Search

Introduction: blood transfusion (BT) is an important part of pediatrics healthcare in sub-Saharan Africa because of anemia due to malaria, malnutrition and hereditary anomalies of red blood cells. However, BT services experienced chronic blood shortage, unsafe blood products and poor procedures of clinical use of blood. This results in inadequate management of severe anemia., Methods: to assess the quality of BT requirements in severe malarial anemia at the regional hospital center of Koudougou in Burkina Faso, we carried out a cross-sectional study including 402 children with severe malaria (WHO 2000 criteria)., Results: over the study period, severe malaria represented 45.6% (402/882) of pediatric admissions. Anemia was observed in 97.5% (392/402) of cases and BT was required for 78.4% (315/402). The median age was 16 months (IQR 9-27) and the average hemoglobin was 51.4±22.2 g/L. The prescriptions were in accordance with WHO and national guidelines respectively in 63.8% and 92.7%. Blood units were issued in 99.4% (350/352) of blood orderings. Out of 350 blood units delivered, blood was administered in 98% (343/350). The median actual time to transfusion was 65 minutes (IQR: 45-100) and median transfusion duration was 73.8 minutes (IQR: 47.5-110). The signs of intolerance to anemia disappeared in 134/138 cases (97.1%) and the average haemoglobin increased of 37.9±17.6 g/L. Death occurred in 23 cases (5.7%)., Conclusion: the management of severe malaria requires blood transfusion in almost half of cases. Blood was available to meet most requests. However, efforts are still required for proper use of the blood., Competing Interests: The authors declare no competing interests., (Copyright: Salam Sawadogo et al.)

Seasonal malaria chemoprevention (SMC) for children < 5 is a strategy that is gaining popularity in West African countries. Although its efficacy to reduce malaria incidence has been demonstrated in trials, the effects of SMC implemented in routine program conditions, outside of experimental contexts, are unknown. In 2014 and 2015, a survey was conducted in 1,311 households located in Kaya District (Burkina Faso) where SMC had been recently introduced. All children < 72 months were tested for malaria and anemia. A pre-post study with control group was designed to measure SMC impact during high transmission season. A difference-in-differences approach was coupled in the analysis with propensity score weighting to control for observable and time-invariant nonobservable confounding factors. SMC reduced the parasitemia point and period prevalence by 3.3 and 24% points, respectively; this translated into protective effects of 51% and 62%. SMC also reduced the likelihood of having moderate to severe anemia by 32%, and history of recent fever by 46%. Self-reported coverage for children at the first cycle was 83%. The SMC program was successfully added to a package of interventions already in place. To our knowledge, with prevalence < 10% during the peak of the transmission season, this is the first time that malaria can be reported as hypo-endemic in a sub-Sahelian setting in Burkina Faso. SMC has great potential, and along with other interventions, it could contribute to approaching the threshold where elimination strategies will be envisioned in Burkina Faso.

Background: Burkina Faso implemented the seasonal malaria chemoprevention (SMC) in 2014 in seven pilot health districts, following the new recommendation by the WHO in 2012 for the prevention of the disease in children under five years old, for areas of highly seasonal malaria transmission.The objective of this study was to assess the implementation fidelity of the seasonal malaria chemoprevention strategy in one of the districts, Kaya Health District., Methodology: We conducted a case study, with a quantitative and qualitative mixed methods. Data were collected after two campaigns of implementation of the intervention, in 2014 and 2015, through a review of specific documents of SMC intervention, and individual interview with key informants (n = 21) involved at various levels in the implementation of the strategy and a household survey with the parents (n = 284) of eligible children for the SMC strategy in 2015 in the Kaya health district. The analysis framework focused on the fidelity of the intervention's content, its coverage, and its schedule, as well as the potential moderating factors, using the model proposed by Hasson, originally from Carroll., Results: All components of the intervention were implemented. Villages and sectors were covered at 100%. In terms of intervention doses received, less than one-third of eligible children (32.3%) received the recommended four doses in 2015. Implementation of the strategy faced some difficulties due to insufficient training of community distributors, inadequate supply of inputs and insufficient financial resources for remuneration, advocacy and supervision, but also because of the contextual constraints due to the rainy season. Moreover, an interaction between the different moderating factors, influencing the degree of implementation of the strategy was noted., Conclusion: Taking into account the moderating factors of the implementation is necessary for achieving the highest possible degree of implementation fidelity and then, reach the expected beneficial effects.

Introduction: Burkina Faso started nationwide community case management of malaria (CCMm) in 2010. In 2011, health center user fees for children under five were abolished in some districts., Objective: To assess the effects of concurrent implementation of CCMm and user fees abolition on treatment-seeking practices for febrile children., Methods: This is a natural experiment conducted in the districts of Kaya (CCMm plus user fees abolition) and Zorgho (CCMm only). Registry data from 2005 to 2014 on visits for malaria were collected from all eight rural health centers in the study area. Annual household surveys were administered during malaria transmission season in 2011 and 2012 in 1,035 randomly selected rural households. Interrupted time series models were fitted for registry data and Fine and Gray's competing risks models for survey data., Results: User fees abolition in Kaya significantly increased health center use by eligible children with malaria (incidence rate ratio for intercept change = 2.1, p <0.001). In 2011, in Kaya, likelihood of health center use for febrile children was three times higher and CHW use three times lower when caregivers knew services were free. Among the 421 children with fever in 2012, the delay before visiting a health center was significantly shorter in Kaya than in Zorgho (1.46 versus 1.79 days, p <0.05). Likelihood of visiting a health center on the first day of fever among households <2.5 km or <5 km from a health center was two and three times higher in Kaya than in Zorgho, respectively (p <0.001)., Conclusions: User fees abolition reduced visit delay for febrile children living close to health centers. It also increased demand for and use of health center for children with malaria. Concurrently, demand for CHWs' services diminished. User fees abolition and CCMm should be coordinated to maximize prompt access to treatment in rural areas.