Malaria and anemia prevention in pregnant women of rural Burkina Faso

Background  

Pregnant women are a major risk group for malaria in endemic areas. Only little information exists on the compliance of pregnant women with malaria and anaemia preventive drug regimens in the rural areas of sub-Saharan Africa (SSA). In this study, we collected information on malaria and anaemia prevention behaviour in pregnant women of rural Burkina Faso.     

HIV/AIDS and sexual-risk behaviors among adolescents: factors influencing the use of condoms in Burkina Faso

To facilitate the design of effective policies that can address adolescent's reproductive health problems, it is necessary to gain a thorough understanding of patterns of adolescents' sexual behavior, and the factors that affect them. Using a unique set of data collected in 2004 from a nationally-representative survey of adolescents, this study examines adolescents' risky and protective sexual behavior in Burkina Faso. Findings show that 11% of adolescent males had sexual intercourse in last twelve months with more than two partners but did not use condoms. Logistic regression analysis shows that the odds of using condoms increased with years of schooling and self-efficacy in use of condoms. Females who were very confident of getting a male partner to wear a condom were six times more likely to have used a condom at last sex than those who were not confident at all.     

Audit of cesarean delivery in Burkina Faso

Objective

To assess the level and determinants of unnecessary cesarean delivery.

Methods

In a retrospective study, the medical charts were reviewed for 300 low-risk women who underwent intrapartum cesarean delivery at 10 referral hospitals in Burkina Faso between May 2009 and April 2010. In this context, cesarean deliveries were delegated to clinical officers who have less training than doctors.

Results

Among the 300 study patients, 223 women (74.3%) were referred from primary healthcare facilities. The reason for referral was not medically justified for 35 women. Cesarean was performed by a gynecologist–obstetrician (46.0%), a trained doctor (35.0%), or a clinical officer (19.0%). Acute fetal distress and fetopelvic disproportion were the main indications recorded for intrapartum cesarean delivery. These diagnoses were not confirmed by an obstetrician–gynecologist in 12.0% of cases. Clinical officers were associated with a higher risk of unnecessary cesarean delivery compared with gynecologist–obstetricians by multivariate analysis (odds ratio, 4.46; 95% confidence interval, 1.44–13.77; P = 0.009).

Conclusion

Verification of cesarean indications by highly qualified personnel (i.e. second opinion), in-service training, and supervision of health workers in primary healthcare facilities might improve the performance of the referral system and help to reduce unnecessary cesarean deliveries in Burkina Faso.     

HIV treatment and reproductive health in the health system in Burkina Faso: resource allocation and the need for integration

Organizational changes, increased funding and the demands of HIV antiretroviral (ARV) treatment create particular challenges for governance in the health sector. We assess resource allocation, policy making and integration of the national responses to ARV provision and reproductive health in Burkina Faso, using national and district budgets related to disease burden, policy documents, organizational structures, and coordination and implementation processes. ARV provision represents the concept of a "crisis scenario", in which reforms are pushed due to a perception of urgent need, whereas the national reproductive health programme, which is older and more integrated, represents a "politics-as-usual scenario". Findings show that the early years of the national response to HIV and AIDS were characterized by new institutions with overlapping functions, and failure to integrate with and strengthen existing structures. National and district budget allocations for HIV compared to other interventions were disproportionately high when assessed against burden of disease. Strategic documents for ARV provision were relatively less developed and referred to, compared to those of the Ministry of Health Directorates for HIV and for Family Health and district health planning teams for reproductive health services. Imbalances and new structures potentially trigger important adverse effects which are difficult to remedy and likely to increase due to the dynamics they create. It therefore becomes crucial, from the outset, to integrate HIV/AIDS funding and responses into health systems.     

Quality cesarean delivery in Ouagadougou, Burkina Faso: A comprehensive approach

Objective

To assess the effects of a comprehensive intervention (staff training, equipment, internal clinical audits, cost sharing system, patients-providers meetings) in improving cesarean delivery access and quality in an urban district of Burkina Faso.

Methods

We conducted a before-after study in the health district sector 30 in Ouagadougou between 2003 and 2006. We measured cesarean delivery quality (accessibility, diagnosis, procedure, postoperative follow-up) and maternal and neonatal health in 1371 sections.

Results

The number of cesarean deliveries performed increased each year, from 42 in 2003 to 630 in 2006. This increase happened without increase in maternal and perinatal post-cesarean mortality (respectively 1.1% and 3.6% in 2006). The cesarean delivery rate for women of the district increased from 1.9% to 3.3% of expected births between 2003 and 2005.

Conclusion

To improve access to quality cesarean delivery, we have shown that it was necessary to have a systemic approach combining technical, operational, sociocultural, and political factors.     

Human papillomaviruses in Western Africa: prevalences and risk factors in Burkina Faso

Purpose

Cervical cancer is the most common cancer in women in low income countries. Certain oncogenic types of human papillomaviruses are causally associated with the cervical cancer. To ensure effective primary prevention through the introduction of a national vaccination program in Burkina Faso, information about the disease burden of HPV infection in the country is of great importance.

Methods

In the present work the prevalence of 54 different HPV types and 18 other sexually transmitted infection as well as the predominant risk factors for the development of cervical cancer were investigated in Ouagadougou. A cross-sectional study on two populations without (n=471) and with known cervical dysplasia (n=39) was carried out between October 2013 and March 2014. Retrospectively, data on possible and secured risk factors of the cervical carcinoma were collected. The participants were examined gynecologically and a vaginal lavage was taken, which was molecular genetically examined for 54 different human papillomavirus genotypes and 18 other STIs.

Results

The prevalence of human papillomavirus was 42.3% (188/444) in the first study population and 87.2% (34/39) in the second study population. The immunization coverage would be 24.5% of the HPV types and 33.9% of the high-risk HPV types with quadrivalent vaccine Gardasil®. The nonavalent vaccine Gardasil®9 (9vHPV) would cover 37.3% of all HPV types and 57.1% of high-risk HPV types.

Conclusion

The prevention of infection with human papillomaviruses by vaccination is expected to result in a drastic reduction in the morbidity and mortality of the cervical cancer in Burkina Faso.

     

Describing safe motherhood programs for priority setting: the case of Burkina Faso.

OBJECTIVE: This study was implemented to describe safe motherhood programs in Burkina Faso for planning and programming purposes. METHODS: Twenty safe motherhood programs were described from November 2003 through May 2004 using a structured questionnaire, interviews with safe motherhood program managers and document reviews. RESULTS: Only 2 of the 20 programs were designed to improve the availability of comprehensive emergency obstetric care, and only 2 comprehensively addressed all components of skilled attendance at delivery. Other gaps identified included poor availability of baseline data, few monitoring measures, and lack of planning for evaluation needs. National geographical coverage was also uneven. CONCLUSION: A systematic overview of safe motherhood programs in a country can help to set priorities and aid in decision making for the allocation of resources towards contextually relevant strategies to curtail maternal mortality and severe morbidity. Planning for program design and evaluation may also be aided by such a process.     

Criminalising HIV transmission: punishment without protection

Allegations of the reckless or intentional transmission of HIV raise challenging questions about how states can best address a disease which is transmitted primarily through behaviours that both states and community “police” in different ways. This paper argues that in the rare cases in which someone engages in specific behaviour with the intent to infect another person with HIV, existing laws such as laws against battery are sufficient to allow for the application of the criminal law. It discusses three key points: the potential consequences of new laws criminalising the transmission of HIV, why vague laws criminalising the knowing transmission of HIV fail to meet key requirements of criminal law and are an abuse of the state’s policing power, and thirdly, the growing inclusion of such laws within sexual offences legislation. Laws criminalising the transmission of HIV risk bringing within the scope of legal sanction people living with HIV who are acting in ways that do not merit punishment and may as a result of prosecution face adverse human rights consequences.     

Ten reasons to oppose the criminalization of HIV exposure or transmission

Recent years have seen a push to apply criminal law to HIV exposure and transmission, often driven by the wish to respond to concerns about the ongoing rapid spread of HIV in many countries. Particularly in Africa, some groups have begun to advocate for criminalization in response to the serious phenomenon of women being infected with HIV through sexual violence or by partners who do not reveal their HIV diagnoses to them. While these issues must be urgently addressed, a closer analysis of the complex issues raised by criminalization of HIV exposure or transmission reveals that criminalization is unlikely to prevent new infections or reduce women's vulnerability to HIV. In fact, it may harm women rather than assist them, and have a negative impact on public health and human rights. This paper is a slightly revised version of a document originally released in December 2008 by a coalition of HIV, women's and human rights organizations. It provides ten reasons why criminalizing HIV exposure or transmission is generally an unjust and ineffective public policy. The obvious exception involves cases where individuals purposely or maliciously transmit HIV with the intent to harm others. In these rare cases, existing criminal laws – rather than new, HIV-specific laws – can and should be used.     

Women's perceptions of homebirths in two rural medical districts in Burkina Faso: a qualitative study

Background  

In developing countries, most childbirth occurs at home and is not assisted by skilled attendants. The situation increases the risk of death for both mother and child and has severe maternal complications. The purpose of this study was to describe women's perceptions of homebirths in the medical districts of Ouargaye and Diapaga.     

Transfer of obstetric patients in a pregnant and postpartum condition to an intensive care unit: eighty-two cases in Burkina Faso

OBJECTIVE: To review all obstetric admissions to an intensive care unit (ICU) of an African hospital. PATIENTS AND METHODS: Retrospective analysis of the records of all obstetric patients admitted to the ICU of Souro Sanou Hospital in Burkina Faso, from January 1st, 1996, to June 30, 1998. RESULTS: Eighty-two patients out of 6119 deliveries were transferred to the ICU, which meant a 1.34% transfer rate. These transfers concerned young patients (mean age of 24 years), coming originally from outlying maternities in 52.4% and having already given birth in 64.63% of the cases. The two main diagnoses at the ICU were: eclampsia and septic shock. The large majority of the patients (73 out of 82) had at least one bad prognosis factor at admission at the ICU. A maternal mortality rate of 60% was noted, the main risk factors for mortality being acute respiratory condition and severe anemia. CONCLUSION: Mortality of obstetric patients admitted to ICUs is very high in our setting. Establishing an ICU within the obstetric unit or early detection of cases to be transferred (scoring system?) should improve the prognosis.     

Short stature and cephalopelvic disproportion in Burkina Faso, West Africa. Operations Research Team.

In order to reduce maternal mortality due to cephalopelvic disproportion (CPD), it is important to screen women for short stature, especially in rural areas of developing countries. We measured the height of 1733 women as they left the maternity services in Ouagadougou and recorded the type of delivery. Women less than 155 cm tall were 4.9 times more likely to have a cesarean section delivery. We propose simplified screening criteria for use by traditional birth attendants.     

Women's sexual health and contraceptive needs after a severe obstetric complication (near-miss): a cohort study in Burkina Faso

Background  

Little is known about the reproductive health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect reproductive events in the first year postpartum.