Assessment of Staffing Needs for Frontline Health Workers in Selected Maternal and Child Health Services in 3 Countries of Sub-Saharan West Africa: Cote d'Ivoire, Burkina Faso, and Niger.

Sub-Saharan African countries health systems are generally faced with shortages and inequitable distribution of qualified health workers. The application of provider-population ratio or fixed staff establishments, not considering variation in workload, given contextual variations in service utilization rates, cannot adequately match the human resource needs of different health facilities. The Workload Indicators of Staffing Need (WISN) method uses workload to determine staffing needs in a given facility. The aim of this study was to assess the current workload and staffing needs of maternal and child health services in 12 primary healthcare facilities from Burkina Faso, Niger, and Cote d'Ivoire. We employed the WISN methodology, using document reviews, in-depth interviews with health providers, and observations, to obtain the data needed for estimating the required number of staff in a given facility. Then, we calculated both the WISN difference (current-required staff), and the WISN ratio (current staff/required staff). Using the WISN ratio, we assessed the work pressure that health workers experience. The results showed a shortage of health workers in most services in Cote d'Ivoire and Niger (WISN ratio <1), in contrast to Burkina Faso where services were either adequately staffed or overstaffed (WISN ratio ⩾1). The workload pressure was generally high or very high in Cote d'Ivoire, while in Niger, it was very high in maternity services but rather low in dispensary ones. There was also a geographic discrepancy in health workers staffing, rural areas services being more understaffed, with a higher workload pressure as compared to urban areas ones. This study results strengthens the body of knowledge on the shortage of health workforce in sub-Saharan Africa French speaking countries. Policies and strategies to increase students training capacities and the application of regular WISN studies for a better staff distribution are necessary to address the human resource needs of health facilities in these countries.

Epidemiologic Profile of Overweight and Obesity in Abidjan, Ivory Coast: A Cross-Sectional Study.

Background: In sub-Saharan Africa, the prevalence of overweight and obesity is high, and it is estimated to increase within the next ten years. In Ivory Coast, the rise in and public health consequences of overweight and obese people are evident. Moreover, data concerning this status are scarce, old, local, and describe only a small sample of the population. Objective: This study has been conducted in order to describe the epidemiologic profile of overweight and obese people in Ivory Coast and identify the potential risk factors of obesity. Methods: From January 2014 to July 2017, 2,643 patients aged 17-70 years old from Abidjan of Ivory Coast were recruited. Statistical analysis was carried out using SPSS 20.0. Chi-square test and binary logistic regression analysis were used to identify risk factors for overweight and obesity. Results: Most of our patients were females (86.3%) with an estimated average age of 43.7 ± 12.19 years. Among 2,643 patients recruited in this study, 83.3% were obese and 87.2% were affected by central abdominal obesity. Binary logistic regression analysis identified seven factors significantly associated with overweight and obesity, including females (OR: 2.06; 95% CI [1.58-2.68]), >54 years old of age (OR: 3.71; 95% CI [1.84-7.50]), occupation of salesperson and traders (OR: 2.42; 95% CI [1.78-3.29]), ethnic group of North Mande ethnicity (OR: 1.47; 95% CI [1.07-2.02]), family history of obesity (OR: 1.96; 95% CI [1.46-2.63]), ≥150 minutes of sport practice (OR:0.72; 95% CI [0.55-0.96]), and parous females (OR: 1.63; 95% CI [1.11-2.38]). Conclusions: Overall, gender (female), older age, and occupation were associated with greater risks of overweight and obesity in patients. Ethnic group, pregnancy and family history of obesity posed a lower but significant risk for obesity. More sport practice played a protective role against the acquisition of overweight and obesity.

[Dietary habits among type 2 diabetic patients attending the Abidjan Diabetes Centre]. / Pratiques alimentaires des diabétiques de type 2 suivis au Centre Antidiabétique d'Abidjan.

Objectives: The prevalence of diabetes is rapidly increasing in sub-Saharan Africa. Healthy lifestyle and dietary conditions play a key role in the control of blood sugar imbalance and cardiovascular complications of diabetes. This study was designed to describe the profile and dietary habits of type 2 diabetic patients attending the Abidjan Diabetes Centre (CADA), and to identify related factors. Methods: This cross-sectional, descriptive and analytic study was conducted in 2014 at the CADA. A total of 384 patients were included. Results: Patients had a mean age of 56.2 (SD: 11.7) years and had been living with diabetes for a mean duration of 8.6 years. Main comorbidities associated with diabetes were overweight (56.8%) and high blood pressure (45.3%). More than one-half of patients (60.7%) did not have a good knowledge of the recommended diet for diabetics: 88.5% did not have regular meal times, 11.7% reported snacking and 61.5% had their meals outside of the home. In addition, 60.4% stated that, during the week preceding the survey, they had eaten at least one "not recommended" food, most commonly fatty meals and fried food (31.5%). Patients who did not know that eating fatty meals and fried food was not recommended for diabetics were 3 times more likely to each this type of food (p < 0.001). Conclusion: Strengthening nutritional support by therapeutic education sessions is a key strategy that should be implemented to improve dietary habits among type 2 diabetic patients in Ivory Coast.

[Abortion practices in high school students in Yamoussoukro, Côte d'Ivoire]. / Pratiques d?avortement chez des lycéennes à Yamoussoukro, Côte d?Ivoire.

INTRODUCTION: Induced abortion is illegal in Cote d'Ivoire, except when the mother's life is in danger. The primary objective of this study was to describe abortion practices among Yamoussoukro high school students. More specifically, this study estimated the prevalence of induced abortion, described the pathway and the methods used for abortion and determined any abortion-related complications. MATERIAL AND METHODS: This cross-sectional study was conducted in July 2011 on 312 randomly selected girls attending the Lycée Jeunes Filles in Yamoussoukro. RESULTS: These girls had a mean age (SD) of 16.1 (4.7) years; 258 (82.7%) of them had already had sexual intercourse and 81 (31.4%) had already been pregnant. Fifty (61.7% [56.3-67.1%]) of these 81 girls had already had an abortion. The abortion pathway was as follows: the main method was self-prescribed medication (70%) as first attempt, followed, in case of failure, by traditional healers (56.4%). Healthcare practitioners were usually consulted at the third attempt (85.7%). The most commonly used methods of abortion were drugs (91.9%), ingestion of plants/beverages (68.5%) and introduction of devices into the uterine cavity (62.3%). Twenty-two (44%) out of 50 induced abortions resulted in complications, mostly infectious complications (81.8%), and bleeding (68.2%). Complications were significantly associated with self-induced abortions or abortions performed by traditional healers (p < 0.001). CONCLUSION: More intensive sexual education, access to modern methods of contraception, awareness campaigns concerning the risks related to unwanted pregnancies and abortions performed by non-medical personnel need to be implemented to prevent school abortions. The quality and accessibility of post-abortion services also need to be reinforced.