The role and contribution of civil society and community actors in COVID-19 prevention and control: the case of the COMVID COVID-19 movement in Burkina Faso.

Communities should play a crucial role in the fight against public health emergencies but ensuring their effective and sustained engagement remains a challenge in many countries. In this article, we describe the process of mobilising community actors to contribute to the fight against COVID-19 in Burkina Faso. During the early days of the pandemic, the national COVID-19 response plan called for the involvement of community actors, but no strategy had been defined for this purpose. The initiative to involve community actors in the fight against COVID-19 was taken, independently of the government, by 23 civil society organisations gathered through a platform called 'Health Democracy and Citizen Involvement (DES-ICI)'. In April 2020, this platform launched the movement 'Communities are committed to Eradicate COVID-19 (COMVID COVID-19)' which mobilised community-based associations organised into 54 citizen health watch units (CCVS) in Ouagadougou city. These CCVS worked as volunteers, performing door-to-door awareness campaigns. The psychosis created by the pandemic, the proximity of civil society organisations to the communities and the involvement of religious, customary and civil authorities facilitated the expansion of the movement. Given the innovative and promising nature of these initiatives, the movement gained recognition that earned them a seat on the national COVID-19 response plan. This gave them credibility in the eyes of the national and international donors, thus facilitating the mobilisation of resources for the continuity of their activities. However, the decrease in financial resources to offset the community mobilisers gradually reduced the enthusiasm for the movement. In a nutshell, the COMVID COVID-19 movement fostered dialogues and collaboration among civil society, community actors and the Ministry of Health, which plans to engage the CCVS beyond the COVID-19 response, for the implementation of other actions within the national community health policy.

The Landscape of Strategic Health Purchasing for Universal Health Coverage in Burkina Faso: Insights from Five Major Health Financing Schemes.

Strategic health purchasing is a key strategy in Burkina Faso to spur progress toward universal health coverage (UHC). However, a comprehensive analysis of existing health financing arrangements and their purchasing functions has not been undertaken to date. This article provides an in-depth analysis of five key health financing schemes in Burkina Faso: Gratuité (a national free health care program for women and children under age 5), crédits délégués (delegated credits), crédits transférés (transfers to municipalities), community-based health insurance, and occupation-based health insurance. This study involved a document review and complementary key informant interviews using the Strategic Health Purchasing Progress Tracking Framework developed by the Strategic Purchasing Africa Resource Center (SPARC). Data were collected using the framework's accompanying Microsoft Excel-based tool. We analyzed the data manually to examine and identify the strengths and weaknesses of governance arrangements and purchasing functions and capacities. The study provides insight into areas that are working well from a strategic purchasing perspective and, more importantly, areas that need more attention. Areas for improvement include low financial and managerial autonomy for some schemes, weak accountability measures, lack of explicit quality standards for contracting and for service delivery, budget overruns and late provider payment, provider payment that is not linked to provider performance, fragmented health information systems, and information generated is not linked to purchasing decisions. Improvements in purchasing functions are required to address shortcomings while consolidating achievements. This study will inform next steps for Burkina Faso to improve purchasing and advance progress toward UHC.

Collaborative Learning to Advance Knowledge and Implementation of Strategic Health Purchasing in Sub-Saharan Africa.

Strategic purchasing means deliberately directing health funds to priority populations, interventions, and services. This is done by actively creating incentives so funding is used equitably and efficiently and is aligned with population health needs. Strategic purchasing is a complex policy area fraught with challenging technical, institutional, and political issues. Policy makers and practitioners are an important source of tacit knowledge-experiential knowledge that is context specific and gained over time. Collaborative learning, through which a group of peers jointly problem-solves and generates lessons and solutions that can be adapted to different country contexts, is an important way to advance collective understanding of how to make progress on strategic purchasing within the unique health financing systems of sub-Saharan Africa. The Strategic Purchasing Africa Resource Center (SPARC), a resource hub hosted by AMREF Health Africa with technical support from Results for Development, is facilitating a collaborative learning agenda among 11 technical partners in 10 countries. SPARC and the technical partners are generating new insights and practical lessons to inform country policy and regional discourse on how to better use strategic purchasing to advance progress toward universal health coverage (UHC). This paper summarizes lessons and best practices from SPARC's collaborative learning approach that can benefit others who are seeking to apply a similar approach to share tacit learning on strategic purchasing and UHC.

Gut Bacterial Diversity and Growth among Preschool Children in Burkina Faso.

There is a lack of empirical, prospective human data on the gut microbiome and its relationship with growth, especially in low- and middle-income countries. We prospectively assessed the association between gut microbial diversity and short-term growth in a cohort of preschool children in Burkina Faso to better characterize whether there is any evidence that changes in gut microbial diversity may affect growth. Data were obtained from a randomized controlled trial evaluating the effect of antibiotic administration on gut microbial diversity in preschool children. We followed up the enrolled children for 35 days, with anthropometric measurements at baseline and day 35 and microbial diversity measured at baseline and day 9 (analytic sample, N = 155). We estimated linear mixed-effects regression models with household random intercepts to assess the association of Simpson's and Shannon's alpha diversity with measures of change in anthropometry (e.g., ponderal growth since baseline) and absolute anthropometric measurements (e.g., day 35 weight). We did not find evidence that alpha gut microbial diversity was associated with growth or absolute anthropometric measurements after adjusting for confounding variables. Effect estimates were close to the null (P ≥ 0.15 for all fully adjusted comparisons), with the association between Simpson's alpha diversity and day 35 height (cm) farthest from the null (coefficient = -0.03, 95% CI: -0.07, 0.01). The change in gut microbial diversity also was not associated with the change in anthropometry in crude or adjusted models. Future research is needed to explore whether gut diversity has an impact on growth over a longer time period, in both healthy and malnourished children.

Rapid Reduction of Campylobacter Species in the Gut Microbiome of Preschool Children after Oral Azithromycin: A Randomized Controlled Trial.

Campylobacter has emerged as a potential important cause of childhood morbidity in sub-Saharan Africa. Biannual mass azithromycin distribution has previously been shown to reduce all-cause child mortality in sub-Saharan Africa. We conducted a randomized controlled trial in Burkina Faso in which children were randomized in a 1:1 fashion to a 5-day course of azithromycin or placebo to investigate the effect of oral antibiotics on the gut microbiome. We evaluated the changes in the gut microbiome of preschool children treated with azithromycin using metagenomic DNA sequencing. We found that three Campylobacter species were reduced with azithromycin treatment compared with placebo. These results were consistent with other studies that have shown decreases in Campylobacter species after azithromycin treatment, generating the hypothesis that a decrease in Campylobacter may contribute to observations of reduction in mortality following azithromycin distribution.

Gut Resistome After Oral Antibiotics in Preschool Children in Burkina Faso: A Randomized, Controlled Trial.

We evaluated the effect of systemic antibiotics (azithromycin, amoxicillin, cotrimoxazole, or placebo) on the gut resistome in children aged 6 to 59 months. Azithromycin and cotrimoxazole led to an increase in macrolide and sulfonamide resistance determinants. Resistome expansion can be induced with a single course of antibiotics.

Short-term weight gain among preschool children in rural Burkina Faso: a secondary analysis of a randomised controlled trial.

OBJECTIVES: Nutrition has profound effects on children's health outcomes and is linked to weight gain and cognitive development. We used data from a randomised controlled trial to evaluate the prospective associations between dietary, socioeconomic and demographic factors and short-term weight gain during the lean season in a rural area of Burkina Faso. DESIGN: Prospective cohort data arising from a randomised controlled trial of the effect of antibiotic distribution on child growth and intestinal microbial diversity. SETTING: Two rural communities in Nouna District, Burkina Faso. PARTICIPANTS: 246 children aged 6-59 months living in the study communities were enrolled in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: Anthropometric measurements, including weight and height, were obtained at baseline and 1 month. RESULTS: Of 246 children, the median weight for wasted children at baseline (weight-for-height z-score <-2) was 9.7 kg (IQR 8.65-10.8) and the weight of non-wasted children was 12.8 kg (IQR 10.9-14.75). Food insecurity was significantly associated with decreased weight gain velocity (mean difference -0.03 g/kg/day, 95% CI -0.06 to -0.006, p=0.04). CONCLUSION: Experiences of household food insecurity before the beginning of the lean season were associated with decreased weight gain in children in rural Burkina Faso during the lean season, although the mean difference was small. Understanding the relationship between timing of food insecurity and anthropometric outcomes may help to develop policies and health programme that address both of these issues. TRIAL REGISTRATION NUMBER: NCT03187834.

Smartphone photography as a possible method of post-validation trachoma surveillance in resource-limited settings.

BACKGROUND: Validation of trachoma elimination requires monitoring after discontinuation of trachoma program activities, though such evaluations are not commonly done. METHODS: Conjunctival examinations and smartphone photography were performed on a random sample of pre-school children from 15 villages in a region of Burkina Faso thought to have eliminated trachoma. RESULTS: No clinically active trachoma was detected by in-field or photographic evaluation. Smartphone images demonstrated high agreement with field grading (>99% concordance). CONCLUSIONS: Trachoma appears to have been eliminated from this area of Burkina Faso. Smartphone cameras may be a useful aid for monitoring in resource-limited settings.

Indirect Effect of Azithromycin Use on the Intestinal Microbiome Diversity of Untreated Children: A Randomized Trial.

Cohabiting children may share components of their intestinal microbiome. We evaluated whether receipt of azithromycin in one sibling confers changes to the intestinal microbiome in an untreated sibling compared with placebo in a randomized controlled trial. We found no evidence of an indirect effect of antibiotic use in cohabiting children. Clinical Trials Registrations: NCT03187834.

Antibiotic Prescription Patterns among Children Younger than 5 Years in Nouna District, Burkina Faso.

Understanding antibiotic use may help predict emergence of antimicrobial resistance. We evaluated antibiotic prescription trends in rural Burkina Faso, where little is known about antibiotic consumption. Antibiotic prescription data for 20 communities were extracted through record review in six primary health-care facilities serving the communities. The number of antibiotic prescriptions per child-year was calculated using population-based census data from the communities. A total of 1,444 antibiotic prescriptions were made from March to June 2017 among 3,401 children in the communities. The frequency of antibiotic prescription was 1.70 prescriptions per child-year (95% CI: 1.61-1.79). Penicillins were the most common (1.04 prescriptions per child-year, 95% CI: 1.01-1.06), followed by sulfonamides (0.69 prescriptions per child-year, 95% CI: 0.67-0.71) and macrolides (0.38 prescriptions per child-year, 95% CI: 0.37-0.40). Continued monitoring of antibiotic consumption in diverse settings will be important to understand the potential for emergence of antibiotic resistance.

Effect of Commonly Used Pediatric Antibiotics on Gut Microbial Diversity in Preschool Children in Burkina Faso: A Randomized Clinical Trial.

BACKGROUND: Exposure to antibiotics may result in alterations to the composition of intestinal microbiota. However, few trials have been conducted, and observational studies are subject to confounding by indication. We conducted a randomized controlled trial to determine the effect of 3 commonly used pediatric antibiotics on the intestinal microbiome in healthy preschool children. METHODS: Children aged 6-59 months were randomized (1:1:1:1) to a 5-day course of 1 of 3 antibiotics, including amoxicillin (25 mg/kg/d twice-daily doses), azithromycin (10 mg/kg dose on day 1 and then 5 mg/kg once daily for 4 days), cotrimoxazole (240 mg once daily), or placebo. Rectal swabs were obtained at baseline and 5 days after the last dose and were processed using 16S rRNA gene sequencing. The prespecified primary outcome was inverse Simpson's α-diversity index. RESULTS: Post-treatment Simpson's diversity was significantly different across the 4 arms (P = .003). The mean Simpson's α-diversity among azithromycin-treated children was significantly lower than in placebo-treated children (6.6; 95% confidence interval [CI], 5.5-7.8; vs 9.8; 95% CI, 8.7-10.9; P = .0001). Diversity in children treated with amoxicillin (8.3; 95% CI, 7.0-9.6; P = .09) or cotrimoxazole (8.3; 95% CI, 8.2-9.7; P = .08) was not significantly different than placebo. CONCLUSIONS: Azithromycin affects the composition of the pediatric intestinal microbiome. The effect of amoxicillin and cotrimoxazole on microbiome composition was less clear. CLINICAL TRIALS REGISTRATION: clinicaltrials.gov NCT03187834.

[Determinants of the choice of healthcare worker positions in rural areas in Burkina Faso.] / Déterminants du choix des postes en zone rurale par les professionnels de santé au Burkina Faso.

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.

Effect of Antibiotics on Short-Term Growth among Children in Burkina Faso: A Randomized Trial.

Antibiotics improve both weight and height gain in randomized trials of preschool children with preexisting morbidity. Here, we assess the effect of a short course of three different antibiotics (amoxicillin, azithromycin, and cotrimoxazole) on short-term linear and ponderal growth in a population-based sample of preschool children in rural Burkina Faso. We randomized households with at least two children in the Nouna district, Burkina Faso, to a 5-day course of amoxicillin, azithromycin, cotrimoxazole, or placebo. Within each antibiotic-randomized household, one child was randomly assigned to receive the antibiotic and the other to receive the placebo. Weight and height measurements were taken at baseline and 30 days following the last study medication dose. Weight-for-height Z (WHZ), height-for-age Z (HAZ), and weight-for-age Z (WAZ) scoreswere calculated based on the 2006 World Health Organization standards. Of the 124 households and 248 children enrolled, 229 had anthropometry measurements at 1 month and were analyzed. Children randomized to amoxicillin gained significantly more weight compared with both the placebo household (mean difference 317 g, 95% confidence interval [CI]: 115-519 g) and placebo sibling (mean difference 315 g, 95% CI: 147-482 g) controls. Growth velocity in g/kg/day, and WHZ and WAZ scores were higher in amoxicillin-treated children compared with placebo households and siblings. There were no differences in weight gain in children randomized to azithromycin or cotrimoxazole compared with placebo households or placebo siblings. There were no differences in height gain or HAZ across any of the study arms. Amoxicillin may have short-term growth-promoting effects in healthy children.

Dietary diversity and nutritional status among children in rural Burkina Faso.

Background: Burkina Faso has a seasonal malnutrition pattern, with higher malnutrition prevalence during the rainy season when crop yields are low. We investigated the association between dietary diversity and nutritional status among children aged 6-59 mo during the low crop yield season in rural Burkina Faso to assess the role of dietary diversity during the lean season on childhood nutritional status. Methods: Caregivers reported the dietary diversity of the past 7 d, consisting of 11 food groups, summed into a scale. Anthropometric measurements were taken from all children. Height-for-age (HAZ), weight-for-height (WHZ) and weight-for-age (WAZ) z-scores were calculated based on 2006 WHO standards. Stunting, wasting and underweight were defined as HAZ, WHZ and WAZ <-2 SD, respectively. Multivariable regression models adjusting for potential confounders including household food insecurity and animal ownership were used to assess the relationship between anthropometric indices and dietary diversity. Results: Of 251 children enrolled in the study, 20.6% were stunted, 10.0% wasted and 13.9% underweight. Greater dietary diversity was associated with greater HAZ (SD 0.14, 95% CI 0.04 to 0.25) among all children. There was no association between dietary diversity and wasting or mid-upper arm circumference in this study. Conclusions: Increasing dietary diversity may be an approach to reduce the burden of stunting and chronic malnutrition among young children in regions with seasonal food insecurity.