Determinants of childbirth care quality along the care continuum in limited resource settings: A structural equation modeling analysis of cross-sectional data from Burkina Faso and Côte d'Ivoire.

INTRODUCTION: Despite the important increase in in-facility births, perinatal mortality rates have remained high and slow to decrease in many developing countries. This situation is attributed to poor childbirth care quality. The reason why women delivering in health facilities do not always receive care of an adequate standard is unclear. We assessed the determinants of childbirth care quality along the care continuum by means of different approaches. METHODS: A health facility-based cross-sectional study with a direct observation of health care workers' practices while caring for mother-newborn pairs was carried out in Burkina Faso and Côte d'Ivoire. The performance of a set of essential best practices (EBPs) was assessed in each birth event at the admission, prepushing and immediate postpartum stages. A quality score, in the form of the additive sum of EBPs effectively delivered, was computed for each stage. We used negative binomial regression models and a structural equation modeling analysis to assess the determinants of care quality at each stage and the relationships of the quality delivered at the different stages, respectively. RESULTS: A total of 532 and 627 mother-newborn pairs were evaluated in Burkina Faso and Côte d'Ivoire, respectively. In both countries, delivery care quality varied significantly at all stages between health districts. Predelivery care quality was consistently higher in referral hospitals than in primary health care facilities (incident rate ratio (IRR) = 1.02, p < 0.05, and IRR = 1.10, p < 0.05, respectively, for Burkina Faso and Côte d'Ivoire). Quality at admission was poorer among nurses than among midwives in Burkina Faso (IRR = 0.81, p < 0.001). Quality at the admission and predelivery stages was positively correlated with immediate postpartum care quality (ß = 0.48, p < 0.001, and ß = 0.29, p < 0.001, respectively). CONCLUSION: Quality improvement strategies must target both providers and health facilities, and different inputs are needed depending on the stage in the care continuum.

Severe dengue in adults and children, Ouagadougou (Burkina Faso), West Africa, October 2015-January 2017.

Introduction: Although dengue is the most common arbovirus infection worldwide, studies of severe dengue in Africa are lacking, and risk factors for severe dengue have been insufficiently described. This study was conducted in the context of the 2016 dengue epidemic in Burkina Faso to determine the prevalence of severe dengue, identify factors associated with severe dengue, and perform mapping of dengue cases in the country's capital, Ouagadougou. Methods: This cross-sectional study was conducted from November 2015 to January 2017. Data were collected in 15 public and private health centres, and included sociodemographic, clinical and patient outcome variables. Dengue was diagnosed using SD Bioline Dengue Duo rapid diagnostic tests. Data were analysed using Epi-Info Version 7. Logistic regression was used to identify predictors of severe dengue. P<0.05 was considered significant. Dengue case mapping was performed using Geographic Information System software (ArcGIS). Results: Of the 811 patients who tested positive for dengue, 609 (75%) had early dengue (AgNS1 positive) and 272 (33.5%) had severe dengue. Patient age ranged from 1 to 83 years (median 30.5 years) and 393 (48.3%) were female. Renal failure (13.1%) and severe bleeding (10.6%) were the most common signs of severe dengue. Risk factors for severe dengue included age, male sex, haemoglobin S, diabetes, hypertension, and primary dengue. Dengue cases were more concentrated  in sectors located in the centre of the city and close to the health centres. Conclusion: Dengue is increasingly common in Africa and factors associated with severity should be sought systematically as soon as a patient tests positive. Additional studies are needed to determine if the factors found to be associated with severity can be used to identify patients at risk for dengue-related complications, and to provide early and specialized management to reduce morbidity and mortality related to dengue in Africa.

Awareness, treatment, control of hypertension and utilization of health care services following screening in the North-central region of Burkina Faso.

INTRODUCTION: In Africa, a non-urban area is affected by hypertension. But in Burkina Faso, no study on factors associated with awareness, treatment and control of hypertension has not yet been published. The objectives of this report are to: (i) identify the factors associated with awareness, treatment, and control of hypertension in the adult population of Kaya health and demographic surveillance system (Kaya HDSS) and (ii) estimate health care services utilization by participant newly screened as hypertensive. METHODS: A screening survey for hypertension was conducted on 1481 adults in Kaya HDSS in late 2012. Hypertensive individuals provided information relating to "awareness", "treatment" and "control" of their hypertension. After approximately two months, unaware hypertensive individuals were interviewed to know whether they had sought treatment. RESULTS: During the screening survey, 123 individuals (9.4%) were identified as having hypertension. Among them, 33 (26.8%, 95% CI: 18.9-34.8) were aware of their condition, 25 (75.8%, 95% CI: 60.3-91.2) of them were receiving medication. Among those receiving treatment, 15 (60.0%, 95% CI: 39.4-80.6) had their blood pressure controlled. Semi-urban residence, presence of chronic diseases and physical inactivity were significantly associated with awareness of hypertension. Seventy two of the 90 participants who were classified as unaware were interviewed two months later. Out of them, 37 individuals had consulted a health worker and 28 received a diagnosis of hypertension. CONCLUSION: Awareness was low but treatment and control of those who knew they were hypertensive were relatively high. These results could be used to improve management of hypertension in Burkina Faso.