Evaluation of the quality of maternal death review cycles in Burkina Faso.

OBJECTIVE: To assess the quality of the maternal death review (MDR) cycle in selected health facilities in Burkina Faso in accordance with national standards. METHODS: A multiple case study using a qualitative approach performed in five health districts and two regional hospital centers in Burkina Faso. The facilities were chosen by contrasted purposive sampling based on hospital maternal mortality rate and urban or rural location. Structured and semistructured interviews were conducted and data analyzed thematically, horizontally, and vertically. RESULTS: Of the seven facilities included, six performed MDR. The MDR cycle was incomplete in five facilities because the implementation of recommendations had not been assessed. All cases of maternal death lacked vital information. Case analysis was not conducted in accordance with the national standards in most of the facilities. The action plans for implementing recommendations were not commonly used. CONCLUSION: The MDR process and its various stages did not meet quality standards. Identifying the determinants leading to lack of adherence to MDR standards will contribute to optimal choice of interventions and improving good practices in health facilities.

Assessment Of Maternity Staff Training And Knowledge Of Obstetric Care In Burkina Faso: A Repeated Cross-Sectional Study.

BACKGROUND AND AIM: The quality of maternity care in low-income countries has often been questioned. The objective of this study was to describe the trend of the percentage of staff trained on selected obstetric care topics and their level of knowledge of maternal care over a 5-year period in Burkina Faso. METHODS: We conducted a secondary analysis of data from two national emergency obstetric and newborn care (EmONC) needs assessments. Staff members' knowledge scores were determined at the facility level for 2010 and 2014 and were further categorized into low (less than 50%), medium (50 to 74%) or high (at least 75%) levels. We used McNemar's test with a 5% significance level to compare the distribution of the proportions in 2010 versus 2014. RESULTS: Out of 789 facilities surveyed in the 2014 assessment, 736 (93.3%) were eligible for this study. Most of them were primary healthcare centers (87.2%). Overall, 21.6% (n=197) of health workers in 2010 and 39% in 2014 were midwives. The proportions of staff who received training on focused antenatal care (FANC) and on how to perform active management of the third stage of labor (AMSTL) have increased by 15.8% and 14.7%, respectively. A significant proportion of facilities had health workers with a low level of knowledge of FANC (p<0.001), the parameters that indicate the start of labor (p<0.001), the monitoring of labor progress (p<0.001) and AMSTL (p<0.001). There was no significant change in staff knowledge in hospitals over the 5-year period. CONCLUSION: From 2010 to 2014, the proportion of staff trained in obstetric care has increased. Their level of knowledge also improved, except in hospitals. However, further efforts are needed to reach a high level of knowledge.

[Is the fight against maternal mortality in Burkina Faso adapted to reduce the three delays?]. / La lutte contre la mortalité maternelle au Burkina Faso est-elle adaptée pour réduire les trois retards?

OBJECTIVE: Maternal mortality remains high in Burkina Faso despite numerous interventions designed to reduce this mortality. It therefore appeared important to analyse attempts to lower maternal mortality in Burkina Faso over the last fifteen years in order to identify the strengths and weaknesses and to improve the national programme. METHODS: Analysis according to the ?three delays? model using the strengths, weaknesses, opportunities and threats method was conducted. Data sources were scientific publications as well as national gray literature. RESULTS: Many studies have identified factors predisposing to the first delay, but very few effective interventions covering all of the country have been conducted to reduce this delay. The development of infrastructures, a rapid transfer system and integration of the cost of transfer into the cost of delivery subsidy were interventions designed to reduce the second delay. The promotion of blood transfusion, emergency obstetric and neonatal care, an increased number of trained health professionals, delegation of tasks, subsidy and then free delivery costs were interventions designed to reduce the third delay. The analysis globally demonstrated that interventions on the first delay were insufficient and rarely implemented and weaknesses were observed in relation to the intervention designed to act on the last two delays. CONCLUSION: Due to their inadequacy and poor quality, the interventions failed to significantly reduce the three delays. Priority needs to be given to new interventions, especially community-based interventions, and reinforcement of the quality of care by health training.

[Local culture and community participation: Djandioba family planning day in Burkina Faso]. / Culture locale et participation communautaire : journées du Djandioba de la planification familiale au Burkina Faso.

The combination of "local culture and community participation" as implementation support for health programmes is an effective approach to reduce cultural barriers of access to health services. These events have reduced the negative impact of perceptions, erroneous beliefs and misinformation about modern contraceptive methods commonly observed in target populations..

Soutenir l'utilisation des évidences scientifiques issues de la recherche pour l'élaboration des politiques dans les systèmes de santé en Afrique / Supporting the Use of Research Evidence (sure) for policy in African Health Systems

Au Burkina Faso, la promotion de la santé de la mère et de l'enfant a toujours fait partie du paquet d'activités développé par les services de santé. Cependant, l'efficacité de ces nombreuses interventions reste très faible surtout en termes d'impact sur la mortalité maternelle et néonatale. Problèmes: 1-ratio de mortalité maternelle élevé (307,3 pour 100 000 naissances vivantes en 2006); 2-retard pour décider de consulter les services de santé; 3-retard pour arriver à létablissement de santé; 4-retard pour recevoir un traitement adéquat au niveau de létablissement de santé. Options politiques: 1) La motivation du personnel pourrait permettre daméliorer la permanence des agents de santé à leur poste et doffrir des soins continus et de qualité aux parturie