[Patient complaints: an opportunity to improve the quality of care of older people with multimorbidity in Burkina Faso]. / Plaintes des patients: une opportunité pour améliorer la qualité des soins des personnes âgées avec des multimorbidités au Burkina Faso.

INTRODUCTION: Little data exist on patient complaints to identify the strategy for the improvement of the quality of care of older people with multimorbidities. The aim of this study was to investigate the complaints of older people with multimorbidities at the health care facilities in Bobo-Dioulasso, Burkina Faso. METHODS: We conducted a cross-sectional study in the health care facilities in Bobo-Dioulasso from November 2013 to February 2014. Older people aged 60 years or more, with at least a chronic disease, examined in ambulatory or in hospital during the study period were included. Qualitative interviews were conducted using a semi-structured questionnaire. A content analysis was performed. RESULTS: We recorded the complaints related to long waiting time for health care, unsuitable hospital transfer service, lack of shared information on diseases and unsuitable hospitality conditions for older patients come to consultation and hospitalization. CONCLUSION: Improvement strategies should include the renovation and extension of the waiting rooms in the health care facilities, the separation of chronic care practice from acute care practice in ambulatory and in hospital, the support to the empowerment through a better communication with the patient, a community mutual assistance group and the involvement of family members.

[Potentially inappropriate medication use in elderly care in Burkina Faso]. / Utilisation des médicaments potentiellement inappropriés dans les soins gériatriques au Burkina Faso.

These results suggest approaches to encourage the development of care provider skills, standardized practices and rational prescription to help improve medication use in the elderly..

[Functional disability in activities of daily living and instrumental or domestic activities of daily living in the elderly living at home in Bobo-Dioulasso (Burkina Faso)]. / L'incapacité fonctionnelle dans les domaines des activités de la vie quotidienne et domestique chez les personnes âgées vivant à domicile à Bobo-Dioulasso (Burkina Faso).

In sub-Saharan Africa, various studies have been conducted on severe disability in activities of daily living, instrumental or domestic activities. These studies have reported different rates without describing the social context for understanding their results. This study was conducted in Burkina Faso to fill the gaps in scientific information on disability in these areas. We conducted a cross-sectional descriptive study in Bobo-Dioulasso among the older population, aged 60 and above. Their functional status was evaluated using the Functional Autonomy Measurement System (SMAF). Data analysis was done with the help of Stata. A systematic random sample of 351 aging adults was interviewed. Moderate to severe functional disability or the need for supervision or assistance was present in 7% in activities of daily living and 86% in instrumental or domestic activities of daily living. This need for assistance varied according to the different activities or items in each domain. The proportions of disability found in this study are higher than those of previous studies that measured the often severe disabilities. All persons with disability claimed to have stable human resources which help them to manage their disabilities. The social context instrumental or domestic activities of daily living are divided by generation and/or by sex. That explains some results. With this division, it's inacceptable in some family that elders and/or old men do instrumental or domestic activities of daily living as prepare meals, do laundry, carry water to wash. The variation of this division from one family to another complicates the assessment of functional disability. To best manage elders disabilities, strategies must develop to: 1) retard the resignation of the family in care of its elderly in functional disability, 2) anticipate the preparation of formal social networks, public structures to support the elderly.

[Quality of chronic patient care according to the Chronic Care Model in Burkina Faso]. / Qualité de la prise en charge des malades chroniques au Burkina Faso selon le Chronic Care Model.

INTRODUCTION: There is a lack of organizational knowledge concerning optimal management by the health care system for patients with chronic health conditions in sub-Saharan Africa. The objective of this study was to describe the quality of chronic patient care at first-line heath facilities in Bobo-Dioulasso, Burkina Faso. METHODS: We conducted a cross-sectional study in six health facilities in Bobo-Dioulasso from October to November 2013. The chronic care model was used as a reference to describe the care of hypertensive patients. A score was calculated for each item in the model, and the strengths and weaknesses of health care organization were identified RESULTS: The overall level of support for the management of hypertensive patients was "basic" for all surveyed structures: median score and IQR 3.7 (3.4, 4.4). The level of support was basic for primary health facilities (median score 4.4), district hospitals (median score 4.1) and the University health center (median score 5.4). The relationship with the community and support to decision-making were identified as weak components of the model. CONCLUSIONS: To improve the quality of chronic patient care in first-line health facilities in Burkina Faso, efforts must be made to strengthen clinical governance and partnership with the community.

Prevalence and patterns of multimorbidity among the elderly in Burkina Faso: cross-sectional study.

OBJECTIVES: To assess the prevalence and distribution patterns of multimorbidity among urban older adults in Burkina Faso. METHODS: Cross-sectional study among community-dwelling elderly people aged ≥60 in Bobo-Dioulasso. We performed interviews, clinical examination and medical record review. Multimorbidity was defined as co-occurrence of at least two chronic diseases in one person whether as a coincidence or not. RESULTS: The overall prevalence of multimorbidity among older adults was 65%. Age ≥70 was associated with multimorbidity in multivariate analysis: adjusted OR = 1.65, 95% CI (1.01-2.68, P = 0.04). The most common chronic diseases were hypertension (82%) 95% CI (78; 86), malnutrition (39%) 95% CI (34; 44), visual impairments (28%) 95% CI (24; 33) and diabetes mellitus (27%) 95% CI (22; 31). Those aged ≥70 had significantly more malnutrition (50% vs. 31%, P = 0.0003) and osteoarthritis (8% vs. 3%, P = 0.01) than those aged 60-69. CONCLUSIONS: The high prevalence of multimorbidity requires a reorganization of healthcare systems in sub-Saharan Africa, especially in Burkina Faso. Interventions and care guidelines usually focused on individual diseases should be improved to better reflect this reality.

The key actors maintaining elders in functional autonomy in Bobo-Dioulasso (Burkina Faso).

BACKGROUND: Globally, a significant increase in functional disability among the elderly is expected in the near future. It is therefore vital to begin considering how Sub-Saharan Africa countries can best start building or strengthening the care and support system for that target population. Study objectives are: 1) identify the key actors of the social system who maintain elders in functional autonomy at home in Bobo-Dioulasso (Burkina Faso) and 2) to describe the functional status of older people living at home. METHODS: We conducted a longitudinal descriptive study among the elderly aged 60 and above (351). Their functional status was evaluated using the Functional Autonomy Measurement System (SMAF). Data analysis was done using the statistical software package STATA (SE11). RESULTS: In Bobo-Dioulasso, 68% of seniors have good functional capacity or a slight incapacity and 32% have moderate to severe incapacities. Older people die before (3%) or during (14%) moderate to severe disabilities. This would mean that the quality of medical and/or social care is not good for maintaining functional autonomy of older people with moderate to severe disabilities. Two main groups of people contribute to maintain elders in functional autonomy: the elderly themselves and their family. Community, private or public structures for maintaining elders in functional autonomy are non-existent. The social system for maintaining elders in functional autonomy is incomplete and failing. In case of functional handicap at home, the elders die. But stakeholders are not conscious of this situation; they believe that this system is good for maintaining elders in functional autonomy. CONCLUSION: It is likely that the absence of formal care and support structure likely shortens the lifespan of severely disabled older people. Stakeholders have not yet looked at this possibility. The stakeholders should seriously think about: 1) how to establish the third level of actors who can fulfill the needs to maintain elders in functional autonomy that are not satisfied by others (family members or the older individuals themselves), and 2) how to reinforce the role of each actor and the collaboration between the different groups of people of this system.

[The elderly in sub-Saharan Africa: a vulnerable population often ignored in public policy]. / Les personnes âgées en Afrique subsaharienne : une population vulnérable, trop souvent négligée dans les politiques publiques.

Many people and financial institutions believe that the elderly are not a priority in sub-Saharan Africa, a region marked by serious economic, socio-political and health crises. The purpose of this paper is to describe and analyze the assumptions and arguments underlying this view and to demonstrate that the elderly are a vulnerable priority population ignored by all stakeholders and primarily by technical and financial partners. The premise is that development must be viewed as a whole. In addition to improving the living conditions of children, youth and women, efforts to promote development in Africa must also take into account the needs of the elderly. The paper argues that there are four main reasons for focusing on the elderly in sub-Saharan Africa: systemic reasons, ethical/humanitarian reasons, developmental reasons and/or the interests and future of youth and adults.

[Analysis of the Burkinabe National Health Program for the Elderly (BNPEH) 2008-2012]. / Analyse du Programme National de Santé des Personnes Agées (PNSPA) 2008-2012 du Burkina Faso.

INTRODUCTION: As a result of ageing of the population, most countries of sub-Saharan Africa, either spontaneously and/or in response to international incentives, are starting to develop sectorial or multisectorial action plans in favour of the elderly. Are these plans relevant and consistent and do they improve the health of the elderly? This study was performed to assess the relevance, consistency and implementation of the National Health Programme for the Elderly (PNSPA) 2008-2012 in Burkina Faso. METHODS: This qualitative analysis was conducted in Ouagadougou in November-December 2011 in 47 subjects including 27 elderly subjects and 20 stakeholders responsible for the design and/or implementation of the PNSPA. These respondents were selected rattionally and were individually interviewed. Content analysis was therefore performed. RESULTS: The PNSPA is relevant in the Burkinabe context. It takes into account the health needs of elderly people in Burkina Faso as well as the availability of resources in health centres. It presents several consistency problems. It has rarely been implemented due to lack of political support and inadequate financial resources. DISCUSSION: The Burkina Faso PNSPA has encountered more difficulties than similar plans in Senegal and Mali, which have also encountered low implementation rates. This situation confirms that the elderly in sub-Saharan Africa constitute a top priority vulnerable population but which is neglected by all actors to varying degrees.

[Functional disabilities in elderly people living at home in Bobo-Dioulasso, Burkina Faso]. / Les incapacités fonctionnelles des personnes âgées vivant à domicile à Bobo-Dioulasso, Burkina Faso.

In sub-Saharan Africa, very little research has been conducted on moderate to severe disabilities affecting mobility, communication and mental function in elderly people living at home. The studies that have been conducted have not always described the broader social context, a key factor for understanding and interpreting results. This study was conducted in Burkina Faso and was designed to fill the gaps in our understanding of disability in these areas. A cross-sectional descriptive study was conducted in Bobo-Dioulasso among the elderly population (aged 60 and above). Functional status was assessed using the Functional Autonomy Measurement System (SMAF). Data analysis was performed using Stata software. Interviews were conducted with a systematic random sample of 351 elderly adults. Moderate to severe functional disability or the need for supervision or assistance were related to mobility in 10 % of cases, to mental function in 28 % of cases and to communication in 37 % of cases. The need for assistance varied according to the different activities or items in each domain. The rates of disability in this study were higher than those found in previous studies, which have often assessed severe disabilities. All individuals affected by disability stated that they had a stable support network to manage their disability. Families were found to be the primary source of support. The results can be explained by the social context. A good visibility of moderate to severe disabilities should contribute to the development of effective policies to provide care and support to the elderly.