Aetiology and use of antibiotics in pregnancy-related infections: results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort.

BACKGROUND: Pregnancy-related infections are important contributors to maternal sepsis and mortality. We aimed to describe clinical, microbiological characteristics and use of antibiotics by source of infection and country income, among hospitalized women with suspected or confirmed pregnancy-related infections. METHODS: We used data from WHO Global Maternal Sepsis Study (GLOSS) on maternal infections in hospitalized women, in 52 low-middle- and high-income countries conducted between November 28th and December 4th, 2017, to describe the frequencies and medians of maternal demographic, obstetric, and clinical characteristics and outcomes, methods of infection diagnosis and causative pathogens, of single source pregnancy-related infection, other than breast, and initial use of therapeutic antibiotics. We included 1456 women. RESULTS: We found infections of the genital (n = 745/1456, 51.2%) and the urinary tracts (UTI) (n = 531/1456, 36.5%) to be the most frequent. UTI (n = 339/531, 63.8%) and post-caesarean skin and soft tissue infections (SSTI) (n = 99/180, 55.0%) were the sources with more culture samples taken and microbiological confirmations. Escherichia coli was the major uropathogen (n = 103/118, 87.3%) and Staphylococcus aureus (n = 21/44, 47.7%) was the commonest pathogen in SSTI. For 13.1% (n = 191) of women, antibiotics were not prescribed on the same day of infection suspicion. Cephalosporins (n = 283/531, 53.3%) were the commonest antibiotic class prescribed for UTI, while metronidazole (n = 303/925, 32.8%) was the most prescribed for all other sources. Ceftriaxone with metronidazole was the commonest combination for the genital tract (n = 98/745, 13.2%) and SSTI (n = 22/180, 12.2%). Metronidazole (n = 137/235, 58.3%) was the most prescribed antibiotic in low-income countries while cephalosporins and co-amoxiclav (n = 129/186, 69.4%) were more commonly prescribed in high-income countries. CONCLUSIONS: Differences in antibiotics used across countries could be due to availability, local guidelines, prescribing culture, cost, and access to microbiology laboratory, despite having found similar sources and pathogens as previous studies. Better dissemination of recommendations in line with antimicrobial stewardship programmes might improve antibiotic prescription.

Perinatal outcomes in women with lower-range elevated blood pressure and stage 1 hypertension: insights from the Kaya health and demographic surveillance system, Burkina Faso.

BACKGROUND: The impact of lower thresholds for elevated blood pressure (BP) on adverse perinatal outcomes has been poorly explored in sub-Saharan African populations. We aimed to explore the association between lower BP cutoffs (according to the 2017 American College of Cardiology/American Heart Association [ACC/AHA] criteria) and adverse perinatal outcomes in Kaya, Burkina Faso. METHODS: This retrospective cohort study included 2,232 women with singleton pregnancies between February and September 2021. BP was categorized according to the ACC/AHA criteria and applied throughout pregnancy. A multivariable Poisson regression model based on Generalized Estimating Equation with robust standard errors was used to evaluate the association between elevated BP, stage 1 hypertension, and adverse perinatal outcomes, controlling for maternal sociodemographic characteristics, parity, and the number of antenatal consultations, and the results were presented as adjusted risk ratios (aRRs) with corresponding 95% confidence intervals (CIs). RESULTS: Of the 2,232 women, 1000 (44.8%) were normotensive, 334 (14.9%) had elevated BP, 759 (34.0%) had stage 1 hypertension, and 139 (6.2%) had stage 2 hypertension. There was no significant association between elevated BP and adverse pregnancy outcomes. Compared to normotensive women, women with elevated BP had a 2.05-fold increased risk of delivery via caesarean section (aRR;2.05, 95%CI; 1.08-3.92), while those with stage 1 hypertension had a 1.41-fold increased risk of having low birth weight babies (aRR; 1.41, 95%CI; 1.06-1.86), and a 1.32-fold increased risk of having any maternal or neonatal adverse outcome (aRR; 1.32, 95%CI; 1.02-1.69). CONCLUSIONS: Our results suggest that the risk of adverse pregnancy outcomes is not increased with elevated BP. Proactive identification of pregnant women with stage 1 hypertension in Burkina Faso can improve hypertension management through enhanced clinical surveillance.

Stakeholder perceptions on the deployment of multiple first-line therapies for uncomplicated malaria: a qualitative study in the health district of Kaya, Burkina Faso.

BACKGROUND: In Burkina Faso, malaria remains the first cause of medical consultation and hospitalization in health centres. First-line case management of malaria in the country's health facilities is based on the use of artemisinin-based combination therapy (ACT). To optimize the use of these anti-malarial drugs in the perspective of mitigating the emergence of artemisinin resistance, which is a serious threat to malaria control and elimination, a pilot programme using multiple first-line therapies (MFTs) [three artemisinin-based combinations-pyronaridine-artesunate, dihydroartemisinin-piperaquine and artemether-lumefantrine] has been designed for implementation. As the success of this MFT pilot programme depends on the perceptions of key stakeholders in the health system and community members, the study aimed to assess their perceptions on the implementation of this strategy. METHODS: Semi-structured interviews, including 27 individual in-depth interviews and 41 focus groups discussions, were conducted with key stakeholders including malaria control policymakers and implementers, health system managers, health workers and community members. Volunteers from targets stakeholder groups were randomly selected. All interviews were recorded, transcribed and translated. Content analysis was performed using the qualitative software programme QDA Miner. RESULTS: The interviews revealed a positive perception of stakeholders on the implementation of the planned MFT programme. They saw the strategy as an opportunity to strengthen the supply of anti-malarial drugs and improve the management of fever and malaria. However, due to lack of experience with the products, health workers and care givers expressed some reservations about the effectiveness and side-effect profiles of the two anti-malarial drugs included as first-line therapy in the MFT programme (pyronaridine-artesunate, dihydroartemisinin-piperaquine). Questions were raised about the appropriateness of segmenting the population into three groups and assigning a specific drug to each group. CONCLUSION: The adherence of both populations and key stakeholders to the MFT implementation strategy will likely depend on the efficacy of the proposed drugs, the absence of, or low frequency of, side-effects, the cost of drugs and availability of the different combinations.

Attitudes, practices, and determinants of community care-seeking behaviours for fever/malaria episodes in the context of the implementation of multiple first-line therapies for uncomplicated malaria in the health district of Kaya, Burkina Faso.

BACKGROUND: Malaria case management relies on World Health Organization (WHO)-recommended artemisinin-based combination therapy (ACT), and a continuous understanding of local community knowledge, attitudes, and practices may be a great support for the success of malaria disease control efforts. In this context, this study aimed to identify potential facilitators or barriers at the community level to inform a health district-wide implementation of multiple first-line therapies (MFT) as a new strategy for uncomplicated malaria case management. METHODS: A community-based cross-sectional study using a mixed-method design was carried out from November 2018 to February 2019, in the health district (HD) of Kaya in Burkina Faso. Quantitative data were collected using a standardized questionnaire from 1394 individuals who had fever/malaria episodes four weeks prior to the survey. In addition, 23 focus group discussions (FGDs) were conducted targeting various segments of the community. Logistic regression models were used to assess the predictors of community care-seeking behaviours. RESULTS: Overall, 98% (1366/1394) of study participants sought advice or treatment, and 66.5% did so within 24 h of fever onset. 76.4% of participants preferred to seek treatment from health centres as the first recourse to care, 5.8% were treated at home with remaining drug stock, and 2.3% preferred traditional healers. Artemether-lumefantrine (AL) was by far the most used anti-malarial drug (98.2%); reported adherence to the 3-day treatment regimen was 84.3%. Multivariate analysis identified less than 5 km distance travelled for care (AOR = 2.7; 95% CI 2.1-3.7) and education/schooling (AOR = 1.8; 95% CI 1.3-2.5) as determinants of prompt care-seeking for fever. Geographical proximity (AOR = 1.5, 95% CI 1.2-2.1), having a child under five (AOR = 4.6, 95% CI 3.2-6.7), being pregnant (AOR = 6.5, 95% CI 1.9-22.5), and living in an urban area (AOR = 2.8, 95% CI 1.8-4.2) were significant predictors for visiting health centres. The FGDs showed that participants had good knowledge about malaria symptoms, prevention tools, and effective treatment. Behaviour change regarding malaria treatment and free medication for children under five were the main reasons for participants to seek care at health centres. CONCLUSIONS: The study showed appropriate knowledge about malaria and positive community care-seeking behaviour at health centres for fever/malaria episodes. This could potentially facilitate the implementation of a MFT pilot programme in the district. CLINICALTRIALS: gov Identifier: NCT04265573.

Low prevalence of high blood pressure in pregnant women in Burkina Faso: a cross-sectional study.

BACKGROUND: High blood pressure (HBP) during pregnancy causes maternal and fetal mortality. Studies regarding its prevalence and associated factors in frontline level health care settings are scarce. We thus aimed to evaluate the prevalence of HBP and its associated factors among pregnant women at the first level of the health care system in Burkina Faso. METHODS: This cross-sectional study was conducted in six health facilities between December 2018 and March 2019. HBP was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Multivariable logistic regression analysis was performed to identify factors associated with HBP. RESULTS: A total of 1027 pregnant women were included. The overall prevalence of HBP was 1.4% (14/1027; 95% confidence interval [CI] 0.7-2.3), with 1.6% (7/590; 95% CI 0.8-3.3) in rural and 1.2% (7/437; 95% CI 0.6- 2.5) in semi-urban areas. The prevalence was 0.7% (3/440; 95% CI 0.2-2.1) among women in the first, 1.5% (7/452; 95% CI 0.7-3.2) in the second and 3% (4/135; 95% CI 1.1-7.7) in the third trimester. In the multivariable analysis, pregnancy trimester, maternal age, household income, occupation, parity, and residential area were not associated with HBP during pregnancy. CONCLUSION: The prevalence of HBP among pregnant women at the first level of health system care is significantly lower compared to prevalence's from hospital studies. Public health surveillance, primary prevention activities, early screening, and treatment of HDP should be reinforced in all health facilities to reduce the burden of adverse pregnancy outcomes in Burkina Faso.

Describing the safety of abortion at the population level using network-based survey approaches.

BACKGROUND: Despite the negative impact of unsafe abortions on women's health and rights, the degree of abortion safety remains strikingly undocumented for a large share of abortions globally. Data on how women induce abortions (method, setting, provider) are central to the measurement of abortion safety. However, health-facility statistics and direct questioning in population surveys do not yield representative data on abortion care seeking pathways in settings where access to abortion services is highly restricted. Recent developments in survey methodologies to study stigmatized / illegal behaviour and hidden populations rely on the fact that such information circulates within social networks; however, such efforts have yet to give convincing results for unsafe abortions. OBJECTIVE: This article presents the protocol of a study whose purpose is to apply and develop further two network-based methods to contribute to the generation of reliable population-level information on the safety of abortions in contexts where access to legal abortion services is highly restricted. METHODS: This study plans to obtain population-level data on abortion care seeking in two Health and Demographic Surveillance Systems in urban Kenya and rural Burkina Faso by applying two methods: Anonymous Third-Party Reporting (ATPR) (also known as confidantes' method) and Respondent Driven Sampling (RDS). We will conduct a mixed methods formative study to determine whether these network-based approaches are pertinent in the study contexts. The ATPR will be refined notably by incorporating elements of the Network Scale-Up Method (NSUM) to correct or account for certain of its biases (transmission, barrier, social desirability, selection). The RDS will provide reliable alternative estimates of abortion safety if large samples and equilibrium can be reached; an RDS multiplex variant (also including social referents) will be tested. DISCUSSION: This study aims at documenting abortion safety in two local sites using ATPR and RDS. If successful, it will provide data on the safety profiles of abortion seekers across sociodemographic categories in two contrasted settings in sub-Saharan Africa. It will advance the formative research needed to determine whether ATPR and RDS are applicable or not in a given context. It will improve the questionnaire and correcting factors for the ATPR, improve the capacity of RDS to produce quasi-representative data on abortion safety, and advance the validation of both methods.

Representative data on how women induce abortions and their consequences are central to measurements of abortion safety. However, due to the stigmatized nature of abortion, measuring the details of the process is challenging when the latter occur out of the realm of the law and do not result in complications registered in hospital statistics. Hence, there is sparse empirical population-level data on how women terminate their pregnancies in countries where access to abortion services is highly restricted, as well as little data on the side effects and complications associated with the methods they chose and health seeking for these complications. Recent developments in indirect survey methodologies to study stigmatized/illegal behaviour and hidden populations are likely to improve the quality of data collected on abortion safety in restrictive contexts: all are based on the sharing of information on stigmatized practices in social networks. We propose to refine and pilot two such network-based methods to validate their use for collecting (quasi) representative data on abortion safety in large population health surveys. These two approaches are: (i) a modified Anonymous Third-Party Reporting method (ATPR) integrating elements of the Network-Scale-up Method (NSUM) and (ii) Respondent-Driven Sampling (RDS). We will conduct this study in two African Health and Demographic Surveillance Systems (HDSS) sites, one urban (Nairobi, Kenya), and one comprising a town and adjacent villages (Kaya, Burkina Faso).

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.

Yam Daabo interventions' effects on postpartum family planning use in Burkina Faso at 24 months after childbirth.

INTRODUCTION: After testing the interventions for improving the prevalence of contraceptive use, very few studies have measured the long-term effects thereafter the end of the implementation. This study aimed to measure Yam Daabo interventions' effects on contraceptive use in Burkina Faso at twelve months after completion of the intervention. METHODS: Yam Daabo was a two-group, multi-intervention, single-blind, cluster randomized controlled trial. Interventions comprised refresher training for the provider, a counseling tool, supportive supervision, availability of contraceptive services 7 days a week, client appointment cards, and invitation letters for partners. We used generalized linear mixed-effects models (log Poisson) to compare the modern contraceptive prevalence at 12 months post-intervention in the two groups. We collected data between September and November 2018. We conducted an intention-to-treat analysis and adjusted the prevalence ratios on cluster effects and unbalanced baseline characteristics. RESULTS: Twelve months after the completion of the Yam Daabo trial, we interviewed 87.4% (485 out of 555 women with available data at 12 months, that is, 247/276 in the intervention group (89.5%) and 238/279 in the control group (85.3%). No difference was observed in the use of hormonal contraceptive methods between the intervention and control groups (adjusted prevalence ratio = 1.21; 95% confidence interval [CI] = [0.91-1.61], p = 0.191). By contrast, women in the intervention group were more likely to use long-acting reversible contraceptives (LARC) than those in the control group (adjusted prevalence ratio = 1.35; 95% CI = [1.08-1.69], p = 0.008). CONCLUSION: Twelve months after completion of the intervention, we found no significant difference in hormonal contraceptive use between women in the intervention and their control group counterparts. However, women in the intervention group were significantly more likely to use long-acting reversible contraceptives than those in the control group. TRIAL REGISTRATION: The trial registration number at the Pan African Clinical Trials Registry is PACTR201609001784334 . The date of the first registration is 27/09/2016.

'We always find things to learn from.' Lessons from the implementation of the global maternal sepsis study on research capacity: a qualitative study.

BACKGROUND: Research capacity strengthening could be an indirect outcome of implementing a research project. The objective of this study was to explore the ability of the global maternal sepsis study (GLOSS), implemented in 52 countries, to develop and strengthen sexual and reproductive health research capacity of local participants in low- and middle- income participating countries. METHODS: We carried out a qualitative study employing grounded theory in sixteen countries in Africa and Latin America. We used inductive and deductive methods through a focus group discussion and semi-structured interviews for the emergence of themes. Participants of the focus group discussion (n = 8) were GLOSS principal investigators (PIs) in Latin America. Interviewees (n = 63) were selected by the country GLOSS PIs in both Africa and Latin America, and included a diverse sample of participants involved in different aspects of study implementation. Eighty-two percent of the participants were health workers. We developed a conceptual framework that took into consideration data obtained from the focus group and refined it based on data from the interviews. RESULTS: Six themes emerged from the data analysis: recognized need for research capacity, unintended effects of participating in research, perceived ownership and linkage with the research study, being just data collectors, belonging to an institution that supports and fosters research, and presenting study results back to study implementers. Research capacity strengthening needs were consistently highlighted including involvement in protocol development, training and technical support, data analysis, and project management. The need for institutional support for researchers to conduct research was also emphasised. CONCLUSION: This study suggests that research capacity strengthening of local researchers was an unintentional outcome of the large multi-country study on maternal sepsis. However, for sustainable research capacity to be built, study coordinators and funders need to deliberately plan for it, addressing needs at both the individual and institutional level.

Analyse de la performance d'un hôpital public à mode de gestion privée au Burkina Faso.

INTRODUCTION: Hospitals in Sub-Saharan Africa face many challenges. Burkina Faso has experimented a private operating system in a public hospital, in order to improve its performance. AIM: To assess the Tengandogo Teaching Hospital's (TTH's) performance in Ouagadougou. Burkina Faso. METHOD: We carried out a mixed-method cross-sectional study. We collected data in April 2017 using document review and quantitative data (key performance indicators), individual interviews with key informants. The analytical framework covered services continuity, health department efficiency and staff working environment safety. RESULTS: Our study findings indicated that the performance of TTH hospital is hampered by frequent shortages in medicine and medical consumables, deteriorating facilities, poor coordination of care and lack of data on patients and staff security. CONCLUSION: Private management of public hospitals is not sufficient to improve the performance of hospitals in Burkina Faso. More attention should be paid to improving supply management of medicine, consumables and ensuring a safe work environment for health workers.

Seroprevalence and factors associated with IgG anti-DENV positivity in blood donors in Burkina Faso during the 2016 dengue outbreak and implications for blood supply.

OBJECTIVES: Our study aimed to update the seroprevalence and factors associated with anti-dengue virus (DENV) antibody positivity among blood donors and to discuss their implications for blood supply. BACKGROUND: Questions on the potential transmission of DENV by transfusion increased after the documentation of the risk of transmission of the West Nile virus. This risk was estimated after transfusion of DENV RNA-positive blood units of up to 37.5%. In Burkina Faso, very few studies on DENV in blood donors have been conducted. As a result, there were no reliable data on DENV to allow the implementation of appropriate measures to control the risk of transmission of the dengue virus by blood transfusion. METHODS: We conducted a 4-week cross-sectional study from December 4 to 30, 2016. Blood donors of both genders, aged 18-60 years, accepted for blood donation after medical selection were consecutively enrolled. RESULTS: Our study included a total of 1007 blood donors, in which donors living in urban areas represented 78.2%. The mean age was 26.1 ± 8.1 years. After adjustment in a multiple regression logistic model, the odds of having IgG anti-DENV increased as age increased. The odds of DENV was 53% lower in rural areas (OR = 0.47; P = .000) compared to urban settings and 42% lower in mobile sites (OR = 0.58; P = .03) compared to fixed ones. CONCLUSION: Our study provides new and useful insights for future research on the risk of TT-DENV throughout blood transfusion.

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.

[Performance analysis of a privately managed public hospital in Burkina Faso]. / Analyse de la performance d'un hôpital public à mode de gestion privée au Burkina Faso.

INTRODUCTION: Hospitals in Sub-Saharan Africa face many challenges. Burkina Faso has experimented a private operating system in a public hospital, in order to improve its performance. AIM: To assess the Tengandogo Teaching Hospital's (TTH's) performance in Ouagadougou. Burkina Faso. METHOD: We carried out a mixed-method cross-sectional study. We collected data in April 2017 using document review and quantitative data (key performance indicators), individual interviews with key informants. The analytical framework covered services continuity, health department efficiency and staff working environment safety. RESULTS: Our study findings indicated that the performance of TTH hospital is hampered by frequent shortages in medicine and medical consumables, deteriorating facilities, poor coordination of care and lack of data on patients and staff security. CONCLUSION: Private management of public hospitals is not sufficient to improve the performance of hospitals in Burkina Faso. More attention should be paid to improving supply management of medicine, consumables and ensuring a safe work environment for health workers.

Human immunodeficiency virus (HIV) among men who have sex with men: results of the first integrated biological and behavioral survey in Burkina Faso, West Africa.

BACKGROUND: Many men who have sex with men (MSM) are at significant risk for HIV infection. The objective of this study was to determine the prevalence and correlates of HIV infection among MSM in Burkina Faso. METHODS: A cross-sectional biological and behavioral survey was conducted from January to August 2013 among MSM in Ouagadougou and Bobo-Dioulasso. MSM 18 years old and above were recruited using respondent driven sampling (RDS). A survey was administered to study participants followed by HIV testing. Population prevalence estimates and 95% confidence intervals (CI) adjusted for the RDS design were produced using the RDS Analysis Tool version 6.0.1 (RDS, Inc., Ithaca, NY). RESULTS: A total of 662 MSM were enrolled in Ouagadougou (n = 333) and Bobo-Dioulasso (n = 329). The majority were unmarried, with an average age of 22.1 ± 4.4 years old in Ouagadougou and 23.1 ± 4.7 years old in Bobo-Dioulasso. RDS-adjusted HIV prevalence was 1.7% (95% CI: 0.9-3.1) in Ouagadougou and 2.7% (95% CI: 1.6-4.6) in Bobo-Dioulasso. HIV prevalence among MSM under 25 years old was 1.3% (95% CI: 0.6-2.8) and 0.9% (95% CI: 0.4-2.5) respectively in Ouagadougou and Bobo-Dioulasso, compared to 5.4% (95% CI: 2.2-12.5) and 6.6% (95% CI: 3.4-12.3) among those 25 years old or older in these cities (p = 0.010 and p < 0.001). CONCLUSIONS: Results from this first biological and behavioral survey among MSM in Burkina Faso suggest a need for programs to raise awareness among MSM and promote safer sex, particularly for young MSM to prevent HIV transmission. These programs would need support from donors for innovative actions such as promoting and providing pre-exposure prophylaxis, condoms and water-based lubricants, HIV counseling, testing, early treatment initiation and effective involvement of the MSM communities.

[Educational practices and diabetes study of health professionals in Burkina Faso and Mali]. / Pratiques éducatives et diabète : étude auprès des professionnels de santé au Burkina Faso et au Mali.

OBJECTIVE: To examine educational practices in type 2 diabetes among health professionals. METHODS: A cross-sectional study took place from June to September 2012 in Bamako and Ouagadougou. The study population consisted of all health professionals responsible for diabetes care in secondary and tertiary public health facilities. RESULTS: A total of 78 participants were interviewed. Doctors and nurses accounted for 77% and 23% respectively. The median number of patients seen in consultation was 10 per week (range 1-100). The median age of experience in diabetes care for health professionals was 5 years (range: 1-25 years). Sixteen participants reported giving advice for cooking. Of the 62 that did not, the reasons given were mainly: non-competence to give such advice (60/62); lack of time (35/62) and useless counseling (5/62). For out-of-home meals, recommendations included: taking a meal to work (60/77); avoiding meals outside the home (30/77); avoid alcohol and oils at parties (10/77). CONCLUSION: The recommendations made to patients come down to information and advice. As a result, the data collected lacks an educational strategy that aims to render the patient more independent by facilitating his adherence to counseling and improving his quality of life.

Sexual and Reproductive Health Research and Research Capacity Strengthening in Africa: Perspectives from the region.

Developing the capacity to effectively carry out public health research is an integral part of health systems at both the national and global levels and strengthening research capacity is recognized as an approach to better health and development in low- and middle-income countries (LMICs). Especially fields such as sexual and reproductive health (SRH) would require inter-disciplinary teams of researchers equipped with a range of methodologies to achieve this. In November 2013, as part of the International Family Planning Conference in Addis Ababa, Ethiopia, a group of African researchers came together to discuss the gaps and strategies to improve sexual and reproductive health research and research capacity strengthening in Africa. This commentary summarizes the three broad areas where the issues and proposed solutions have concentrated around: 1) Addressing research gaps that are most relevant to policies and programmes in SRH, 2) Carrying out high quality and collaborative research, and 3) Translating research findings into SRH policies and programmes. Even though the focus of the discussions was Africa, the issues and proposed solutions can also be applied to other regions facing a high burden of disease with limited resources. The time is now and these can be achieved through synergistic commitment of African and global researchers, funders and organizations.

Infection-related severe maternal outcomes and case fatality rates in 43 low and middle-income countries across the WHO regions: Results from the Global Maternal Sepsis Study (GLOSS).

The highest toll of maternal mortality due to infections is reported in low and middle-income countries (LMICs). However, more evidence is needed to understand the differences in infection-related severe maternal outcomes (SMO) and fatality rates across the WHO regions. This study aimed to compare the burden of infection-related SMO and case fatality rates across the WHO regions using the Global Maternal Sepsis Study (GLOSS) data. GLOSS was a hospital-based one-week inception prospective cohort study of pregnant or recently pregnant women admitted with suspected or confirmed infection in 2017. Four hundred and eight (408) hospitals from 43 LMICs in the six WHO regions were considered in this analysis. We used a logistic regression model to compare the odds of infection-related SMOs by region. We then calculated the fatality rate as the proportion of deaths over the total number of SMOs, defined as maternal deaths and near-misses. The proportion of SMO was 19.6% (n = 141) in Africa, compared to 18%(n = 22), 15.9%(n = 50), 14.7%(n = 48), 12.1%(n = 95), and 10.8%(n = 21) in the Western Pacific, European, Eastern Meditteranean, Americas, and South-Eastern Asian regions, respectively. Women in Africa were more likely to experience SMO than those in the Americas (aOR = 2.41, 95%CI: [1.78 to 2.83]), in South-East Asia (aOR = 2.60, 95%CI: [1.57 to 4.32]), and the Eastern Mediterranean region (aOR = 1.58, 95%CI: [1.08 to 2.32]). The case fatality rate was 14.3%[3.05% to 36.34%] (n/N = 3/21) and 11.4%[6.63% to 17.77%] (n/N = 16/141) in the South-East Asia and Africa, respectively. Infection-related SMOs and case fatality rates were highest in Africa and Southeast Asia. Specific attention and actions are needed to prevent infection-related maternal deaths and severe morbidity in these two regions.

Embedding research capacity strengthening in multi-country studies in low-and middle-income countries: learnings from sexual and reproductive health research.

Research capacity strengthening (RCS) can empower individuals, institutions, networks, or countries to define and prioritize problems systematically; develop and scientifically evaluate appropriate solutions; and reinforce or improve capacities to translate knowledge into policy and practice. However, how to embed RCS into multi-country studies focusing on sexual and reproductive health and rights (SRHR) is largely undocumented. We used findings from a qualitative study, from a review of the literature, and from a validation exercise from a panel of experts from research institutions that work on SRHR RCS. We provide a framework for embedded RCS; suggest a set of seven concrete actions that research project planners, designers, implementers, and funders can utilise to guide embedded RCS activities in low- and middle-income countries; and present a practical checklist for planning and assessing embedded RCS in research projects.

Paper ContextMain findings: Building on findings from a primary qualitative study, a literature review, and a consultation with experts on capacity strengthening in LMICs, we propose a systematic approach to embedded RCS.Added knowledge: We present a framework for embedding RCS in multi-country studies and propose seven action points and a checklist for the implementation of RCS in multi-country research projects with considerations for sexual and reproductive health and rights research.Global health impact for policy and action: An easy-to-use checklist can enable global health researchers and policymakers to ensure RCS is an integral component of multi-country research.

A global analysis of the determinants of maternal health and transitions in maternal mortality.

The reduction of maternal mortality and the promotion of maternal health and wellbeing are complex tasks. This Series paper analyses the distal and proximal determinants of maternal health, as well as the exposures, risk factors, and micro-correlates related to maternal mortality. This paper also examines the relationship between these determinants and the gradual shift over time from a pattern of high maternal mortality to a pattern of low maternal mortality (a phenomenon described as the maternal mortality transition). We conducted two systematic reviews of the literature and we analysed publicly available data on indicators related to the Sustainable Development Goals, specifically, estimates prepared by international organisations, including the UN and the World Bank. We considered 23 frameworks depicting maternal health and wellbeing as a multifactorial process, with superdeterminants that broadly affect women's health and wellbeing before, during, and after pregnancy. We explore the role of social determinants of maternal health, individual characteristics, and health-system features in the production of maternal health and wellbeing. This paper argues that the preventable deaths of millions of women each decade are not solely due to biomedical complications of pregnancy, childbirth, and the postnatal period, but are also tangible manifestations of the prevailing determinants of maternal health and persistent inequities in global health and socioeconomic development. This paper underscores the need for broader, multipronged actions to improve maternal health and wellbeing and accelerate sustainable reductions in maternal mortality. For women who have pregnancy, childbirth, or postpartum complications, the health system provides a crucial opportunity to interrupt the chain of events that can potentially end in maternal death. Ultimately, expanding the health sector ecosystem to mitigate maternal health determinants and tailoring the configuration of health systems to counter the detrimental effects of eco-social forces, including though increased access to quality-assured commodities and services, are essential to improve maternal health and wellbeing and reduce maternal mortality.

Prevalence and factors associated with overweight in children under 5 years in West African countries.

Background: Overweight is a risk factor for non-communicable diseases and is affecting an increasing number of children worldwide. The objective of this study was to measure the prevalence and related factors to overweight among children under 5 years in five West African countries. Methods: This study was a secondary analysis of nationally representative cross-sectional data. These data were drawn from Demographic and Health Surveys (DHS) from five countries in the West African region (Benin, Guinea, Mali, Nigeria, and Togo) from 2015 to 2018.Continuous quantitative data were categorized and all analyses were weighted according to the probability that each participant was selected in the sample. Children under 5 years of age were the study population. Multilevel logistic regression was used with Stata 16.0 software. Results: The total sample size for the analysis was 38,657 children. The pooled prevalence of overweight among children under 5 years of age in the five countries was 3%. Guinea had the highest prevalence (6%) compared to the other countries, which had a prevalence of 2%. The likelihood of being overweight was higher among children aged 0-6 months (adjusted odds ratio [AOR] = 3.09; 95% confidence interval [CI] [2.41-3.95]), who had a high birth height (AOR = 1.64; 95% CI [1.29-2.09]), whose mothers were overweight (AOR = 1.35; 95% CI [1.09-1.68]), who lived in households with fewer than five members (AOR = 1.19; 95% CI [1.00-1.46]), or who lived in Guinea (AOR = 2.79; 95% CI [1.62-4.79]). Conclusion: This study showed that overweight concerns few children under 5 years of age in West Africa. However, it does exist, and its prevalence could likely increase if its modifiable factors (maternal overweight, household size, and height at birth) are not taken into account in nutritional interventions.