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Seasonal malaria chemoprevention (SMC) by mass administration of sulfadoxine pyrimethamine + amodiaquine (SPAQ) reduces the burden of malaria in children aged 3–59 months. The occurrence of adverse drug reaction (ADR) may affect the success of this intervention. There are few studies of SMC adverse event surveillance in sub-Saharan Africa, particularly in Burkina Faso, a highly endemic country. Our main objective was to characterize the ADRs reported during SMC campaigns in Burkina Faso. Secondly, we evaluated the performance of the pharmacovigilance integrated into the SMC program in order to support safe administration of SMC., SCOPUS: ar.j, info:eu-repo/semantics/published

The rapid deployment of COVID-19 vaccines to a large proportion of the population requires a focus on safety. However, few studies have assessed the safety of COVID-19 vaccines in Africa. In Burkina Faso, this issue has not yet been addressed. The objective of this study was to contribute to the description of the characteristics of adverse events following immunization (AEFIs) related to COVID-19 vaccines in Burkina Faso. This was a cross-sectional descriptive retrospective study of spontaneous reports of COVID-19 vaccine-related AEFIs recorded in VigiBase® between June 2021 and November 2022 in Burkina Faso. Individual case safety reports (ICSRs) were extracted from VigiBase® using the Anatomical Therapeutic Chemical level 2 (ATC2) code. The proportion of ICSRs according to the reporter’s qualification, the reporting rate, the time taken to submit and record ICSRs, and the completeness score were calculated. A total of 973 ICSRs concerned COVID-19 vaccines and represented 32.6% of all 2,988 reports in VigiBase®. Overall, 82.0% of the reporters were nurses/midwives, 7.8% were physicians, 6.7% were pharmacists, and 3.4% were patients. The median time between the onset of AEFIs and the submission of the report to the Pharmacovigilance Center was 180 days (IQR: 136; 281). The median registration time was 188 days (IQR: 149; 286). The mean ICSR completeness score was 0.8 (standard deviation = 0.1). The overall AEFI reporting rate was 27.8 per 100,000 vaccine doses. The AEFI reporting rates for the ChAdOx1-nCoV-19, JNJ 78436735, Elasomeran, Tozinameran, and HB02 vaccines were 454.2, 17.4, 11.0, 10.2, and 0.4 per 100,000 vaccine doses, respectively. The majority of AEFIs were systemic in nature (90.1%). Headache (21.2%), fever (19.4%), and myalgia (11.0%) were the most frequently reported AEFIs. Eighteen cases (1.8%) of serious AEFIs (9 hospitalizations, 4 life threatening, 3 temporary disabilities, and 2 others unspecified) were reported. The majority of AEFIs reported, SCOPUS: ar.j, info:eu-repo/semantics/published

Taro (Colocasia esculenta (L.) Schott) is a food crop mainly produced for its nutrient-rich corms. This study aims to characterize the nutritional and antioxidant potential of fifty-nine genotypes of taro to identify the most interesting chemotypes. The traits evaluated were: starch, proteins, soluble sugars, total phenolics, flavonoids, and antioxidant capacity, assessed by Ferric reducing antioxidant power (FRAP) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) methods. Results indicate that taro corms are a good source of nutritional and bioactive compounds. Also, significant variations were recorded between genotypes for the different parameters evaluated. Total phenolics content varied from 4.37± 0.02 to 115.21 ± 8.24 mg GAE/100 g dw, flavonoids from 0.25 ± 0 to 1.47 ± 0.07 mg quercetin equivalent (QE)/100 g dw, starch content from 0.31 ± 0.17 to 17.56 ± 0.27 mg/100 mg dw, proteins from 0.03 ± 0.03 to 0.80 ± 0.02 mg/100 mg dw and soluble sugars from 0.02 ± 0 to 8.10 ± 0.38 mg/100 mg dw. Antioxidant activities ranged from 39.20 ± 1.74 to 98.67 ± 1.62% for the ability to reduce DPPH and from 0.06 ± 0.03 to 12.16 ± 0.72 mg AAE/100 g dw for the ability to reduce iron (FRAP). These variations have allowed us to distinguish four chemotypes.

Background: In 2015, peptic ulcer disease (PUD) was cause of 52.3% and 17% of digestive bleeding and death in respectively among in-hospital patients at the gastro-enterology units of the main hospital in Ouagadougou. We aimed to assess the knowledge, attitudes and practices of the health care workers in the management of PUD.Subjects dan Method: It was a descriptive cross-sectional study with a prospective data collection implemented at the Paul VI and the Bogodogo District Hospitals in Ouagadougou (Burkina Faso) from December 15, 2015 to January 25, 2016. A questionnaire was administered to 134 health care workers including medical doctors, nurses and midwives.Results: The mean age was 33 years (Mean= 33.6; SD= 5.84). Females represented 61.9%. Know­ledge levels were good to excellent for general knowledge, symptoms and treatment of PUD. Depending on the agent's qualification, knowledge levels were excellent in all areas for two-thirds to three-quarters of the general practitioners, except for knowledge of additional investigation analyses, where only 47.8% had an excellent knowledge. Depending on the level of education, the level of knowledge was at least good for more than 50% of the agents except for the knowledge of additional investigation analyses where only 45.2 % of the agents of secondary school level had a good knowledge. The main attitudes consisted in managing the patients in emergency and out of an emergency context in 45.8% and 42.2% of the cases, respectively. Regarding the practices, 51.5% of the HCWs systematically requested investigation analyses before starting an aetiological therapy.Conclusion: The PUD knowledge ranks from good to excellent. However, the frequent pre­scription of symptomatic treatments could be the cause of many complications. The promotion of continuous medical education is a good mitigation plan to resolve the issues of knowledge and competence regarding the PUD.Keywords: attitude, knowledge, peptic ulcer disease, practiceCo

Background: In 2015, peptic ulcer disease (PUD) was cause of 52.3% and 17% of digestive bleeding and death in respectively among in-hospital patients at the gastro-enterology units of the main hospital in Ouagadougou. We aimed to assess the knowledge, attitudes and practices of the health care workers in the management of PUD.Subjects dan Method: It was a descriptive cross-sectional study with a prospective data collection implemented at the Paul VI and the Bogodogo District Hospitals in Ouagadougou (Burkina Faso) from December 15, 2015 to January 25, 2016. A questionnaire was administered to 134 health care workers including medical doctors, nurses and midwives.Results: The mean age was 33 years (Mean= 33.6; SD= 5.84). Females represented 61.9%. Know­ledge levels were good to excellent for general knowledge, symptoms and treatment of PUD. Depending on the agent's qualification, knowledge levels were excellent in all areas for two-thirds to three-quarters of the general practitioners, except for knowledge of additional investigation analyses, where only 47.8% had an excellent knowledge. Depending on the level of education, the level of knowledge was at least good for more than 50% of the agents except for the knowledge of additional investigation analyses where only 45.2 % of the agents of secondary school level had a good knowledge. The main attitudes consisted in managing the patients in emergency and out of an emergency context in 45.8% and 42.2% of the cases, respectively. Regarding the practices, 51.5% of the HCWs systematically requested investigation analyses before starting an aetiological therapy.Conclusion: The PUD knowledge ranks from good to excellent. However, the frequent pre­scription of symptomatic treatments could be the cause of many complications. The promotion of continuous medical education is a good mitigation plan to resolve the issues of knowledge and competence regarding the PUD.Keywords: attitude, knowledge, peptic ulcer disease, practiceCo

Background: In 2015, peptic ulcer disease (PUD) was cause of 52.3% and 17% of digestive bleeding and death in respectively among in-hospital patients at the gastro-enterology units of the main hospital in Ouagadougou. We aimed to assess the knowledge, attitudes and practices of the health care workers in the management of PUD.Subjects dan Method: It was a descriptive cross-sectional study with a prospective data collection implemented at the Paul VI and the Bogodogo District Hospitals in Ouagadougou (Burkina Faso) from December 15, 2015 to January 25, 2016. A questionnaire was administered to 134 health care workers including medical doctors, nurses and midwives.Results: The mean age was 33 years (Mean= 33.6; SD= 5.84). Females represented 61.9%. Know­ledge levels were good to excellent for general knowledge, symptoms and treatment of PUD. Depending on the agent's qualification, knowledge levels were excellent in all areas for two-thirds to three-quarters of the general practitioners, except for knowledge of additional investigation analyses, where only 47.8% had an excellent knowledge. Depending on the level of education, the level of knowledge was at least good for more than 50% of the agents except for the knowledge of additional investigation analyses where only 45.2 % of the agents of secondary school level had a good knowledge. The main attitudes consisted in managing the patients in emergency and out of an emergency context in 45.8% and 42.2% of the cases, respectively. Regarding the practices, 51.5% of the HCWs systematically requested investigation analyses before starting an aetiological therapy.Conclusion: The PUD knowledge ranks from good to excellent. However, the frequent pre­scription of symptomatic treatments could be the cause of many complications. The promotion of continuous medical education is a good mitigation plan to resolve the issues of knowledge and competence regarding the PUD.Keywords: attitude, knowledge, peptic ulcer disease, practiceCo

Introduction: Stroke is a major public health concern. It is a frequent pathology, 80% of which is of ischemic origin. Approximately 86% of all stroke deaths worldwide occur in low-and middle-income countries. The objective of this study was to investigate prognostic factors for in hospital lethality of stroke cases admitted in a public university hospital in Burkina Faso. Methods: This was a retrospective cohort study with a descriptive and analytical aim on adults admitted for a stroke confirmed by a brain scan at the Sourô Sanou University Teaching Hospital (CHUSS) of Bobo-Dioulasso over the period from January 1, 2009, to December 31, 2013. Results: The proportion of cases confirmed by the brain CT scan was 32% of all patients admitted for stroke in the CHUSS. The overall case fatality was 27.6%. This lethality was more pronounced in patients with hemorrhagic stroke (35.8%) compared to patients with ischemic stroke (22.4%). Median survival was higher in patients with ischemic stroke than those with hemorrhagic one (36 and 25 days, respectively) with a statistically significant difference (p value = 0.001). In multivariate analysis and hemorrhagic stroke (hazard ratio [HR]: 2.25; CI 95%: 1.41-3.61), an altered state of consciousness (HR: 1.90; CI 95%: 1.20-2.99) and the presence of central facial paralysis (HR: 1.67; CI 95%: 1.04-2.67) are factors that increased significantly the lethality. Conclusion: The study has identified three prognostic factors of lethality that are the hemorrhagic stroke type, the altered state of consciousness, and the central facial paralysis. Given the high case fatality, it is important to develop and implement effective prevention and management strategies adapted to the resources for the optimal control of stroke in Africa., SCOPUS: ar.j, info:eu-repo/semantics/published

PR, IFPRI3; ISI; Stories of Change in Nutrition; Transform Nutrition West Africa; DCA; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Looking back at what has effectively improved nutrition may inform policy makers on how to accelerate progress to end all forms of malnutrition by 2030. As under-five stunting declined substantially in Burkina Faso, we analyzed its nutrition story at the micro-level. We conducted a regression-decomposition analysis to identify demographic and health drivers associated with change in height-for-age using longitudinal, secondary, nationally-representative data. We triangulated results with findings from semi-structured community interviews (n = 91) in two “model communities” with a history of large stunting reduction. We found that improvement in immunization coverage, assets accumulation and reduction in open defecation were associated with 23%, 10% and 6.1% of the improvement in height-for-age, respectively. Associations were also found with other education, family planning, health and WASH indicators. Model communities acknowledged progress in the coverage and quality of nutrition-specific and nutrition-sensitive sectoral programs co-located at the community level, especially those delivered through the health and food security sectors, though delivery challenges remained in a context of systemic poverty and persistent food insecurity. Burkina Faso’s health sector’s success in improving coverage of nutrition and healthcare programs may have contributed to improvements in child nutrition alongside other programmatic improvements in the food security, WASH and education sectors. Burkina Faso should continue to operationalize sectoral nutrition-sensitive policies into higher-quality programs at scale, building on its success stories such as vaccination. Community leverage gaps and data gaps need to be filled urgently to pressure for and monitor high coverage, quality delivery, and nutrition impact of agriculture, education, and WASH interventions.

Burkina Faso has high prevalence of anemia in pregnancy (hemoglobin < 11 g/dL), despite the implementation of the WHO recommended guidelines. This study aimed to test the effects of personalized support for pregnant women at home on the trend of anemia prevalence in pregnancy. A cluster randomized trial was conducted from January 2015 to August 2016 at Sindou health district in Burkina Faso. Data were collected from 617 women in their first or second trimester of pregnancy, including 440 and 177 women in the intervention and control groups, respectively. The intervention consisted of a monthly home-based visit to the pregnant woman, focusing on nutritional counseling and pregnancy management, alongside an improvement antenatal visit quality. Compared with the prevalence of anemia in pregnancy in the control group [64.0% (95% confidence interval [CI]: 52.1-74.4%)], that of the intervention group was significantly lower from the fifth home visit onward [36.8% (95% CI: 32.1-41.8%)] (P < 0.001). The adjusted difference-in-differences in anemia prevalence between the two groups was -19.8% (95% CI: -30.2% to -9.4%) for women who received more than four home visits (P < 0.001). The corresponding difference in hemoglobin levels was 0.644 g/dL (95% CI: 0.309-0.167; P < 0.001). Personalized support for pregnant women at home, combined with appropriate antenatal care, can significantly reduce anemia prevalence during pregnancy in rural Burkina Faso., SCOPUS: ar.j, info:eu-repo/semantics/published

Balanites aegyptiaca (L.) Del (Balanitaceae) is traditionally used for the treatment of various ailments such as syphilis, jaundice and liver disorders, epilepsy, ... This study was designed to evaluate acute toxicity and hepatoprotective effect of aqueous extract of Balanites aegyptiaca on CCl4 induced hepatotoxicity in rats.Methods: Acute toxicity was assessed with the extract at a dose of 2000 mg / kg bw. The extract at doses of 25, 50 and 100 mg / kg b.w. was orally administered respectively to CC14-induced hepatotoxicity (0.5 ml / kg) animals. Silymarin (100 mg / kg) was given as a reference. Biochemical parameters such as ALT, AST, PT, ALB and ALP were assayed as well as enzymatic antioxidant activities SOD, CAT and MDA. Nitrogen monoxide (NO) involved in inflammation was also measured.Results: Activities of liver marker enzymes, ALT, AST and ALP, total protein, albumin and showed a significant hepatoprotective effect. Regarding antioxidant enzymatic activities in vivo (SOD, CAT and MDA) of aqueous extract exhibited a significant effect showing increasing levels of SOD, CAT and reducing malondialdehyde (MDA) levels. The production of NO is significantly reduced compared to the batch intoxicated by CCl4.Conclusion: Balanites aegyptiaca is endowed with hepatoprotective properties that can be attributed to antioxidant potential which could justify its use in traditional medicine in liver disorders.

Balanites aegyptiaca (L.) Del (Balanitaceae) is traditionally used for the treatment of various ailments such as syphilis, jaundice and liver disorders, epilepsy, ... This study was designed to evaluate acute toxicity and hepatoprotective effect of aqueous extract of Balanites aegyptiaca on CCl4 induced hepatotoxicity in rats.Methods: Acute toxicity was assessed with the extract at a dose of 2000 mg / kg bw. The extract at doses of 25, 50 and 100 mg / kg b.w. was orally administered respectively to CC14-induced hepatotoxicity (0.5 ml / kg) animals. Silymarin (100 mg / kg) was given as a reference. Biochemical parameters such as ALT, AST, PT, ALB and ALP were assayed as well as enzymatic antioxidant activities SOD, CAT and MDA. Nitrogen monoxide (NO) involved in inflammation was also measured.Results: Activities of liver marker enzymes, ALT, AST and ALP, total protein, albumin and showed a significant hepatoprotective effect. Regarding antioxidant enzymatic activities in vivo (SOD, CAT and MDA) of aqueous extract exhibited a significant effect showing increasing levels of SOD, CAT and reducing malondialdehyde (MDA) levels. The production of NO is significantly reduced compared to the batch intoxicated by CCl4.Conclusion: Balanites aegyptiaca is endowed with hepatoprotective properties that can be attributed to antioxidant potential which could justify its use in traditional medicine in liver disorders.

Background: Strokes are the second leading cause of death and the third leading cause of disability-adjusted life-years lost in the world. Most of incident and prevalent cases of strokes occur in low-income and middle-income countries. The purpose of this study was to describe the overall trend of stroke prevalence and mortality among adults in Burkina Faso. Methods: This was an exhaustive document review of strokes using the Ministry of Health’s statistical yearbooks over an 11 years period. Patients aged 15 years or over were taken into consideration. The process of compiling statistical yearbooks takes place from the periphery to central level. The assessment of temporal trends was performed using linear equations. Results: From 2002 to 2012, the number of adult stroke consultations increased from 15,976 to 134,049. We noticed a clear increase in the number of hospitalized patients of both genders, from 523 in 2002 to 9,047 in 2012. Furthermore, we observed a regression of in-hospital mortality rates from 2004 onwards. Conclusions: In our study, we noted a substantial increase in the number of stroke cases requiring consultation and hospitalisation. In contrast, the mortality rate was decreasing., SCOPUS: ar.j, info:eu-repo/semantics/published

BackgroundPatients facing tuberculosis (TB) and human immunodeficiency virus (HIV) infection receive particular care. Despite efforts in the care, misconceptions about TB and HIV still heavily impact patients, their families and communities. This situation severely limits achievement of TB and HIV programs goals. This study reports current situation of TB patients and patients living with HIV/AIDS (PLWHA) facing their disease and its implications, by comparing results from both qualitative and quantitative study design.MethodsCross sectional study using mixed methods was used and excluded patients co-infected by TB and HIV. Focus group included 96 patients (6 patients per group) stratified by setting, disease profile and gender; from rural (Orodara Health District) and urban (Bobo Dioulasso) areas, all from Hauts-Bassins region in Burkina Faso. Quantitative study included 862 patients (309 TB patients and 553 PLWHA) attending TB and HIV care facilities in two main regions (Hauts-Bassins and Centre) of Burkina Faso.ResultsA content analysis of reports found TB patients and PLWHA felt discriminated and stigmatized because of misconceptions with its aftermaths (rejection, emotional and financial problems), mainly among PLWHA and women patients. PLWHA go to healers when facing limited solutions in health system. There are fewer associations for TB patients, and less education and sensitization sessions to give them opportunity for sharing disease status and learning from other TB patients. TB patients and PLWHA still need to better understand their disease and its implication. Access to care (diagnosis and treatment) remains one of the key issues in health system, especially for PLWHA. Individual counseling is centered among PLWHA but not for TB patients. With research progress and experiences sharing, TB patients and PLWHA have some hope to implement their life project, and to receive psychosocial and nutritional support.ConclusionDespite international aid, TB patients

BackgroundPatients facing tuberculosis (TB) and human immunodeficiency virus (HIV) infection receive particular care. Despite efforts in the care, misconceptions about TB and HIV still heavily impact patients, their families and communities. This situation severely limits achievement of TB and HIV programs goals. This study reports current situation of TB patients and patients living with HIV/AIDS (PLWHA) facing their disease and its implications, by comparing results from both qualitative and quantitative study design.MethodsCross sectional study using mixed methods was used and excluded patients co-infected by TB and HIV. Focus group included 96 patients (6 patients per group) stratified by setting, disease profile and gender; from rural (Orodara Health District) and urban (Bobo Dioulasso) areas, all from Hauts-Bassins region in Burkina Faso. Quantitative study included 862 patients (309 TB patients and 553 PLWHA) attending TB and HIV care facilities in two main regions (Hauts-Bassins and Centre) of Burkina Faso.ResultsA content analysis of reports found TB patients and PLWHA felt discriminated and stigmatized because of misconceptions with its aftermaths (rejection, emotional and financial problems), mainly among PLWHA and women patients. PLWHA go to healers when facing limited solutions in health system. There are fewer associations for TB patients, and less education and sensitization sessions to give them opportunity for sharing disease status and learning from other TB patients. TB patients and PLWHA still need to better understand their disease and its implication. Access to care (diagnosis and treatment) remains one of the key issues in health system, especially for PLWHA. Individual counseling is centered among PLWHA but not for TB patients. With research progress and experiences sharing, TB patients and PLWHA have some hope to implement their life project, and to receive psychosocial and nutritional support.ConclusionDespite international aid, TB pat

This work investigated the possibility of using the biodegradable gentamicin-monoolein-water gels as models, in order to obtain a similar sustained release of ciprofloxacin hydrochloride. Four gels containing antibiotics were prepared and were examined with regard to their physicochemical properties and in vitro drug release characteristics. Ciprofloxacin, unlike gentamicin, which was dissolved in the matrix, was in dispersed form. However, despite its insolubility, microscopic observation, differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), and X-ray diffraction showed that the developed gel was in the cubic liquid crystalline structure and have maintained their ability to progressively release ciprofloxacin. ciprofloxacin-monoolein-water (5:80:15% w/w), which released in vitro approximately 85% of ciprofloxacin after 16 days could possibly be considered as an alternative to a gentamicin-monoolein-water gel for the treatment of chronic osteomyelitis., SCOPUS: ar.j, info:eu-repo/semantics/published

This work investigated the possibility of using the biodegradable gentamicin-monoolein-water gels as models, in order to obtain a similar sustained release of ciprofloxacin hydrochloride. Four gels containing antibiotics were prepared and were examined with regard to their physicochemical properties and in vitro drug release characteristics. Ciprofloxacin, unlike gentamicin, which was dissolved in the matrix, was in dispersed form. However, despite its insolubility, microscopic observation, differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), and X-ray diffraction showed that the developed gel was in the cubic liquid crystalline structure and have maintained their ability to progressively release ciprofloxacin. ciprofloxacin-monoolein-water (5:80:15% w/w), which released in vitro approximately 85% of ciprofloxacin after 16 days could possibly be considered as an alternative to a gentamicin-monoolein-water gel for the treatment of chronic osteomyelitis., SCOPUS: ar.j, info:eu-repo/semantics/published

Phytochemical screening and biological activities of methanol extracts from three Acanthaceae species namely Hygrophila auriculata (H. auriculata), Nelsonia canescens (N. canescens) and Peristrophe bicalyculata (P. bicalyculata), widely used in local ethnomedicine, were carried out. Phenolic content quantification indicated that H. auriculata extract possessed the highest polyphenolics content followed by N. canescens and P. bicalyculata. Biological activities assessment showed that H. auriculata extract has the best antioxidant (through DPPH, FRAP and ABTS methods) capacity. Acetylcholinesterase and Lipoxygenase inhibition tests revealed interesting activities from P. bicalyculata. Testing cancer cells antiproliferation, it was showed that H. auriculata and N. canescens) were of good interest (27.00±1.55 and 29.70±3.11 µg/mL).These results showed that the phenolic compounds of these plants could justify their local traditional use to treat inflammatory and tumoral diseases.

Phytochemical screening and biological activities of methanol extracts from three Acanthaceae species namely Hygrophila auriculata (H auriculata), Nelsonia canescens (N canescenŝ) and Peristrophe bicalyculata (P. bicalyculata), widely used in local ethnomedicine, were carried out. Phenolic content quantification indicated that H auriculata extract possessed the highest polyphenolics content followed by N canescens and P. bicalyculata. Biological activities assessment showed that H. auriculata extract has the best antioxidant (through DPPH, FRAP and ABTS methods) capacity. Acetylcholinesterase and Lipoxygenase inhibition tests revealed interesting activities from P bicalyculata. Testing cancer cells antiproliferation, it was showed that H auriculata and N canescens) wereof good interest (27.00±1.55 and 29.70±3.11 μg/mL). These results showed that the phenolic compounds of these plants could justify their local traditional use to treat inflammatory and tumoral diseases., SCOPUS: ar.j, info:eu-repo/semantics/published

The candidate malaria vaccine RTS,S/AS01 reduced episodes of both clinical and severe malaria in children 5 to 17 months of age by approximately 50% in an ongoing phase 3 trial. We studied infants 6 to 12 weeks of age recruited for the same trial.

The candidate malaria vaccine RTS,S/AS01 reduced episodes of both clinical and severe malaria in children 5 to 17 months of age by approximately 50% in an ongoing phase 3 trial. We studied infants 6 to 12 weeks of age recruited for the same trial.

Evaluation findings from a particular setting need to be generalized into policy implications if they are to find widespread use. Skilled attendance at delivery is widely regarded as one of the most important intervention strategies for safe motherhood in low-resource settings, particularly in Africa, but implementations of such strategies are often not rigorously evaluated or interpreted into future policy. Initiative for Maternal Mortality Programme Assessment (Immpact) has applied a package of research-based monitoring and evaluation tools to assess the Family Care International Skilled Care Initiative in Ouargaye District, Burkina Faso. This evaluation research aimed to generate reliable, evidence-based policies for accelerating safe motherhood programmes in Burkina Faso and elsewhere in Africa. Five policy priorities were identified as representing real chances of improving the safety of motherhood: (1) enhancing national coverage of delivery by professionally skilled attendants; (2) to provide a network of 24-h basic emergency obstetric care within 5 km; (3) to have an effective referral system, equipped and resourced to undertake a reasonable number of Caesarean sections; (4) to promote community mobilization activities as a lever to increasing delivery care utilization; and (5) to implement strategies to remove financial barriers to delivery care. To meet Millennium Development Goal five by 2015, both supply and demand side constraints on the provision of quality maternity care have to be addressed, which in turn need greater political commitment and funding.

Introduction: This paper aims to describe the design, methods and approaches used to assess the effectiveness and cost-effectiveness of the Skilled Care Initiative in reducing pregnancy-related and perinatal mortality in Ouargaye district, Burkina Faso. Methods: The evaluation used a quasi-experimental design, mixed methods and a composite of tools to compare mortality and severe morbidity (near-miss) of women in reproductive age, perinatal mortality, facility functionality, perceived quality of care, utilisation of maternal health services, and costs borne by families and the health care system for maternal health care in Ouargaye and Diapaga districts. Structured questionnaires and interview guides were developed, pre-tested and piloted prior to the main survey. The evaluation was carried out from January to July 2006. A household census was used to retrospectively assess pregnancy-related and perinatal mortality over the previous 5 years, and causes of pregnancy-related death were identified using a newly developed and tested probabilistic model for interpreting verbal autopsy data. Data were directly entered into Personal Digital Assistant devices at the point of interview. Analyses included univariate and multivariate regressions and incremental cost-effectiveness ratios. Results: A population census covering over half a million people, three qualitative surveys and facility surveys in 47 health centres have been carried out. Conclusions: A partnership with key stakeholders and the use of mixed methods proved feasible for evaluating complex safe motherhood strategies, and the use of hand-held computers proved possible for direct data capture, even in this remote rural environment.

Background: Substantial reductions in maternal mortality are called for in Millennium Development Goal 5 (MDG-5), thus assuming that maternal mortality is measurable. A key difficulty is attributing causes of death for the many women who die unaided in developing countries. Verbal autopsy (VA) can elicit circumstances of death, but data need to be interpreted reliably and consistently to serve as global indicators. Recent developments in probabilistic modelling of VA interpretation are adapted and assessed here for the specific circumstances of pregnancy-related death. Methods: A preliminary version of the InterVA-M probabilistic VA interpretation model was developed and refined with adult female VA data from several sources, and then assessed against 258 additional VA interviews from Burkina Faso. Likely causes of death produced by the model were compared with causes previously determined by local physicians. Distinction was made between free-text and closed-question data in the VA interviews, to assess the added value of free-text material on the model's output. Results: Following rationalisation between the model and physician interpretations, cause-specific mortality fractions were broadly similar. Case-by-case agreement between the model and any of the reviewing physicians reached approximately 60%, rising to approximately 80% when cases with a discrepancy were reviewed by an additional physician. Cardiovascular disease and malaria showed the largest differences between the methods, and the attribution of infections related to pregnancy also varied. The model estimated 30% of deaths to be pregnancy-related, of which half were due to direct causes. Data derived from free-text made no appreciable difference. Conclusion: InterVA-M represents a potentially valuable new tool for measuring maternal mortality in an efficient, consistent and standardised way. Further development, refinement and validation are planned. It could become a routine tool in research and serv

Background: Substantial reductions in maternal mortality are called for in Millennium Development Goal 5 (MDG-5), thus assuming that maternal mortality is measurable. A key difficulty is attributing causes of death for the many women who die unaided in developing countries. Verbal autopsy (VA) can elicit circumstances of death, but data need to be interpreted reliably and consistently to serve as global indicators. Recent developments in probabilistic modelling of VA interpretation are adapted and assessed here for the specific circumstances of pregnancy-related death. Methods: A preliminary version of the InterVA-M probabilistic VA interpretation model was developed and refined with adult female VA data from several sources, and then assessed against 258 additional VA interviews from Burkina Faso. Likely causes of death produced by the model were compared with causes previously determined by local physicians. Distinction was made between free-text and closed-question data in the VA interviews, to assess the added value of free-text material on the model's output. Results: Following rationalisation between the model and physician interpretations, cause-specific mortality fractions were broadly similar. Case-by-case agreement between the model and any of the reviewing physicians reached approximately 60%, rising to approximately 80% when cases with a discrepancy were reviewed by an additional physician. Cardiovascular disease and malaria showed the largest differences between the methods, and the attribution of infections related to pregnancy also varied. The model estimated 30% of deaths to be pregnancy-related, of which half were due to direct causes. Data derived from free-text made no appreciable difference. Conclusion: InterVA-M represents a potentially valuable new tool for measuring maternal mortality in an efficient, consistent and standardised way. Further development, refinement and validation are planned. It could become a routine tool in research and serv

Background: Substantial reductions in maternal mortality are called for in Millennium Development Goal 5 (MDG-5), thus assuming that maternal mortality is measurable. A key difficulty is attributing causes of death for the many women who die unaided in developing countries. Verbal autopsy (VA) can elicit circumstances of death, but data need to be interpreted reliably and consistently to serve as global indicators. Recent developments in probabilistic modelling of VA interpretation are adapted and assessed here for the specific circumstances of pregnancy-related death. Methods: A preliminary version of the InterVA-M probabilistic VA interpretation model was developed and refined with adult female VA data from several sources, and then assessed against 258 additional VA interviews from Burkina Faso. Likely causes of death produced by the model were compared with causes previously determined by local physicians. Distinction was made between free-text and closed-question data in the VA interviews, to assess the added value of free-text material on the model's output. Results: Following rationalisation between the model and physician interpretations, cause-specific mortality fractions were broadly similar. Case-by-case agreement between the model and any of the reviewing physicians reached approximately 60%, rising to approximately 80% when cases with a discrepancy were reviewed by an additional physician. Cardiovascular disease and malaria showed the largest differences between the methods, and the attribution of infections related to pregnancy also varied. The model estimated 30% of deaths to be pregnancy-related, of which half were due to direct causes. Data derived from free-text made no appreciable difference. Conclusion: InterVA-M represents a potentially valuable new tool for measuring maternal mortality in an efficient, consistent and standardised way. Further development, refinement and validation are planned. It could become a routine tool in research and serv

Background: Substantial reductions in maternal mortality are called for in Millennium Development Goal 5 (MDG-5), thus assuming that maternal mortality is measurable. A key difficulty is attributing causes of death for the many women who die unaided in developing countries. Verbal autopsy (VA) can elicit circumstances of death, but data need to be interpreted reliably and consistently to serve as global indicators. Recent developments in probabilistic modelling of VA interpretation are adapted and assessed here for the specific circumstances of pregnancy-related death. Methods: A preliminary version of the InterVA-M probabilistic VA interpretation model was developed and refined with adult female VA data from several sources, and then assessed against 258 additional VA interviews from Burkina Faso. Likely causes of death produced by the model were compared with causes previously determined by local physicians. Distinction was made between free-text and closed-question data in the VA interviews, to assess the added value of free-text material on the model's output. Results: Following rationalisation between the model and physician interpretations, cause-specific mortality fractions were broadly similar. Case-by-case agreement between the model and any of the reviewing physicians reached approximately 60%, rising to approximately 80% when cases with a discrepancy were reviewed by an additional physician. Cardiovascular disease and malaria showed the largest differences between the methods, and the attribution of infections related to pregnancy also varied. The model estimated 30% of deaths to be pregnancy-related, of which half were due to direct causes. Data derived from free-text made no appreciable difference. Conclusion: InterVA-M represents a potentially valuable new tool for measuring maternal mortality in an efficient, consistent and standardised way. Further development, refinement and validation are planned. It could become a routine tool in research and serv

Background: Substantial reductions in maternal mortality are called for in Millennium Development Goal 5 (MDG-5), thus assuming that maternal mortality is measurable. A key difficulty is attributing causes of death for the many women who die unaided in developing countries. Verbal autopsy (VA) can elicit circumstances of death, but data need to be interpreted reliably and consistently to serve as global indicators. Recent developments in probabilistic modelling of VA interpretation are adapted and assessed here for the specific circumstances of pregnancy-related death. Methods: A preliminary version of the InterVA-M probabilistic VA interpretation model was developed and refined with adult female VA data from several sources, and then assessed against 258 additional VA interviews from Burkina Faso. Likely causes of death produced by the model were compared with causes previously determined by local physicians. Distinction was made between free-text and closed-question data in the VA interviews, to assess the added value of free-text material on the model's output. Results: Following rationalisation between the model and physician interpretations, cause-specific mortality fractions were broadly similar. Case-by-case agreement between the model and any of the reviewing physicians reached approximately 60%, rising to approximately 80% when cases with a discrepancy were reviewed by an additional physician. Cardiovascular disease and malaria showed the largest differences between the methods, and the attribution of infections related to pregnancy also varied. The model estimated 30% of deaths to be pregnancy-related, of which half were due to direct causes. Data derived from free-text made no appreciable difference. Conclusion: InterVA-M represents a potentially valuable new tool for measuring maternal mortality in an efficient, consistent and standardised way. Further development, refinement and validation are planned. It could become a routine tool in research and serv