Evaluation of the routine implementation of pulse oximeters into integrated management of childhood illness (IMCI) guidelines at primary health care level in West Africa: the AIRE mixed-methods research protocol.

BACKGROUND: The AIRE operational project will evaluate the implementation of the routine Pulse Oximeter (PO) use in the integrated management of childhood illness (IMCI) strategy for children under-5 in primary health care centers (PHC) in West Africa. The introduction of PO should promote the accurate identification of hypoxemia (pulse blood oxygen saturation Sp02 < 90%) among all severe IMCI cases (respiratory and non-respiratory) to prompt their effective case management (oxygen, antibiotics and other required treatments) at hospital. We seek to understand how the routine use of PO integrated in IMCI outpatients works (or not), for whom, in what contexts and with what outcomes. METHODS: The AIRE project is being implemented from 03/2020 to 12/2022 in 202 PHCs in four West African countries (Burkina Faso, Guinea, Mali, Niger) including 16 research PHCs (four per country). The research protocol will assess three complementary components using mixed quantitative and qualitative methods: a) context based on repeated cross-sectional surveys: baseline and aggregated monthly data from all PHCs on infrastructure, staffing, accessibility, equipment, PO use, severe cases and care; b) the process across PHCs by assessing acceptability, fidelity, implementation challenges and realistic evaluation, and c) individual outcomes in the research PHCs: all children under-5 attending IMCI clinics, eligible for PO use will be included with parental consent in a cross-sectional study. Among them, severe IMCI cases will be followed in a prospective cohort to assess their health status at 14 days. We will analyze pathways, patterns of care, and costs of care. DISCUSSION: This research will identify challenges to the systematic implementation of PO in IMCI consultations, such as health workers practices, frequent turnover, quality of care, etc. Further research will be needed to fully address key questions such as the best time to introduce PO into the IMCI process, the best SpO2 threshold for deciding on hospital referral, and assessing the cost-effectiveness of PO use. The AIRE research will provide health policy makers in West Africa with sufficient evidence on the context, process and outcomes of using PO integrated into IMCI to promote scale-up in all PHCs. TRIAL REGISTRATION: Trial registration number: PACTR202206525204526 retrospectively registered on 06/15/2022.

Extended pre-exposure prophylaxis with lopinavir-ritonavir versus lamivudine to prevent HIV-1 transmission through breastfeeding up to 50 weeks in infants in Africa (ANRS 12174): a randomised controlled trial.

BACKGROUND: Strategies to prevent postnatal mother-to-child transmission of HIV-1 in Africa, including infant prophylaxis, have never been assessed past 6 months of breastfeeding, despite breastfeeding being recommended up to 12 months after birth. We aimed to compare the efficacy and safety of infant prophylaxis with the two drug regimens (lamivudine or lopinavir-ritonavir) to prevent postnatal HIV-1 transmission up to 50 weeks of breastfeeding. METHODS: We did a randomised controlled trial in four sites in Burkina Faso, South Africa, Uganda, and Zambia in children born to HIV-1-infected mothers not eligible for antiretroviral therapy (CD4 count >350 cells per µL). An independent researcher electronically generated a randomisation schedule; we then used sequentially numbered envelopes to randomly assign (1:1) HIV-1-uninfected breastfed infants aged 7 days to either lopinavir-ritonavir or lamivudine (paediatric liquid formulations, twice a day) up to 1 week after complete cessation of breastfeeding or at the final visit at week 50. We stratified the randomisation by country and used permuted blocks of four and six. We used a study label on drug bottles to mask participants, study physicians, and assessors to the treatment allocation. The primary outcome was infant HIV-1 infection between age 7 days and 50 weeks, diagnosed every 3 months with HIV-1 DNA PCR, in the modified intention-to-treat population (all who attended at least one follow-up visit). This trial is registered with ClinicalTrials.gov, number NCT00640263. FINDINGS: Between Nov 16, 2009, and May 7, 2012, we enrolled and randomised 1273 infants and analysed 1236; 615 assigned to lopinavir-ritonavir or 621 assigned to lamivudine. 17 HIV-1 infections were diagnosed in the study period (eight in the lopinavir-ritonavir group and nine in the lamivudine group), resulting in cumulative HIV-1 infection of 1.4% (95% CI 0.4-2.5) and 1.5% (0.7-2.5), respectively. Infection rates did not differ between the two drug regimens (hazard ratio [HR] of lopinavir-ritonavir versus lamivudine of 0.90, 95% CI 0.35-2.34; p=0.83). Clinical and biological severe adverse events did not differ between groups; 251 (51%) infants had a grade 3-4 event in the lopinavir-ritonavir group compared with 246 (50%) in the lamivudine group. INTERPRETATION: Infant HIV-1 prophylaxis with lopinavir-ritonavir was not superior to lamivudine and both drugs led to very low rates of HIV-1 postnatal transmission for up to 50 weeks of breastfeeding. Infant pre-exposure prophylaxis should be extended until the end of HIV-1 exposure and mothers should be informed about the persistent risk of transmission throughout breastfeeding. FUNDING: INSERM/National Agency for Research on AIDS and Viral Hepatitis (including funds from the Total Foundation), European Developing Countries Clinical Trials Partnership, Research Council of Norway.

[The challenge of intersectorality in the formulation of policies favourable to the health of older persons in west africa: the case of Burkina Faso]. / Le defi de l'intersectorialite dans la formulation des politiques favorables a la sante des personnes agees en afrique de l'ouest : cas du Burkina Faso.

AIM: The aim of this study was to contribute to a better development of health policies for the elderly in Burkina Faso. MATERIAL AND METHODS: We have done a qualitative cross-sectional study from February to September 2018 in 4 ministerial departments of Burkina Faso (health, human rights, public service and national solidarity). The interviews included non-governmental organisations, associations, technical and financial partners. Inductive approach has used to produce results. RESULTS: A total of 24 key informants were included in the study. Various interventions were implemented differently by the departmental departments. The study identified non-functional interdepartmental consultation frameworks as mechanisms for consultation. These frameworks have not been used in the formulation or implementation of policies for the elderly. CONCLUSION: National coordination of public policies for the elderly in high level of decision-making is important. The activation of interdepartmental consultation frameworks is a necessity for formulating holistic and complementary interventions for the elderly and even beyond this target group.

BUT: Le but de cette étude était de contribuer à une meilleure élaboration des politiques publiques de santé en faveur des personnes âgées au Burkina Faso. MATÉRIELS ET MÉTHODES: il s'est agi d'une étude transversale qualitative de Février à Septembre 2018 dans 4 départements ministériels du Burkina Faso (la santé, les droits humains, la fonction publique et la solidarité nationale). Les entretiens ont inclus des organisations non gouvernementales, des associations, des partenaires au développement. L'approche inductive a été utilisée pour produire les résultats. RÉSULTATS: Au total 24 informateurs clés étaient inclus dans l'étude. Diverses interventions étaient mises en œuvre différemment par les départements ministériels. L'étude a mis en évidence des cadres de concertations interministériels non fonctionnels. Ces cadres n'ont pas été utilisés ni dans la formulation, ni dans la mise en œuvre des politiques en faveur des personnes âgées dans les différents ministères. CONCLUSION: L'absence de coordination interministérielle entre les ministères chargés des politiques publiques en faveur de la santé des personnes âgées et le faible engagement de l'Etat et des partenaires au développement étaient des limites relevées dans cette étude. La définition d'une politique publique de santé des personnes âgées à dimension intersectorielle s'avère nécessaire au Burkina Faso.

[Neonatal morbidity and mortality in 2002-2006 at the Charles de Gaulle pediatric hospital in Ouagadougou (Burkina Faso)]. / Morbidité et mortalité néonatales de 2002 à 2006 au Centre hospitalier universitaire pédiatrique Charles de Gaulle de Ouagadougou (Burkina Faso).

INTRODUCTION: Neonatal diseases remain a major public health problem in developing countries. The Millennium Goal of reducing child mortality by 2/3 by the year 2015 requires a major reduction in neonatal mortality. Accordingly, in March 2006, Burkina Faso began a policy of subsidizing obstetric care and neonatal emergency care. To be able to assess the effectiveness of the steps undertaken, we examined the characteristics of morbidity and neonatal mortality in the principal pediatric teaching hospital (CHUP-CDG) before implementation of the program. MATERIALS AND METHODS: This retrospective study looked at hospital records and the database of newborns hospitalized from 01 January 2002 through 31 December 2006. RESULTS: During the study period, of 23 223 children hospitalized, 1226 (5%) were neonates. The number of neonates hospitalized annually has increased from 118 in 2002 to 414 in 2006. Most (70%) were referred by another healthcare facility. Mean age at admission was 9+/-8 days. The socioeconomic level of 60% of the parents was low. The neonatal mortality rate was 15.3%. More than half (58.8%) the deaths occurred on the first day of hospitalization. The leading causes of morbidity were also the biggest killers: the fatality rate for neonatal infections was 16.8%, and that for congenital malformations and acute accidental poisoning 12.9%. CONCLUSION: Neonatal morbidity and mortality remain at worrisome levels. Improved monitoring of pregnancies and conditions of delivery, reduction in the cost to families of care and the opening of a neonatal unit equipped with appropriate material at the pediatric hospital center (CHUP-CDG) should help to reduce neonatal mortality.