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Introduction : Le paludisme et la dengue sont des maladies vectorielles endémoépidémiques au Burkina Faso. L’objectif de l’étude était d’évaluer l’influence du climat sur le paludisme et la dengue dans les villes de Ouagadougou et de BoboDioulasso. Méthodologie : Il s’agissait d’une analyse exploratoire de séries temporelles utilisant des données du SNIS et de la Direction Générale de la Météorologie. Des modèles ARIMA ont été utilisés pour décrire la tendance de la dengue et du paludisme de 2013 à 2016. Résultats : A Ouagadougou, la dengue a suivi une tendance intra-annuelle bimodale en août et en novembre 2016. En analyse univariée par ARIMA, aucune association significative à 5% n’a été retrouvée entre climat et dengue. La tendance intraannuelle du paludisme était bimodale en août et en octobre dans les deux villes. L’analyse univariée par ARIMA n’a retrouvé aucune association significative à 5% entre le paludisme et le climat à Ouagadougou. La température et l’humidité relative prédisaient l’incidence du paludisme en analyse multivariée. Plus 1% d’humidité induisait 2780 nouveaux cas et +1°C de température maximale,12833 nouveaux cas ; +1°C de température minimale induisait une réduction de 13196 cas. A BoboDioulasso, le paludisme était significativement associé à la pluviométrie et à l’humidité en analyse univariée. En analyse multivariée par ARIMA, l’humidité prédisait significativement le paludisme ; +1% provoquait 400 cas de paludisme. Conclusion : Il y avait une influence différentiée du climat sur les maladies vectorielles selon la zone climatique, commandant des réponses spécifiques. Par ailleurs, la surveillance de la dengue doit être améliorée dans les deux villes. English Title: Influence of climatic factors on the incidence of dengue and malaria in Burkina Faso: an ecological study Introduction: Dengue and malaria are vector-borne diseases that are endemic and epidemic in Burkina Faso. This study aimed to assess the influence of climate on malaria and dengue fever in the cities of Ouagadougou and Bobo-Dioulasso. Methodology: It was an exploratory time series analysis using data from the SNIS and the General Directorate of Meteorology. ARIMA models were used to describe the trend of dengue fever and malaria from 2013 to 2016. Results: From 2014 to 2016, 4287 cases of dengue fever were reported in the city of Ouagadougou, where dengue followed a bimodal intra-annual trend in August and November. In the univariate analysis by ARIMA, no significant association at 5% was found between climate and dengue. In total,3,621,668 malaria cases were reported at Ouagadougou, against 2,521,789 cases at Bobo-Dioulasso. Malaria followed an intra-annual bimodal trend in August and October in both cities. The univariate analysis by ARIMA found no significant association at 5% between malaria and climate in Ouagadougou. Temperature and relative humidity predicted malaria incidence in multivariate analysis. Plus 1% of humidity induced 2780 new cases and +1°C maximum temperature, 12833 new cases; +1°C minimum temperature resulted in a reduction of 13196 cases. In Bobo-Dioulasso, malaria was significantly associated with rainfall and humidity in univariate analysis. In the multivariate analysis by ARIMA, humidity significantly predicted malaria; +1% caused 400 malaria cases. Conclusion: There was a differential influence of climate on vector-borne diseases depending on the climatic zone, commanding specific responses. Moreover, dengue fever surveillance needs to be improved in the two cities.&nbsp

(1) Background: Effective malaria case management relies on World Health Organization (WHO) recommended artemisinin-based combination therapies (ACTs), but partial resistance to artemisinin has emerged and is spreading, threatening malaria control and elimination efforts. The strategy of deploying multiple first-line therapies (MFT) may help mitigate this threat and extend the therapeutic life of current ACTs. (2) Methods: A district-wide pilot quasi-experimental study was conducted, deploying three different ACTs at the public health facility (PHF) level for uncomplicated malaria treatment from December 2019 to December 2020 in the health district (HD) of Kaya, Burkina Faso. Mixed methods, including household and health facility-based quantitative and qualitative surveys, were used to evaluate the pilot programme. (3) Results: A total of 2008 suspected malaria patients were surveyed at PHFs, of which 79.1% were tested by rapid diagnostic test (RDT) with 65.5% positivity rate. In total, 86.1% of the confirmed cases received the appropriate ACT according to the MFT strategy. The adherence level did not differ by study segment (p = 0.19). Overall, the compliance level of health workers (HWs) with MFT strategy was 72.7% (95% CI: 69.7–75.5). The odds of using PHF as the first source of care increased after the intervention (aOR = 1.6; 95% CI, 1.3–1.9), and the reported adherence to the 3-day treatment regimen was 82.1%; (95% CI: 79.6–84.3). Qualitative results showed a high acceptance of the MFT strategy with positive opinions from all stakeholders. (4) Conclusions: Implementing an MFT strategy is operationally feasible and acceptable by stakeholders in the health systems in Burkina Faso. This study provides evidence to support the simultaneous use of multiple first-line artemisinin combination therapies in malaria-endemic countries such as Burkina Faso.

To evaluate the capability of high-volume comprehensive emergency obstetric care (CEmOC) health facilities on the provision of comprehensive postabortion care (PAC) in Sub-Saharan Africa and to determine the frequency of women with severe abortion-related complications in high capability facilities.A cross-sectional analysis conducted across 11 countries in Sub-Saharan Africa, using facility-level information from the World Health Organization (WHO) Multi-Country Survey on Abortion-related morbidity (MCS-A) between 2017 and 2018. PAC signal functions were adapted to assess facilities' capability to deliver comprehensive PAC through infrastructure, standard comprehensive capability, and extended comprehensive capability to provide PAC. The percentage of facilities with each signal function and distribution of facilities by number of signal functions were calculated for the three capability categories. Distribution of severe abortion complications by facility capability score was assessed.Of 210 high-volume CEmOC facilities included, 47.9% (n = 100) had capability to provide all facility infrastructure signal functions, 54.4% (n = 105) for standard comprehensive PAC, reducing to 17.7% (n = 34) for extended comprehensive PAC capability. Overall, there were gaps in extended capabilities including availability of a functioning ICU (available in 37.3% of facilities) and providers 24/7 (65.5% of facilities reported an obstetrician available 24/7 dropping to 41.3% for anesthesiologists). Facilities' PAC capability varied across regions. Overall, 34.6% (n = 614) of women with severe abortion-related complications were treated in facilities with the maximum capability score for extended comprehensive PAC.Although high levels of capability to provide abortion-related care for most signal functions were evident, significant gaps that impact on the management of severe abortion-related complications remain, particularly related to extended facility capabilities including specialized human resources and ICU.

Despite the negative impact of unsafe abortions on women's health and rights, the degree of abortion safety remains strikingly undocumented for a large share of abortions globally. Data on how women induce abortions (method, setting, provider) are central to the measurement of abortion safety. However, health-facility statistics and direct questioning in population surveys do not yield representative data on abortion care seeking pathways in settings where access to abortion services is highly restricted. Recent developments in survey methodologies to study stigmatized / illegal behaviour and hidden populations rely on the fact that such information circulates within social networks; however, such efforts have yet to give convincing results for unsafe abortions.This article presents the protocol of a study whose purpose is to apply and develop further two network-based methods to contribute to the generation of reliable population-level information on the safety of abortions in contexts where access to legal abortion services is highly restricted.This study plans to obtain population-level data on abortion care seeking in two Health and Demographic Surveillance Systems in urban Kenya and rural Burkina Faso by applying two methods: Anonymous Third-Party Reporting (ATPR) (also known as confidantes' method) and Respondent Driven Sampling (RDS). We will conduct a mixed methods formative study to determine whether these network-based approaches are pertinent in the study contexts. The ATPR will be refined notably by incorporating elements of the Network Scale-Up Method (NSUM) to correct or account for certain of its biases (transmission, barrier, social desirability, selection). The RDS will provide reliable alternative estimates of abortion safety if large samples and equilibrium can be reached; an RDS multiplex variant (also including social referents) will be tested.This study aims at documenting abortion safety in two local sites using ATPR and RDS. If successful, it will provide data on the safety profiles of abortion seekers across sociodemographic categories in two contrasted settings in sub-Saharan Africa. It will advance the formative research needed to determine whether ATPR and RDS are applicable or not in a given context. It will improve the questionnaire and correcting factors for the ATPR, improve the capacity of RDS to produce quasi-representative data on abortion safety, and advance the validation of both methods.Representative data on how women induce abortions and their consequences are central to measurements of abortion safety. However, due to the stigmatized nature of abortion, measuring the details of the process is challenging when the latter occur out of the realm of the law and do not result in complications registered in hospital statistics. Hence, there is sparse empirical population-level data on how women terminate their pregnancies in countries where access to abortion services is highly restricted, as well as little data on the side effects and complications associated with the methods they chose and health seeking for these complications. Recent developments in indirect survey methodologies to study stigmatized/illegal behaviour and hidden populations are likely to improve the quality of data collected on abortion safety in restrictive contexts: all are based on the sharing of information on stigmatized practices in social networks. We propose to refine and pilot two such network-based methods to validate their use for collecting (quasi) representative data on abortion safety in large population health surveys. These two approaches are: (i) a modified Anonymous Third-Party Reporting method (ATPR) integrating elements of the Network-Scale-up Method (NSUM) and (ii) Respondent-Driven Sampling (RDS). We will conduct this study in two African Health and Demographic Surveillance Systems (HDSS) sites, one urban (Nairobi, Kenya), and one comprising a town and adjacent villages (Kaya, Burkina Faso).

OBJECTIVE: To investigate the level and determinants of nonreceipt of contraception among women admitted to facilities with abortion-related complications in East and Southern Africa. METHODS: Cross-sectional data from Kenya, Malawi, Mozambique, and Uganda collected as part of the World Health Organization (WHO) Multi-Country Survey on Abortion-related morbidity. Medical record review and the audio computer-assisted self-interviewing system were used to collect information on women's demographic and clinical characteristics and their experience of care. The percentage of women who did not receive a contraceptive was estimated and the methods of choice for different types of contraceptives were identified. Potential determinants of nonreceipt of contraception were grouped into three categories: sociodemographic, clinical, and service-related characteristics. Generalized estimating equations were used to identify the determinants of nonreceipt of a contraceptive following a hierarchical approach. RESULTS: A total of 1190 women with abortion-related complications were included in the analysis, of which 33.9% (n = 403) did not receive a contraceptive. We found evidence that urban location of facility, no previous pregnancy, and not receiving contraceptive counselling were risk factors for nonreceipt of a contraceptive. Women from nonurban areas were less likely not to receive a contraceptive than those in urban areas (AOR 0.52; 95% CI, 0.30-0.91). Compared with women who had a previous pregnancy, women who had no previous pregnancy were 60% more likely to not receive a contraceptive (95% CI, 1.14-2.24). Women who did not receive contraceptive counselling were over four times more likely to not receive a contraceptive (AOR 4.01; 95% CI, 2.88-5.59). CONCLUSION: Many women leave postabortion care having not received contraceptive counselling and without a contraceptive method. There is a clear need to ensure all women receive high-quality contraceptive information and counselling at the facility to increase contraceptive acceptance and informed decision-making.

Background High blood pressure (HBP) during pregnancy causes maternal and fetal mortality. Studies regarding its prevalence and associated factors in frontline level health care settings are scarce. We thus aimed to evaluate the prevalence of HBP and its associated factors among pregnant women at the first level of the health care system in Burkina Faso. Methods This cross-sectional study was conducted in six health facilities between December 2018 and March 2019. HBP was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Multivariable logistic regression analysis was performed to identify factors associated with HBP. Results A total of 1027 pregnant women were included. The overall prevalence of HBP was 1.4% (14/1027; 95% confidence interval [CI] 0.7–2.3), with 1.6% (7/590; 95% CI 0.8–3.3) in rural and 1.2% (7/437; 95% CI 0.6- 2.5) in semi-urban areas. The prevalence was 0.7% (3/440; 95% CI 0.2–2.1) among women in the first, 1.5% (7/452; 95% CI 0.7–3.2) in the second and 3% (4/135; 95% CI 1.1–7.7) in the third trimester. In the multivariable analysis, pregnancy trimester, maternal age, household income, occupation, parity, and residential area were not associated with HBP during pregnancy. Conclusion The prevalence of HBP among pregnant women at the first level of health system care is significantly lower compared to prevalence’s from hospital studies. Public health surveillance, primary prevention activities, early screening, and treatment of HDP should be reinforced in all health facilities to reduce the burden of adverse pregnancy outcomes in Burkina Faso.

Introduction : Les hopitaux publics en Afrique sub-saharienne se caracterisent par une faiblesse de leurs performances. Aussi, le Burkina Faso a-t-il experimente un mode de gestion prive dans un hopital public pour ameliorer sa performance.Objectif : Evaluer la performance du CHU de Tengandogo (CHU-T) de Ouagadougou, un hopital public a mode de gestion privee.Methode : Il s’agit d’une etude transversale realisee dans le service des urgences medico-chirurgicales. Les techniques de collecte de donnees ont consiste en une revue documentaire avec une extraction de donnees quantitatives (indicateurs de performance hospitaliers) et des entretiens individuels semi-structures aupres d’informateurs cles. Les donnees ont ete collectees en avril 2017. Le cadre d’analyse couvre la continuite, l’efficacite et l’efficience des services, la securite du personnel et l’environnement de travail.Resultats : L’etude a montre que la performance du CHU-T etait entravee par la rupture frequente des medicaments et consommables medicaux, l’etat de degradation des infrastructures et des equipements, les difficultes de coordination des soins entre les services, l’etiquette « hopital pour riches » et l’absence de donnees relatives a la securite des patients et du personnel.Conclusion : Cette etude a montre que ce modele de gestion n’a pas permis d’ameliorer la performance attendue de l’hopital. D’autres facteurs devraient etre consideres pour resoudre les problemes structurels affectant la performance des hopitaux en Afrique.

To estimate the prevalence of infection among abortion-related complications in health facilities, describe their management, and identify sociodemographic and clinical factors associated with abortion-related infections.A secondary analysis of the WHO Multi-Country Survey on Abortion-related morbidity (MCS-A) conducted in 210 health facilities of 11 Sub-Saharan African countries between 2017 and 2018. The outcome variable was abortion-related infections, categorized into three mutually exclusive groups of abortion-related complications: infections only, infection with other complications, and other complications without infection. We described the sociodemographic and clinical characteristics and the management of abortion-related infection and identified the factors associated with abortion-related infections using a multinomial logistic model.A total of 9232 women with abortion-related complications were included, with infection occurring among 10.6% of women (n = 974). Infection was involved in 47.4% (n = 153) of severe maternal outcomes with a case fatality rate of 27.4% (n = 42). The most common management approach was antibiotics, uterine evacuation, and uterotonics combined: 43.2% (n = 384) in the group of women with infection only and 48.6% (n = 4235) among those with infection and other complications. In addition, 85.9% (n = 7095) of women without infection also received therapeutic antibiotics. Factors associated with an increased odds of infection only compared with complication without infection were age younger than 20 years compared with those aged over 30 (aOR 1.84; 95% CI,1.24-2.74), not living in a couple (aOR 2.05, 95% CI,1.52-2.76), and gestational age of 13 weeks or more (aOR 1.70, 95% CI,1.27-2.26). The same factors were associated with infection and other complications.Infection is frequent among severe abortion-related complications, and its case fatality rate is high. Further research to assess the relationship between abortion-related infections and outcomes is needed. There is also a need to question the quality of postabortion care and improve adequate use of antibiotics.

OBJECTIVE: To evaluate the capability of high-volume comprehensive emergency obstetric care (CEmOC) health facilities on the provision of comprehensive postabortion care (PAC) in Sub-Saharan Africa and to determine the frequency of women with severe abortion-related complications in high capability facilities. METHODS: A cross-sectional analysis conducted across 11 countries in Sub-Saharan Africa, using facility-level information from the World Health Organization (WHO) Multi-Country Survey on Abortion-related morbidity (MCS-A) between 2017 and 2018. PAC signal functions were adapted to assess facilities' capability to deliver comprehensive PAC through infrastructure, standard comprehensive capability, and extended comprehensive capability to provide PAC. The percentage of facilities with each signal function and distribution of facilities by number of signal functions were calculated for the three capability categories. Distribution of severe abortion complications by facility capability score was assessed. RESULTS: Of 210 high-volume CEmOC facilities included, 47.9% (n = 100) had capability to provide all facility infrastructure signal functions, 54.4% (n = 105) for standard comprehensive PAC, reducing to 17.7% (n = 34) for extended comprehensive PAC capability. Overall, there were gaps in extended capabilities including availability of a functioning ICU (available in 37.3% of facilities) and providers 24/7 (65.5% of facilities reported an obstetrician available 24/7 dropping to 41.3% for anesthesiologists). Facilities' PAC capability varied across regions. Overall, 34.6% (n = 614) of women with severe abortion-related complications were treated in facilities with the maximum capability score for extended comprehensive PAC. CONCLUSION: Although high levels of capability to provide abortion-related care for most signal functions were evident, significant gaps that impact on the management of severe abortion-related complications remain, particularly related to extended facility capabilities including specialized human resources and ICU.

Background Malaria case management relies on World Health Organization (WHO)-recommended artemisinin-based combination therapy (ACT), and a continuous understanding of local community knowledge, attitudes, and practices may be a great support for the success of malaria disease control efforts. In this context, this study aimed to identify potential facilitators or barriers at the community level to inform a health district-wide implementation of multiple first-line therapies (MFT) as a new strategy for uncomplicated malaria case management. Methods A community-based cross-sectional study using a mixed-method design was carried out from November 2018 to February 2019, in the health district (HD) of Kaya in Burkina Faso. Quantitative data were collected using a standardized questionnaire from 1394 individuals who had fever/malaria episodes four weeks prior to the survey. In addition, 23 focus group discussions (FGDs) were conducted targeting various segments of the community. Logistic regression models were used to assess the predictors of community care-seeking behaviours. Results Overall, 98% (1366/1394) of study participants sought advice or treatment, and 66.5% did so within 24 h of fever onset. 76.4% of participants preferred to seek treatment from health centres as the first recourse to care, 5.8% were treated at home with remaining drug stock, and 2.3% preferred traditional healers. Artemether-lumefantrine (AL) was by far the most used anti-malarial drug (98.2%); reported adherence to the 3-day treatment regimen was 84.3%. Multivariate analysis identified less than 5 km distance travelled for care (AOR = 2.7; 95% CI 2.1–3.7) and education/schooling (AOR = 1.8; 95% CI 1.3–2.5) as determinants of prompt care-seeking for fever. Geographical proximity (AOR = 1.5, 95% CI 1.2–2.1), having a child under five (AOR = 4.6, 95% CI 3.2–6.7), being pregnant (AOR = 6.5, 95% CI 1.9–22.5), and living in an urban area (AOR = 2.8, 95% CI 1.8–4.2) were significant predictors for visiting health centres. The FGDs showed that participants had good knowledge about malaria symptoms, prevention tools, and effective treatment. Behaviour change regarding malaria treatment and free medication for children under five were the main reasons for participants to seek care at health centres. Conclusions The study showed appropriate knowledge about malaria and positive community care-seeking behaviour at health centres for fever/malaria episodes. This could potentially facilitate the implementation of a MFT pilot programme in the district. ClinicalTrials.gov Identifier: NCT04265573.

Supplemental material, sj-docx-1-his-10.1177_11786329221092625 for Availability and Utilization of Postabortion Care Services in Burkina Faso, Côte d’Ivoire, and Guinea: A Secondary Analysis of Emergency Obstetric and Neonatal Care Needs Assessments (EmONC) by Rachidatou Compaore, Adja Mariam Ouedraogo, Adama Baguiya, Denise Olga Kpebo, Sidikiba Sidibe and Seni Kouanda in Health Services Insights

Data on lifestyle risk factors for cardiovascular diseases, such as smoking, alcohol consumption, inadequate physical activity, and insufficient consumption of fruits and vegetables, in pregnant women in Africa, are scarce. This study aimed to estimate the prevalence of cardiovascular lifestyle risk factors among pregnant women in Burkina Faso and identify their associated factors. Pregnant women who attended antenatal care services between December 2018 and March 2019 were included in this study. A modified Poisson regression model was used to estimate adjusted prevalence ratios (aPR) with a 95% confidence interval. A total of 1027 pregnant women participated in this study. The prevalence of alcohol consumption, tobacco use, inadequate physical activity, and insufficient consumption of fruits and vegetables were 10.2% [8.5–12.2], 3.0% [2.1–4.3], 79.4% [76.9–81.8], and 53.5% [50.5–56.6], respectively. The prevalence of more than one cardiovascular lifestyle risk factor in pregnant women was 50.9% [48.0–54.0]. The predictors significantly associated with more than one cardiovascular lifestyle risk factor were women over 30 years old aPR 1.26; 95% CI [1.03–1.53]), women living in fourth wealth index households (aPR 1.23; 95% CI [1.06–1.42]), in semi-urban areas (aPR 5.46; 95% CI [4.34–6.88]), and women with no occupation (aPR 1.31; 95% CI [1.18–1.44]). The prevalence of more than one cardiovascular lifestyle risk factor was high during pregnancy in Burkina Faso. Women of childbearing age should be advised on how healthy behaviors can lead to improved pregnancy outcomes.