Women's and health providers' perceptions of companionship during labor and childbirth: a formative study for the implementation of WHO companionship model in Burkina Faso.

INTRODUCTION: A key component of achieving respectful maternal and newborn care is labor companionship. Despite important health benefits for the woman and baby, there are critical gaps in implementing labor companionship for all women globally. The paper aims to present the perceptions and experiences of pregnant women, postpartum women, and health care providers regarding companionship during labor and childbirth, and to identify barriers and facilitating factors to the implementation of labor companionship in Burkina Faso. METHODS: This is a formative study to inform the "Appropriate use of cesarean section through QUALIty DECision-making by women and providers" (QUALI-DEC) study, to design, adapt and implement a strategy to optimize the use of the cesarean section, including labor companionship. We use in-depth interviews (women, potential companions, and health workers) and health facility readiness assessments in eight hospitals across Burkina Faso. We use a thematic analysis approach for interviews, and narrative summaries to describe facility readiness assessment. RESULTS: In all, 77 qualitative interviews and eight readiness assessments are included in this analysis. The findings showed that all participants acknowledged an existing traditional companionship model, which allowed companions to support women only in the hospital waiting room and post-natal room. Despite recognizing clear benefits, participants were not familiar with companionship during labor and childbirth in the hospital as recommended by WHO. Key barriers to implementing companionship throughout labor and birth include limited space in labor and delivery wards, no private rooms for women, hospital rules preventing companionship, and social norms preventing the choice of a companion by the woman. CONCLUSION: Labor companionship was considered highly acceptable in Burkina Faso, but more work is needed to adapt to the hospital environment. Revisions to hospital policies to allow companions during labor and childbirth are needed as well as changes to provide private space for women. Training potential companions about their roles and encouraging women's rights to choose their companions may help to facilitate effective implementation.

A labor companion is a person who supports a woman throughout labor and birth, typically a woman's spouse/partner, family member, or friend. We were interested to explore if a labor companion throughout labor and birth was acceptable to women and health workers, and feasible to start doing for women in Burkina Faso. To achieve this objective, we interviewed 77 women, companions, and health workers about their beliefs and opinions about labor companions, and what might help or be a challenge to having companions. We also visited eight hospitals to understand what the labor ward looks like, and any policies about companions. We found that hospitals were allowing a 'traditional model' of companionship, allowing companions to accompany women only in the waiting and postnatal rooms (not during labor or birth). Both women and health workers believed that companionship during labor and birth would be helpful and desired, which might help to make it a reality for all women. We also identified some challenges, due to crowded labor rooms with limited privacy, and hospital rules that did not allow companionship. We found that sometimes a woman's family would choose the companion, instead of the woman herself, which may mean the woman does not want this person present. We plan to use these findings to help us to develop a program that allows any woman to have a companion present during labor and birth, in a way that ensures that she chooses the companion, and the companion can support her well.

[Social representation of chemotherapy and cancer among intern trainee doctor in Ouagadougou]. / Représentation sociale de la chimiothérapie et du cancer chez les étudiants de troisième cycle d'études médicales à Ouagadougou.

INTRODUCTION: The perceptions that postgraduate medical students have about cancer and chemotherapy could have an impact on the quality of their interactions with their future patients. We conducted this study in order to highlight their representational field for chemotherapy and cancer. METHOD: From February 1st to May 31st 2018, 618 students from the 3rd cycle in medical studies from Saint-Thomas d'Aquin University and Ouaga I Pr Joseph Ki-Zerbo of the city of Ouagadougou took part in the study. They were given self-administered questionnaire, which include a collection of free and hierarchical evocations in response to the inducers "cancer" and "chemotherapy". They were also asked to propose arguments to convince and gain trust of a fictitious patient waiting for chemotherapy. RESULTS: The fatal aspect of cancer was largely present in their representational world. The representational field of chemotherapy was related to the side effects and the expensive aspect of anticancer drugs. In spite of a negative representation of cancer, students were able to find words with positive connotations to convince patients waiting for chemotherapy to follow treatment. DISCUSSION: Knowing these representations makes it possible to understand the stakes of the doctor-patient relationship in order to improve the training of future doctors, as well as the care of patients.

Local sustainability and scaling up for user fee exemptions: medical NGOs vis-à-vis health systems.

Free healthcare obviously works when a partner from abroad supplies a health centre or a health district with medicines and funding on a regular basis, provides medical, administrative and managerial training, and gives incentive bonuses and daily subsistence allowances to staff. The experiments by three international NGO in Burkina Faso, Mali and Niger have all been success stories. But withdrawing NGO support means that health centres that have enjoyed a time of plenty under NGO management will return to the fold of health centres run by the state in its present condition and the health system in its present condition, with the everyday consequences of late reimbursements and stock shortages. The local support given by international NGOs has more often than not an effect of triggering an addiction to aid instead of inducing local sustainability without infusion. In the same way, scaling up to the entire country a local pilot experiment conducted under an NGO involves its insertion into a national bureaucratic machine with its multiple levels, all of which are potential bottlenecks. Only experiments carried out under the "ordinary" management of the state are capable of laying bare the problems associated with this process. Without reformers 'on the inside' (within the health system itself and among health workers), no real reform of the health system induced by reformers 'from the outside' can succeed.

[Sociological perspectives on the management of TB/HIV co-infection in Burkina Faso]. / Mise en perspective sociologique de la prise en charge de la co-infection TB/VIH au Burkina Faso.

In Burkina Faso, the management of TB/HIV co-infection presents a challenge for policy-makers and the health-care system, with its psychological, sociocultural and biomedical issues. The purpose of this paper is to describe the concerns caused by this co-infection and propose a management strategy for these patients. These findings result from a qualitative socio-anthropological study during a public health project in three health districts from 2006 to 2008 and from the observation of care practices in health centres. Patients face a double burden: the negative social image of both diseases and complicated difficult treatment. They deal with problems of social integration, with their social relations impaired by humiliation and marginalisation. The painful experience of daily doses of antiretroviral and anti-TB drugs creates bitterness against drugs, aggravated sometimes by apparently capricious care. In addition to economic insecurity, these chronically ill patients face social stigma and marginalisation, all damaging to their self-esteem.

[Community involvement in tuberculosis care in three rural health districts of Burkina Faso]. / Implication communautaire aux soins tuberculeux dans 3 districts sanitaires du Burkina Faso.

OBJECTIVE: Develop, implement and evaluate a form of community involvement in TB care in three rural health districts (DS). METHODS: Profiles of community representatives were identified within the therapeutic itineraries of TB patients (PATB). Community contributions have been made in a specific context via a committee of community resource persons. The results of patients' care and management were compared over time (2005 to 2007) and space (comparison made with 3 other DS controls). RESULTS: The multifaceted community interventions (material and psycho-social support to patients) have been integrated into the regular management plan for PATB. In the first 12 months, the detection and cure rates have increased significantly in the intervention area, before stabilizing over the course of the following 12 months. CONCLUSION: Community involvement in care can strengthen the capacity of health services to respond and meet the expectations of PATB, including for those with chronic diseases. It requires a coherent distribution of tasks amongst all actors and stakeholders and balance of power relationships between different contributors to care.