Availability and Utilization of Postabortion Care Services in Burkina Faso, Côte d'Ivoire, and Guinea: A Secondary Analysis of Emergency Obstetric and Neonatal Care Needs Assessments (EmONC).

SYNOPSIS: Generally, there are disparities in the availability and utilization of postabortion care services within the different regions at the national level in Burkina Faso, Cote d'Ivoire, and Guinea and between the 3 countries. Access to postabortion care at the primary level must be improved and the adoption of family planning when providing postabortion care. Unsafe abortion remains one of the leading causes of maternal mortality in sub-Sahara Africa, with relatively poor access to quality postabortion care (PAC) services. This study evaluated the quantity and distribution as well as the utilization of PAC services in Burkina Faso, Cote d'Ivoire, and Guinea. We conducted a secondary data analysis using the most recent EmONC surveys in the 3 countries between 2016 and 2017. We used PAC signal functions approach to assess facilities' capacity to provide basic PAC at both primary and referral level of care and comprehensive PAC at the referral level. We illustrated population coverage of PAC services based on the WHO benchmark, and then assessed the utilization of PAC services. Basic PAC capacity at primary level was low (36.6%), ranging from 16.2% in Burkina Faso to 36% in Cote d'Ivoire. About 82.0% of hospitals could provide comprehensive PAC. There were disparities in the geographical distribution of PAC services at both national and subnational levels. Abortion complications represented 16.2% of all obstetric emergencies, and uptake of PAC modern contraceptive was low (37.1%) in all countries. There is a need to focus on access to PAC at the primary level of care in the 3 countries.

Community health workers' involvement in mother-child care during the 1st year after birth, in Kaya health district, Burkina Faso: A contribution analysis.

Introduction: Maternal and infant morbidity and mortality remain high in sub-Saharan Africa. However, actions to strengthen postpartum care are still weak and mainly limited to health facilities (HFs). In Kaya health district, Burkina Faso, community health workers (CHWs) were involved in mother and child care during the 1st year postpartum through home visits, outreach sessions and accompanying mothers to health facilities. The aim of this study was to assess the contribution of CHWs to postpartum women's attendance at the health facilities. Methods: We conducted an effect assessment using Mayne and Lemire's contribution analysis framework. Qualitative and quantitative data were collected through project documents review and individual semi-structured interviews with key-informants. Results: All the participants interviewed acknowledged that the number of women, who came to postpartum care, had increased since the implementation of the project activities. Postpartum consultation rates within the 1st week postpartum increased from 29% in 2011 to 80% in 2015 and from 19 to 50% within 6 weeks. Others interventions such as Performance based financing, Save The Children nutritional project and the health services component of Missed Opportunities in Mother and Infant Health (MOMI) were the alternative explanations. Conclusions: CHWs involvement in women care contributed to improve their adherence to postpartum consultations in Kaya health district.

Determinants of the practice of exclusive breastfeeding in Guinea: evidence from 2018 Guinean demographic and health survey.

BACKGROUND: Exclusive breastfeeding is critical for infant survival and development. However, the rate of exclusive breastfeeding in the first 6 months of life is low in sub-Saharan Africa. With the current trend in breastfeeding rates in many countries including in Guinea, the World Health Assembly target of at least 50% of children aged less than 6 months being exclusively breastfeed by 2025 is likely to be compromised and lives a numerous infant that are be at risk. The objective of this study was to identify the individual and contextual determinants of the practice of Exclusive Breastfeeding (EBF) in Guinea. METHOD: We conducted a secondary analysis of data from the 2018 Guinea Demographic and Health Survey (DHS). The study population consisted of women who gave birth between the ages of 15 and 49. Our sample consisted of women who had their last birth six (06) months prior to collection. The enumeration areas were our second level. A multilevel logistic regression was performed using Stata version 15.1 software. Three statistical models were implemented: The final model was obtained using the bottom-up step-by-step method. The intra-class correlation coefficient was calculated. RESULTS: On the 851 women included in our study, 33% reported having exclusively breastfed during the first 6 months of life of their children. After a multivariate analysis, the variables associated with exclusive breastfeeding are: children aged 2-3 months (OR = 0.53 CI95% = [0.36-0.79]) and children aged 4-5 months (OR = 0.23 IC95% = [0.14-0.36]), women in the Faranah area (OR = 2.69 IC95% = [1.21-5.94]) and those in Mamou (OR = 2.27 IC95% = [1.00-5.94]), women who gave birth in a health facility (OR = 1.94 IC95% = [1.34-2.80]) and women living in polygamous households (OR = 0.68 IC95% = [0.48-0.98]). CONCLUSION: The practice of exclusive breastfeeding remains low in Guinea. For the achievement of Sustainable Development Goals, particularly the improvement of exclusive breastfeeding practices, the individual and contextual determinants identified in this study should be taken into consideration in policies and programmes.

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.

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.

[Clinical and paraclinical profile of autoimmune myasthenia gravis in Ouagadougou, Burkina Faso]. / Profil clinique et paraclinique de la myasthénie auto-immune à Ouagadougou au Burkina Faso.

Introduction: Certain differences in the epidemiological, clinical, paraclinical and evolution profiles of autoimmune myasthenia gravis (AIMG) are increasingly described in patients according to geographic origins. The present study was carried out in order to help characterize the socio-demographic, clinical and paraclinical profile of AIMG in Ouagadougou, Burkina Faso. Patients and methods: This was a cross-sectional, descriptive, multicenter, hospital study carried out in Ouagadougou (Burkina Faso), over a period of 5 years 6 months, from March 2015 to September 2019. The study concerned all patients who had a clinical symptomatology suggestive of myasthenia gravis, associated with the presence in the serum of anti-AChR Ab and / or anti-MuSK Ab and / or the presence of a >10% decrement in electroneuromyography and / or a positive therapeutic test for oral anticholinestherasics. Sociodemographic, clinical and paraclinical variables, were analyzed. Results: A total of 25 patients (15 women and 10 men), were included. The young adult form was predominant (20 cases). The median time between the first symptoms and the diagnosis was 28.4 months +/- 44.8 (2 - 217 months). Diplopia and/or ptosis (80%) and dysphonia (72%) were the most frequent revealing clinical presentations. On admission, 7 patients (28%) had a moderate generalized form (MGFA class III) and 9 patients (36%) had a severe to very severe generalized form (MGFA class IV to V). Plasma Ab assays were performed in 17 patients (68%): anti-RACh Ab were positive in 11 patients (64.7%) and anti-MuSK Ab in 3 patients (14.3%). Thoracic CT revealed thymus hyperplasia in 12 patients (48%), thymoma in 5 patients (20%). Hyperthyroidism was associated in 2 patients (8%). Conclusion: AIMG in Ouagadougou, Burkina Faso is marked by delayed diagnosis, a predominance in young women, severe generalized forms and a high frequency of plasma anti-MuSK Ab. This profile appears to be different from that of Caucasian patients. Collaborative studies in the sub-Saharan region on AIMG in general populations are needed.

[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.

[Acceptability and satisfaction with pregnancy and newborn diagnostic assessment (PANDA) system providing prenatal care in Burkina Faso]. / Acceptabilité et satisfaction de l'utilisation du système Pregnancy and Newborn Diagnostic Assessment (PANDA) pour les soins prénatals au Burkina Faso.

INTRODUCTION: mobile health technologies are increasingly being used as innovative solutions to improve antenatal care in Primary Care Services (PCSs). This study assessed the acceptability and satisfaction with PANDA system used in PCSs in Burkina Faso. METHODS: we conducted a cross-sectional mixed-methods study of 35 users of PCSs and 35 health workers in the Koupela Health District, in the Central East region of Burkina Faso in September 2017. Interviews and 4 focus groups were conducted among PCSs users and semi-structured interviews among health-care professionals. Quantitative data analysis was carried out using the SPSS software and qualitative data analysis using a thematic analysis with NVivo 10. RESULTS: PANDA system was very well accepted and appreciated by users and healthcare providers. Factors influencing customer satisfaction included the improvement of interactions with health care providers and the access to better quality care at lower cost. Health care providers appreciated the relevance of PANDA system as well as service improvements, follow-up and monitoring of pregnant women. CONCLUSION: in primary health-care system in Burkina Faso, PANDA system is very well accepted and appreciated by both health care providers and users of prenatal care services.

Mortalité à 3 mois des infarctus cérébraux au Burkina Faso : une étude de cohorte prospective

La mortalité à 3 mois des infarctus cérébraux demeure encore élevée en Afrique Sub Saharienne. L'objectif de notre étude était d'évaluer la mortalité intra hospitalière, à un mois et à 3 mois des patients hospitalisés pour infarctus cérébral au Burkina Faso. Il s'agissait d'une étude de cohorte prospective de patients consécutivement hospitalisés pour infarctus cérébral, de mars 2015 à février 2016, puis suivis en consultation externe durant au moins 3 mois après l'AVC au Centre Hospitalier Universitaire de Tingandogo, à Ouagadougou, au Burkina Faso. Les caractéristiques sociodémographiques, cliniques et paracliniques des patients à l'admission, les complications et la mortalité cumulée respectivement à la sortie d'hospitalisation, à un mois et à 3 mois, ont été analysées. En tout, 151 patients ont été enregistrés, avec une prédominance masculine (59,6 %) et une moyenne d'âge de 63,4 ans. Lors de l'admission, le National Institute of Health Stroke Score (NIHSS) moyen était de 14. L'oedème cérébral (39,7 %) et l'effet de masse (35,1 %) était les complications neuroradiologiques précoces les plus fréquentes. La durée moyenne d'hospitalisation était de 13,4 jours. Les taux de mortalité, intra hospitalière, à un mois et 3 mois étaient respectivement de 17,9 %, 19 % et 25,9 %. La mortalité des infarctus cérébraux reste élevée en Afrique Sub Saharienne. L'utilisation de la fibrinolyse, la mise en place des unités neurovasculaires et un accès des patients à la rééducation fonctionnelle, contribueront à l'amélioration de la survie des patients après infarctus cérébraux

Indicators of availability, use, and quality of emergency obstetric and neonatal care in Togo in 2012.

OBJECTIVE: To assess the availability, utilization, and quality of emergency obstetric and neonatal care (EmONC) in Togo. METHODS: A cross-sectional study of EmONC services in all public and private health facilities in the territory of Togo conducted from July to December, 2012. The generic tools developed by the Averting Maternal Death and Disability program were used as the basic tools for this evaluation. RESULTS: The survey involved 1019 health facilities including 864 potential EmONC facilities that constituted the final sample. The results showed that there was low availability of functional EmONC health facilities (8 basic EmONC and 24 comprehensive EmONC) with a large urban/rural variation. Among the 24 current CEmONC, 22 were in urban areas and half were from the private sector. The national ratio of availability was 3 EmONC health facilities per 500 000 inhabitants. Nationally, the cesarean delivery rate was 3.5%. The lethality rate of direct obstetric causes was estimated at 1.3%. CONCLUSION: Needs assessment for EmONC showed low availability of EmONC services and underutilization of the available services.