Postabortion care service availability, readiness, and access in Burkina Faso: results from linked female-facility cross-sectional data.

BACKGROUND: Little is known about postabortion care (PAC) services in Burkina Faso, despite PAC's importance as an essential and life-saving component of emergency obstetric care. This study aims to evaluate PAC service availability, readiness, and accessibility in Burkina Faso. METHODS: Data for this study come from the Performance Monitoring for Action (PMA) Burkina Faso project and the Harmonized Health Facility Assessment (HHFA) conducted by the Institut de Recherche en Sciences de la Santé and the Ministry of Health. PMA data from a representative sample of women aged 15-49 (n = 6,385) were linked via GPS coordinates to HHFA facility data (n = 2,757), which included all public and private health facilities in Burkina Faso. We assessed readiness to provide basic and comprehensive PAC using the signal functions framework. We then calculated distance to facilities and examined percent within 5 kms of a facility with any PAC, basic PAC, and comprehensive PAC overall and by women's background characteristics. RESULTS: PAC services were available in 46.4% of health facilities nationwide; only 38.3% and 35.0% of eligible facilities had all basic and comprehensive PAC signal functions, respectively. Removal of retained products of conception was the most common missing signal function for both basic and comprehensive PAC, followed by provision of any contraception (basic) or any LARC (comprehensive). Nearly 85% of women lived within 5 km of a facility providing any PAC services, while 50.5% and 17.4% lived within 5 km of a facility providing all basic PAC and all comprehensive PAC signal functions, respectively. Women with more education, greater wealth, and those living in urban areas had greater odds of living within 5 km of a facility with offering PAC, basic PAC, or comprehensive PAC. CONCLUSIONS: Results indicate a need for increased PAC availability and readiness, prioritizing basic PAC services at the primary level-the main source of care for many women-which would reduce structural disparities in access. The current deficiencies in PAC signal a need for broader strengthening of the primary healthcare services in Burkina Faso to reduce the burden of unsafe abortion-related morbidity and mortality while improving maternal health outcomes more broadly.

A Multilevel Analysis of the Associated and Determining Factors of TB among Adults in South Africa: Results from National Income Dynamics Surveys 2008 to 2017.

TB is preventable and treatable but remains the leading cause of death in South Africa. The deaths due to TB have declined, but in 2017, around 322,000 new cases were reported in the country. The need to eradicate the disease through research is increasing. This study used population-based National Income Dynamics Survey data (Wave 1 to Wave 5) from 2008 to 2017. By determining the simultaneous multilevel and individual-level predictors of TB, this research examined the factors associated with TB-diagnosed individuals and to what extent the factors vary across such individuals belonging to the same province in South Africa for the five waves. Multilevel logistic regression models were fitted using frequentist and Bayesian techniques, and the results were presented as odds ratios with statistical significance set at p < 0.05. The results obtained from the two approaches were compared and discussed. Findings reveal that the TB factors that prevailed consistently from wave 1 to wave 5 were marital status, age, gender, education, smoking, suffering from other diseases, and consultation with a health practitioner. Also, over the years, the single males aged 30-44 years suffering from other diseases with no education were highly associated with TB between 2008 and 2017. The methodological findings were that the frequentist and Bayesian models resulted in the same TB factors. Both models showed that some form of variation in TB infections is due to the different provinces these individuals belonged. Variation in TB patients within the same province over the waves was minimal. We conclude that demographic and behavioural factors also drive TB infections in South Africa. This research supports the existing findings that controlling the social determinants of health will help eradicate TB.

Predicting factors of sexual behaviours at risk of HIV infection among people living with disabilities: a generalized structural equation model.

Many studies have shown the HIV vulnerability of people with disabilities (PWD). This vulnerability is supported by risky sexual behaviours, which need to be well described. The objective of this study is to identify predictors of sexual behaviours at risk of HIV infection among PWD in Burkina Faso. We conducted a population-based cross-sectional study on disability and HIV in four regions in Burkina Faso. PWD were selected through a probabilistic method. The Washington Group Short questionnaire was used to identify PWD. Five sexual risk behaviours were considered in this analysis (having multiple sex partners, starting sex at an early age, having had sex with a nonregular partner, sex in return for payment and condomless sex). A composite variable was created and called "risky sexual behaviour (RSB)", which was defined in three categories (low risk, moderate risk and high risk) based on the co-occurrence of the individual sexual risk behaviours. Generalized structural equation was used to identify the predictors of RSB withincome possession as a mediator. A total of 973 PWD were included in this study. The proportion of PWD who were engaged in at least two risky sexual behaviours was 9.5% (95%CI: 6.5-13.8), those with one risky sexual behaviour represented 42.8% (95%CI: 39.4-46.3) and less than half ( 47.7% (95%CI: 43.3-52.1)) werenot engaged in risky sexual behaviour. The prevalence of HIV increased with the level of risky sexual behaviour. Age, education level and type of disability have a significant direct effect on RSB. Indeed, the oddof engaging in sexual risk behaviour was low among PWD who attended at least secondary school compared to those who were not schooled (adjusted odds ratio (aOR): 0.62 (95%CI: 0.41-0.92). The indirect effect of sex on RSB mediating by income possession was significant. Indeed, women with income have a low oddof engaging in RSB compared to men (aOR: 0.83 [95%CI: 0.71-0.98]). Our results confirm a certain ambivalence in the sexuality of people with disabilities. Hence, there is a need for a particular focus on risky sexual behaviour to enable the development of an effective HIV strategy in this group.

Low prevalence of HIV infection among persons with disabilities in Niger: findings from a household-based cross-sectional study in 2018.

The aim of this work was to report for the first time the prevalence of HIV infection among people with disabilities (PWDs) in Niger. The Washington Group Short questionnaire was used to identify people with disabilities during a household survey. Blood samples for HIV testing were collected using the Dried Blood Sampling (DBS) method. HIV testing was performed according to the Niger national HIV testing guideline. A total of 21,979 persons aged 15-69 years were screened, of them 2237 (10.17%) had disabilities and 949 participants (4.32%) had severe disabilities (level 3 or 4). Finally, 821 participants agreed to participate in the HIV testing. Female persons with disabilities accounted for the majority (52.25%). People with physical impairment were mostly represented (39.27%) followed by those with visual impairment (38.66%). At least one-third had multiple impairs (36.91%). HIV prevalence among person with disabilities was 0.66% (95% CI: 0.33-1.30). There is no difference between HIV prevalence and type of disabilities or socio-demographic characteristics. Hence, there is a need to consider them in the development and implementation of an effective HIV strategy.

Bootstrapping of compliance to anti-Tuberculosis medication: South Africa, 2014.

BACKGROUND: Although, Tuberculosis (TB) is curable if the treatment is adhered to and completed it is still a major cause of death globally including South Africa. The success rate for TB treatment was 77.2% in 2014, of which more than 37 000 lives were lost because of it in South Africa. Several studies have been carried out on this subject, but the difference between the present study and the previous work done is the methodology proposed to establish the determinants of anti-TB medication compliance. Understanding the determinant of anti-TB medication compliance will help the policymakers on the appropriate decision to reduce the menace of the disease. METHODS: In this study, we proposed logistic regression to a sample of individuals taken from the National Income Dynamics Survey data that self-reported to have been TB diagnosed. A comparison of the classical logistic regression and parametric bootstrap estimation methods was done for this data to determine the model that best describes the data. RESULTS: The results obtained from the two methods were similar and identified gender, language, alcohol, English literacy, belief in religion and household SES as the determinants of TB patients on medication. The standard errors for the bootstrap logistic model were bigger than the standard errors of the classical model. CONCLUSION: We conclude that the classical model is better and for this scenario, there was no need to resample. The outcome of this study supports the existing findings that controlling the social and economic determinants of health will help eradicate TB.

Bayesian Generalized Linear Mixed Modeling of Breast Cancer.

BACKGROUND: Breast cancer is one of the most common cancers among women. Breast cancer treatment strategies in Nigeria need urgent strengthening to reduce mortality rate because of the disease. This study aimed to determine the relationship between the ages at diagnosis and established the prognostic factors of modality of treatment given to breast cancer patient in Nigeria. METHODS: The data was collected for 247 women between years 2011-2015 who had breast cancer in two different hospitals in Ekiti State, Nigeria. Model estimation is based on Bayesian approach via Markov Chain Monte Carlo. A multilevel model based on generalized linear mixed model is used to estimate the random effect. RESULTS: The mean age of the patients (at the time of diagnosis) was 42.2 yr with 52% of the women aged between 35-49 yr. The results of the two approaches are almost similar but preference is given to Bayesian because the approach is more robust than the frequentist. Significant factors of treatment modality are age, educational level and breast cancer type. CONCLUSION: Differences in socio-demographic factors such as educational level and age at diagnosis significantly influence the modality of breast cancer treatment in western Nigeria. The study suggests the use of Bayesian multilevel approach in analyzing breast cancer data for the practicality, flexibility and strength of the method.

Bayesian generalized linear mixed modeling of Tuberculosis using informative priors.

TB is rated as one of the world's deadliest diseases and South Africa ranks 9th out of the 22 countries with hardest hit of TB. Although many pieces of research have been carried out on this subject, this paper steps further by inculcating past knowledge into the model, using Bayesian approach with informative prior. Bayesian statistics approach is getting popular in data analyses. But, most applications of Bayesian inference technique are limited to situations of non-informative prior, where there is no solid external information about the distribution of the parameter of interest. The main aim of this study is to profile people living with TB in South Africa. In this paper, identical regression models are fitted for classical and Bayesian approach both with non-informative and informative prior, using South Africa General Household Survey (GHS) data for the year 2014. For the Bayesian model with informative prior, South Africa General Household Survey dataset for the year 2011 to 2013 are used to set up priors for the model 2014.

TB/HIV risk factors identified from a General Household Survey of South Africa in 2006.

The level of human immunodeficiency virus (HIV), tuberculosis (TB) as well as the co-infection TB/HIV in South Africa is among the highest in the world. TB is curable while HIV is not, yet the combination of both is a growing feature in the world. This study examined TB and HIV affecting people living in South Africa. Analyses have been undertaken based on data from the General Household Survey of South Africa in 2006. The study focused on respondents aged 15-49 years, corresponding to a total of 55,384 people composed of 25,859 males and 29,525 females. Among this population, 5935 people suffered from illness/injury, including 2469 (41.6%) males and 3466 (58.4%) females. Weighted multivariate logistic regression is performed on TB and/or HIV in association with the province, background characteristics of the target population, and selected socioeconomic and demographic variables included in the survey. In this study we focus on variables of health status and whether subjects suffered from TB and/or HIV. Findings of this investigation show that TB is the second most common cause of illness in the provinces of KwaZulu-Natal (KN) (9.1%), North West (5.4%) and Limpopo (4.2%). People who are married have a 50% lower risk compared to those currently not married to suffer from TB and/or HIV. Those with living spouses have a 5% lower risk to suffer from TB and/or HIV than those whose partners are not alive. This study concluded that rapid action is needed to curb the spread of TB and/or HIV to produce a healthy population. Therefore, follow-up care and special preventative measures are urgently needed in provinces with higher reported rates of TB and/or HIV such as KN.

Maternal Mortality in Burkina Faso: A Method from Population Census 2006.

BACKGROUND: Estimating maternal mortality level is constantly challenging researchers and planners both in rich and poor countries. In developing countries, particularly in Burkina Faso where the registration system is not working properly, censuses and surveys are the main providers of maternal mortality estimates. However, censuses provide more reliable data about maternal mortality especially at sub-national level. Strength of this situation, the census 2006 of Burkina Faso collected information about maternal mortality. Unfortunately, the census also under reported the phenomenon. In this regard, a methodology was developed to provide adjusted estimates of the phenomenon. METHODS: This paper aims to assess the census 2006 estimates of maternal mortality through a critical review of the questionnaire, data quality, adjustment technique and outputs. Incoherencies, duplicated cases and missing data were the key aspects of the data quality assessment. The assumptions and outputs of the method were examined and comparison made with existent estimates. RESULTS: Findings highlighted weaknesses regarding the assumptions of the method and showed that the levels of the phenomenon were still under-estimated. In this research, propositions have been made concerning data cleaning, situations of adjustment coefficients less than 1 and the problem of weak assumptions. Findings led to a MMRatio of 331 [293-402] maternal deaths per 100 000 live births. CONCLUSION: The level of maternal mortality as published in the census 2006 report (MMRatio of 307) is acceptable because falling in the range 293-402. However, the questionnaire, data and method used needed improvements.