risk factors for malaria transmission was generally good. Most interviewees stated they performed personal protective measures against vector mosquitoes including the use of bed nets and sometimes mosquito coils and traditional repellents. The acceptance of larviciding in and around the villages was high and the majority of respondents reported a relief in mosquito nuisance and malarial episodes. There was high interest in the project and demand for future continuation. CONCLUSION: This study showed that larviciding interventions received positive resonance from the population. People showed a willingness to be involved and financially support the program. The positive environment with high acceptance for larviciding programs would facilitate routine implementation. An essential factor for the future success of such programs would be inclusion in regional or national malaria control guidelines.
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Culicidae , Conhecimentos, Atitudes e Prática em Saúde , Malária/prevenção & controle , Controle Biológico de Vetores , População Rural , Animais , Bacillus thuringiensis , Burkina Faso , Feminino , Humanos , Insetos Vetores , Larva , Masculino , Pesquisa Qualitativa , População Rural/estatística & dados numéricosRESUMO
INTRODUCTION: In 2014, in Burkina Faso, more than 60% of healthcare workers were working in urban areas to the detriment of rural areas. The two largest cities concentrated the majority of healthcare workers, while these cities represent only 10% of the population. This study was designed to identify incentive strategies that could enable more equitable deployment of healthcare workers. METHODS: A cross-sectional survey was carried out in 2016 in six health regions in Burkina Faso. Key informant interviews were conducted to determine the factors influencing the choice of jobs. The results were used to construct job packages useful for the discrete choice experiment survey.Levels of preferences for 1,173 health workers for incentive packages linked to the job were explored by means of electronic questionnaire data collection.Sawtooth software was used to develop and randomize job pairing preferences proposed to healthcare workers. STATA14 software was used for mixed-logit analysis. RESULTS: The determinants to promote more equitable deployment and maintenance of health workers in their workplace include access to good accommodation, on-job training, responsibility, and improved salaries.In terms of acceptability of deployment, more than 75% (p-value < 0.001) of workers would agree to be redeployed in rural areas if the above conditions were met. CONCLUSION: Adequate and sustainable human resource development strategies should be set up by policymakers in order to improve the maintenance of healthcare workers in rural areas.
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Comportamento de Escolha , Pessoal de Saúde/psicologia , Área de Atuação Profissional/estatística & dados numéricos , Serviços de Saúde Rural/organização & administração , Burkina Faso , Estudos Transversais , Humanos , Motivação , Salários e BenefíciosRESUMO
BACKGROUND: Education, as a key indicator of human capital, is considered one of the major determinants of internal migration, with previous studies suggesting that human capital accumulates in urban areas at the expense of rural areas. However, there is fragmentary evidence concerning the educational correlates of internal migration in sub-Saharan Africa. OBJECTIVES: The study questions whether more precise measures of migration in Health and Demographic Surveillance System (HDSS) populations support the hypothesis that migrants are self-selected on human capital and more educated people are more likely to leave rural areas or enter urban areas within a geographical region. METHODS: Using unique longitudinal data representing approximately 900,000 people living in eight sub-Saharan African HDSS sites that are members of the INDEPTH Network, the paper uses Event History Analysis techniques to examine the relationship between formal educational attainment and in-and out-migration, over the period 2009 to 2011. RESULTS: Between 7% and 27% of these local populations are moving in or out of the HDSS area over this period. Education is positively associated with both in-and out-migration in the Kenyan HDSS areas; however, the education effect has no clear pattern in the HDSS sites in Burkina Faso, Mozambique, and South Africa. CONCLUSIONS: Empirical results presented in this paper confirm a strong age profile of migration consistent with human capital expectation, yet the results point to variability in the association of education and the propensity to migrate. In particular, the hypothesis of a shift of human capital from rural to urban areas is not universally valid.
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OBJECTIVES: Long-acting reversible contraception (LARC) initiation has been well-studied and intervened upon. Because LARC requires provider intervention for initiation and removal, it is critical to measure informed choice at the time of desired discontinuation as well. We examined perceptions of access to LARC discontinuation among women at two sites in Burkina Faso, where LARC is the dominant method in the contraceptive mix. STUDY DESIGN: We analyzed data from a 2017-2018 population-based, cross-sectional survey of 281 implant users and 55 intrauterine device users at two sites in Burkina Faso. We measured perceptions of access to LARC discontinuation through survey items assessing whether participants (1) were informed on how to discontinue the method, (2) believed they could have LARC removed without a lot of difficulty, (3) believed cost would be a barrier to discontinuation, (4) had ever attempted to have a provider remove LARC, and (5) successfully had LARC removed. The distribution of these measures was examined in the population and for differences by gravida, parity, domestic partnership, fertility desires, and recency of last childbirth. RESULTS: Thirty-eight (11%) of current LARC users reported that they were not informed on how to discontinue, 56 (17%) believed having their device removed would be difficult, and 54 (16%) believed cost would be a barrier to removal. Of women who attempted removal, providers did not immediately remove LARC on request for 10 (28%). CONCLUSIONS: Findings indicate that LARC uptake is an insufficient measure of reproductive access or choice. Future studies should include patient-centered measures that span the full duration of contraceptive use. IMPLICATIONS: This paper finds that a sizable proportion of LARC users lack information about method discontinuation and perceive or experience barriers to method removal. These findings call for a reconsideration of free and informed contraceptive choice to include the entire duration of contraceptive use, not only the time of method provision.
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Anticoncepcionais Femininos , Dispositivos Intrauterinos , Contracepção Reversível de Longo Prazo , Gravidez , Feminino , Humanos , Burkina Faso , Estudos Transversais , Anticoncepção/métodosRESUMO
BACKGROUND: High ambient air temperatures in Africa pose significant health and behavioral challenges in populations with limited access to cooling adaptations. The built environment can exacerbate heat exposure, making passive home cooling adaptations a potential method for protecting occupants against indoor heat exposure. METHODS: We are conducting a 2-year community-based stratified cluster randomized controlled trial (cRCT) implementing sunlight-reflecting roof coatings, known as "cool roofs," as a climate change adaptation intervention for passive indoor home cooling. Our primary research objective is to investigate the effects of cool roofs on health, indoor climate, economic, and behavioral outcomes in rural Burkina Faso. This cRCT is nested in the Nouna Health and Demographic Surveillance System (HDSS), a population-based dynamic cohort study of all people living in a geographically contiguous area covering 59 villages, 14305 households and 28610 individuals. We recruited 1200 participants, one woman and one man, each in 600 households in 25 villages in the Nouna HDSS. We stratified our sample by (i) village and (ii) two prevalent roof types in this area of Burkina Faso: mud brick and tin. We randomized the same number of people (12) and homes (6) in each stratum 1:1 to receiving vs. not receiving the cool roof. We are collecting outcome data on one primary endpoint - heart rate, (a measure of heat stress) and 22 secondary outcomes encompassing indoor climate parameters, blood pressure, body temperature, heat-related outcomes, blood glucose, sleep, cognition, mental health, health facility utilization, economic and productivity outcomes, mosquito count, life satisfaction, gender-based violence, and food consumption. We followed all participants for 2 years, conducting monthly home visits to collect objective and subjective outcomes. Approximately 12% of participants (n = 152) used smartwatches to continuously measure endpoints including heart rate, sleep and activity. DISCUSSION: Our study demonstrates the potential of large-scale cRCTs to evaluate novel climate change adaptation interventions and provide evidence supporting investments in heat resilience in sub-Saharan Africa. By conducting this research, we will contribute to better policies and interventions to help climate-vulnerable populations ward off the detrimental effects of extreme indoor heat on health. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00023207. Registered on April 19, 2021.
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Temperatura Baixa , Saúde Ambiental , Feminino , Humanos , Masculino , Burkina Faso/epidemiologia , Estudos de Coortes , Ensaios Clínicos Controlados Aleatórios como Assunto , HabitaçãoRESUMO
BACKGROUND: Extreme weather is becoming more common due to climate change and threatens human health through climate-sensitive diseases, with very uneven effects around the globe. Low-income, rural populations in the Sahel region of west Africa are projected to be severely affected by climate change. Climate-sensitive disease burdens have been linked to weather conditions in areas of the Sahel, although comprehensive, disease-specific empirical evidence on these relationships is scarce. In this study, we aim to provide an analysis of the associations between weather conditions and cause-specific deaths over a 16-year period in Nouna, Burkina Faso. METHODS: In this longitudinal study, we used de-identified, daily cause-of-death data from the Health and Demographic Surveillance System led by the Centre de Recherche en Santé de Nouna (CRSN) in the National Institute of Public Health of Burkina Faso, to assess temporal associations between daily and weekly weather conditions (maximum temperature and total precipitation) and deaths attributed to specific climate-sensitive diseases. We implemented distributed-lag zero-inflated Poisson models for 13 disease-age groups at daily and weekly time lags. We included all deaths from climate-sensitive diseases in the CRSN demographic surveillance area from Jan 1, 2000 to Dec 31, 2015 in the analysis. We report the exposure-response relationships at percentiles representative of the exposure distributions of temperature and precipitation in the study area. FINDINGS: Of 8256 total deaths in the CRSN demographic surveillance area over the observation period, 6185 (74·9%) were caused by climate-sensitive diseases. Deaths from communicable diseases were most common. Heightened risk of death from all climate-sensitive communicable diseases, and malaria (both across all ages and in children younger than 5 years), was associated with 14-day lagged daily maximum temperatures at or above 41·1°C, the 90th percentile of daily maximum temperatures, compared with 36·4°C, the median (all communicable diseases: 41·9°C relative risk [RR] 1·38 [95% CI 1·08-1·77], 42·8°C 1·57 [1·13-2·18]; malaria all ages: 41·1°C 1·47 [1·05-2·05], 41·9°C 1·78 [1·21-2·61], 42·8°C 2·35 [1·37-4·03]; malaria younger than 5 years: 41·9°C 1·67 [1·02-2·73]). Heightened risk of death from communicable diseases was also associated with 14-day lagged total daily precipitation at or below 0·1 cm, the 49th percentile of total daily precipitation, compared with 1·4 cm, the median (all communicable diseases: 0·0 cm 1·04 [1·02-1·07], 0·1 cm 1·01 [1·006-1·02]; malaria all ages: 0·0 cm 1·04 [1·01-1·08], 0·1 cm 1·02 [1·00-1·03]; malaria younger than 5 years: 0·0 cm 1·05 [1·01-1·10], 0·1 cm 1·02 [1·00-1·04]). The only significant association with a non-communicable disease outcome was a heightened risk of death from climate-sensitive cardiovascular diseases in individuals aged 65 years and older associated with 7-day lagged daily maximum temperatures at or above 41·9°C (41·9°C 2·25 [1·06-4·81], 42·8°C 3·68 [1·46-9·25]). Over 8 cumulative weeks, we found that the risk of death from communicable diseases was heightened at all ages from temperatures at or above 41·1°C (41·1°C 1·23 [1·05-1·43], 41·9°C 1·30 [1·08-1·56], 42·8°C 1·35 [1·09-1·66]) and risk of death from malaria was heightened by precipitation at or above 45·3 cm (all ages: 45·3 cm 1·68 [1·31-2·14], 61·6 cm 1·72 [1·27-2·31], 87·7 cm 1·72 [1·16-2·55]; children younger than 5 years: 45·3 cm 1·81 [1·36-2·41], 61·6 cm 1·82 [1·29-2·56], 87·7 cm 1·93 [1·24-3·00]). INTERPRETATION: Our results indicate a high burden of death related to extreme weather in the Sahel region of west Africa. This burden is likely to increase with climate change. Climate preparedness programmes-such as extreme weather alerts, passive cooling architecture, and rainwater drainage-should be tested and implemented to prevent deaths from climate-sensitive diseases in vulnerable communities in Burkina Faso and the wider Sahel region. FUNDING: Deutsche Forschungsgemeinschaft and the Alexander von Humboldt Foundation.
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Doenças Transmissíveis , Malária , Criança , Humanos , Adulto , Recém-Nascido , Pessoa de Meia-Idade , Temperatura , Estudos Longitudinais , Burkina Faso/epidemiologia , População RuralRESUMO
INTRODUCTION: Provider bias has become an important topic of family planning research over the past several decades. Much existing research on provider bias has focused on the ways providers restrict access to contraception. Here, we propose a distinction between the classical "downward" provider bias that discourages contraceptive use and a new conception of "upward" provider bias that occurs when providers pressure or encourage clients to adopt contraception. METHODS: Using cross-sectional data from reproductive-aged women in Burkina Faso, we describe lifetime prevalence of experiencing provider encouragement to use contraception due to provider perceptions of high parity (a type of upward provider bias) and provider discouragement from using contraception due to provider perceptions of low parity (a type of downward provider bias). We also examine associations between sociodemographic characteristics and experiences of provider encouragement to use contraception due to perceptions of high parity. RESULTS: Sixteen percent of participants reported that a provider had encouraged them to use contraception due to provider perceptions of high parity, and 1% of participants reported that a provider had discouraged them from using contraception because of provider perceptions of low parity. Being married, being from the rural site, having higher parity, and having attended the 45th-day postpartum check-up were associated with increased odds of being encouraged to use contraception due to provider perceptions of high parity. CONCLUSION: We find that experiences of upward provider bias linked to provider perceptions of high parity were considerably more common in this setting than downward provider bias linked to perceptions of low parity. Research into the mechanisms through which upward provider bias operates and how it may be mitigated is imperative to promote contraceptive autonomy.
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Anticoncepção , Serviços de Planejamento Familiar , Gravidez , Feminino , Humanos , Adulto , Paridade , Estudos Transversais , Anticoncepcionais , Viés , Comportamento ContraceptivoRESUMO
Family planning researchers have traditionally focused efforts on understanding contraceptive non-use and promoting contraceptive uptake. Recently, however, more scholars have been exploring method dissatisfaction, questioning the assumption that contraceptive users necessarily have their needs met. Here, we introduce the concept of "non-preferred method use", which we define as the use of one contraceptive method while having the desire to use a different method. Non-preferred method use reflects barriers to contraceptive autonomy and may contribute to method discontinuation. We use survey data collected from 2017 to 2018 to better understand non-preferred contraceptive method use among 1210 reproductive-aged family planning users in Burkina Faso. We operationalise non-preferred method use as both (1) use of a method that was not the user's original preference and (2) use of a method while reporting preference for another method. Using these two approaches, we describe the prevalence of non-preferred method use, reasons for using non-preferred methods, and patterns in non-preferred method use by current and preferred methods. We find that 7% of respondents reported using a method they did not desire at the time of adoption, 33% would use a different method if they could and 37% report at least one form of non-preferred method use. Many women cite facility-level barriers, such as providers refusing to give them their preferred method, as reasons for non-preferred method use. The high prevalence of non-preferred method use reflects the obstacles that women face when attempting to fulfil their contraceptive desires. Further research on reasons for use of non-preferred methods is necessary to promote contraceptive autonomy.
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Anticoncepcionais , Serviços de Planejamento Familiar , Humanos , Feminino , Adulto , Burkina Faso , Estudos Transversais , Prevalência , Comportamento ContraceptivoRESUMO
Background: Climate change significantly impacts health in low-and middle-income countries (LMICs), exacerbating vulnerabilities. Comprehensive data for evidence-based research and decision-making is crucial but scarce. Health and Demographic Surveillance Sites (HDSSs) in Africa and Asia provide a robust infrastructure with longitudinal population cohort data, yet they lack climate-health specific data. Acquiring this information is essential for understanding the burden of climate-sensitive diseases on populations and guiding targeted policies and interventions in LMICs to enhance mitigation and adaptation capacities. Objective: The objective of this research is to develop and implement the Change and Health Evaluation and Response System (CHEERS) as a methodological framework, designed to facilitate the generation and ongoing monitoring of climate change and health-related data within existing Health and Demographic Surveillance Sites (HDSSs) and comparable research infrastructures. Methods: CHEERS uses a multi-tiered approach to assess health and environmental exposures at the individual, household, and community levels, utilizing digital tools such as wearable devices, indoor temperature and humidity measurements, remotely sensed satellite data, and 3D-printed weather stations. The CHEERS framework utilizes a graph database to efficiently manage and analyze diverse data types, leveraging graph algorithms to understand the complex interplay between health and environmental exposures. Results: The Nouna CHEERS site, established in 2022, has yielded significant preliminary findings. By using remotely-sensed data, the site has been able to predict crop yield at a household level in Nouna and explore the relationships between yield, socioeconomic factors, and health outcomes. The feasibility and acceptability of wearable technology have been confirmed in rural Burkina Faso for obtaining individual-level data, despite the presence of technical challenges. The use of wearables to study the impact of extreme weather on health has shown significant effects of heat exposure on sleep and daily activity, highlighting the urgent need for interventions to mitigate adverse health consequences. Conclusion: Implementing the CHEERS in research infrastructures can advance climate change and health research, as large and longitudinal datasets have been scarce for LMICs. This data can inform health priorities, guide resource allocation to address climate change and health exposures, and protect vulnerable communities in LMICs from these exposures.
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Mudança Climática , Projetos de Pesquisa , Humanos , Atividades Cotidianas , África , AlgoritmosRESUMO
BACKGROUND: Sub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods and nutrition, with recovery slowed down by lagging vaccination progress. OBJECTIVE: This study investigated the economic impacts of COVID-19 on food prices, consumption and dietary quality in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. METHODS: We conducted a repeated cross-sectional study using a mobile platform to collect data from July-December, 2021 (round 2). We assessed participants' dietary intake of 20 food groups over the previous seven days and computed the primary outcome, the Prime Diet Quality Score (PDQS), and Dietary Diversity Score (DDS), with higher scores indicating better quality diets. We used generalized estimating equation (GEE) linear regression models to assess factors associated with diet quality during COVID-19. RESULTS: Most of the respondents were male and the mean age was 42.4 (±12.5) years. Mean PDQS (±SD) was low at 19.4(±3.8), out of a maximum score of 40 in this study. Respondents (80%) reported higher than expected prices for all food groups. Secondary education or higher (estimate: 0.73, 95% CI: 0.32, 1.15), medium wealth status (estimate: 0.48, 95% CI: 0.14, 0.81), and older age were associated with higher PDQS. Farmers and casual laborers (estimate: -0.60, 95% CI: -1.11, -0.09), lower crop production (estimate: -0.87, 95% CI: -1.28, -0.46) and not engaged in farming (estimate: -1.38, 95% CI: -1.74, -1.02) were associated with lower PDQS. CONCLUSION: Higher food prices and lower diet quality persisted during the COVID-19 pandemic. Economic and social vulnerability and reliance on markets (and lower agriculture production) were negatively associated with diet quality. Although recovery was evident, consumption of healthy diets remained low. Systematic efforts to address the underlying causes of poor diet quality through transforming food system value chains, and mitigation measures, including social protection programs and national policies are critical.
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COVID-19 , Pandemias , Masculino , Humanos , Adulto , Feminino , Estudos Transversais , COVID-19/epidemiologia , Dieta , Burkina FasoRESUMO
PURPOSE: This multicountry survey assessed the levels and the determinants of the impacts of the pandemic on education and mental health among adolescents in sub-Saharan Africa and the potential factors that may exacerbate these adverse impacts. METHODS: A phone survey was conducted among adolescents in nine diverse areas in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania between July and December 2021. Approximately 300 adolescents per area and 2,803 adolescents in total were included. The survey collected information on adolescents' sociodemographic characteristics, current COVID-19 preventive measures, and the impacts of the pandemic on daily activities, education, and mental health. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) for determinants of education and mental health outcomes. RESULTS: Overall, 17% of the adolescents were not receiving any education. Compared to boys, girls were 15% more likely than boys to lack fully in-person education (aPR: 1.15; 95% confidence interval [CI]: 1.02, 1.30). Rural residence was associated with 2.7 times the prevalence of not currently receiving any education (aPR: 2.68; 95% CI: 2.23, 3.22). Self-reported experience of the current impacts of the pandemic on daily activities was associated with a higher prevalence of possible psychological distress (aPR: 1.86; 95% CI: 1.55, 2.24), high anxiety level (aPR: 3.37; 95% CI: 2.25, 5.06), and high depression level (aPR: 3.01; 95% CI: 2.05, 4.41). DISCUSSION: The COVID-19 pandemic presents continued challenges to adolescents' education and mental health. Multisectoral efforts are needed to ensure that adolescents in sub-Saharan Africa do not fall further behind due to the pandemic.
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COVID-19 , Saúde Mental , Masculino , Feminino , Humanos , Adolescente , Pandemias , Escolaridade , TanzâniaRESUMO
Even though formal education is considered a key determinant of individual well-being globally, enrollment in secondary schooling remains low in many low- and middle-income countries, suggesting that the perceived returns to such schooling may be low. We jointly estimate survival and monetary benefits of secondary schooling using detailed demographic and surveillance data from the Boucle du Mouhoun region, Burkina Faso, where national upper secondary schooling completion rates are among the lowest globally (<10%). We first explore surveillance data from the Nouna Health and Demographic Surveillance System from 1992 to 2016 to determine long-term differences in survival outcomes between secondary and higher and primary schooling using Cox proportional hazards models. To estimate average increases in asset holdings associated with secondary schooling, we use regionally representative data from the Burkina Faso Demographic Health Surveys (2003, 2010, 2014, 2017-18; N = 3,924). Survival was tracked for 14,892 individuals. Each year of schooling was associated with a mortality reduction of up to 16% (95% CI 0.75-0.94), implying an additional 1.9 years of life expectancy for men and 5.1 years for women for secondary schooling compared to individuals completing only primary school. Relative to individuals with primary education, individuals with secondary or higher education held 26% more assets (SE 0.02; CI 0.22-0.30). Economic returns for women were 3% points higher than male returns with 10% (SE 0.03; CI 0.04-0.16) vs. 7% (SE 0.02; CI 0.02-0.012) and in rural areas 20% points higher than in urban areas with 30% (SE 0.06; CI 0.19-0.41) vs. 4% (SE 0.01; CI 0.02-0.07). Our results suggest that secondary education is associated with substantial health and economic benefits in the study area and should therefore be considered by researchers, governments, and other major stakeholders to create for example school promotion programs.
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Pobreza , Instituições Acadêmicas , Burkina Faso , Escolaridade , Feminino , Humanos , Renda , MasculinoRESUMO
Ethnic diversity has been a topic of contention across the globe, contrasted with economic development, social security, and political stability. The link between health and ethnic diversity is not yet well established especially in low-middle- income countries. Our study aims to explore the association between ethnic diversity and all-cause mortality in rural areas of Burkina Faso. We used data from the Nouna Health & Demographic Surveillance System (HDSS) collected between 2000 and 2012. To derive Standardized Mortality Ratios (SMR), the observed number of deaths was compared to the expected deaths based on the entire HDSS taking into account sex, age, rainy season, calendar year, and village. SMR were calculated for ethnic and religious diversity on a village level (using the Simpson Index), sub-region, wealth, and distance to Healthcare Facilities (HCF). Furthermore, we modeled SMR with a multilevel random intercept Poisson regression considering individual ethnic and religious groups in addition to the above-mentioned village-level information. Village wealth (poorest fifth: SMR 1.07; 95% CI: 1.02-1.13, richest fifth: SMR 0.85; 95% CI: 0.82-0.88), distance to HCF (within the village: SMR 0.88; 95% CI: 0.85-0.91, further than 5km: SMR 1.13; 95% CI: 1.10-1.16), and sub-region showed significant associations with overall mortality. Villages belonging to the third with the highest ethnic diversity had lowered SMR (0.86; 95% CI: 0.84-0.89) compared to the entire HDSS, while those belonging to the lowest diversity third yielded elevated SMR (1.13; 95% CI: 1.09-1.17). The multilevel model confirmed the association. Our study showed that historically established ethnic diversity in rural areas of Burkina Faso was associated with lower all-cause mortality. Generally, the literature suffers from a lack of standardization in defining ethnic diversity, along with measuring it. More research is needed to understand this relation and to establish it in different settings.
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Objectives: The purpose of the present study was to: (i) provide timely data on dental caries and periodontal conditions in rural Burkina Faso; (ii) identify the oral health practices carried out in this population, and (iii) to prioritize evidence-based interventions at the community level. Methods: Leaning on WHO recommendations for oral health epidemiological studies, clinical examinations and questionnaire-based surveys were conducted in two different age groups (adolescents: 15-19 years old; adults: 35-44 years old) in the health district of Nouna, Burkina Faso. Caries and tooth status were assessed according to the DMFT Index. The periodontal status was assessed by a modified Community Periodontal Index on all teeth present and measuring the level of attachment-loss of six index teeth. Questionnaire items specifically included utilization of oral health care and oral health behaviors. Results: The prevalence of untreated caries was 38% in adolescents and 73% in adults. In terms of periodontal health, 21% of adolescents and 61% of adults had an attachment loss ≥4 mm. Ninety seven percent of adolescents had not attended a dentist in the previous year and 78% of adults had never seen a dentist in their life. About one third of adolescents and adults cleaned their teeth less often than once per day with equal proportions of toothbrushes and traditional chewing sticks made of tree branches. Fluoride toothpaste was used by <10% of study participants. Almost half of the examined people reported to drink a sugar-sweetened beverage at least once a day. Conclusions: Dental caries and periodontitis are highly prevalent in rural Burkina Faso. These findings highlight the key relevance of epidemiological data for identifying people's oral health needs as basis for developing, testing, and implementing oral health interventions and programs. Special emphasis should be put on the design and evaluation of community-based interventions.
Assuntos
Cárie Dentária , Adolescente , Adulto , Burkina Faso/epidemiologia , Cárie Dentária/epidemiologia , Estudos Epidemiológicos , Humanos , Saúde Bucal , Prevalência , Adulto JovemRESUMO
BACKGROUND: Malaria control is based on early treatment of cases and on vector control. The current measures for malaria vector control in Africa are mainly based on long-lasting insecticidal nets (LLINs) and to a much smaller extent on indoor residual spraying (IRS). While bed net use is widely distributed and its role is intensively researched, Bti-based larviciding is a relatively novel tool in Africa. In this study, we analyze the perception and acceptability of Bti-based larval source management under different larviciding scenarios that were performed in a health district in Burkina Faso. OBJECTIVE: To research people's perception and acceptance regarding biological larviciding interventions against malaria in their communities. METHODS: A cross-sectional study was undertaken using a total of 634 administered questionnaires. Data were collected in a total of 36 rural villages and in seven town quarters of the semi-urban town of Nouna. RESULTS: Respondents had basic to good knowledge regarding malaria transmission and how to protect oneself against it. More than 90% reported sleeping under a bed net, while other measures such as mosquito coils and insecticides were only used by a minority. The majority of community members reported high perceived reductions in mosquito abundance and the number of malaria episodes. There was a high willingness to contribute financially to larviciding interventions among interviewees. CONCLUSIONS: This study showed that biological larviciding interventions are welcomed by the population that they are regarded as an effective and safe means to reduce mosquito abundance and malaria transmission. A routine implementation would, despite low intervention costs, require community ownership and contribution.
Assuntos
Anopheles , Bacillus thuringiensis , Inseticidas , Malária , Animais , Burkina Faso , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Malária/prevenção & controle , Controle de Mosquitos , Mosquitos Vetores , Controle Biológico de VetoresRESUMO
As the epidemiological transition progresses throughout sub-Saharan Africa, life lived with diseases is an increasingly important part of a population's burden of disease. The burden of disease of climate-sensitive health outcomes is projected to increase considerably within the next decades. Objectively measured, reliable population health data is still limited and is primarily based on perceived illness from recall. Technological advances like non-invasive, consumer-grade wearable devices may play a vital role in alleviating this data gap and in obtaining insights on the disease burden in vulnerable populations, such as heat stress on human cardiovascular response. The overall goal of this study is to investigate whether consumer-grade wearable devices are an acceptable, feasible and valid means to generate data on the individual level in low-resource contexts. Three hundred individuals are recruited from the two study locations in the Nouna health and demographic surveillance system (HDSS), Burkina Faso, and the Siaya HDSS, Kenya. Participants complete a structured questionnaire that comprises question items on acceptability and feasibility under the supervision of trained data collectors. Validity will be evaluated by comparing consumer-grade wearable devices to research-grade devices. Furthermore, we will collect demographic data as well as the data generated by wearable devices. This study will provide insights into the usage of consumer-grade wearable devices to measure individual vital signs in low-resource contexts, such as Burkina Faso and Kenya. Vital signs comprising activity (steps), sleep (duration, quality) and heart rate (hr) are important measures to gain insights on individual behavior and activity patterns in low-resource contexts. These vital signs may be associated with weather variables-as we gather them from weather stations that we have setup as part of this study to cover the whole Nouna and Siaya HDSSs-in order to explore changes in behavior and other variables, such as activity, sleep, hr, during extreme weather events like heat stress exposure. Furthermore, wearable data could be linked to health outcomes and weather events. As a result, consumer-grade wearables may serve as a supporting technology for generating reliable measurements in low-resource contexts and investigating key links between weather occurrences and health outcomes. Thus, wearable devices may provide insights to better inform mitigation and adaptation interventions in these low-resource settings that are direly faced by climate change-induced changes, such as extreme weather events.