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Abstract Background Pregnant women are a vulnerable population to COVID-19 given an increased susceptibility to severe SARS-CoV-2 infection and pregnancy complications. However, few SARS-CoV-2 serological surveys have been performed among this population to assess the extent of the infection in sub-Saharan countries. The objectives of this study were to determine SARS-CoV-2 seroprevalence among Beninese pregnant women, to identify spatial seropositivity clusters and to analyse factors associated with the infection. Methods A cross-sectional study including women in their third trimester of pregnancy attending the antenatal care (ANC) clinics at Allada (south Benin) and Natitingou (north Benin) was conducted. Rapid diagnostic tests (RDT) for detection of IgG/IgM against the SARS-CoV-2 spike protein were performed using capillary blood. Seroprevalence of SARS-CoV-2 antibodies and associations between SARS-CoV-2 serostatus and maternal characteristics were analyzed by multivariate logistic regression. Spatial analyses were performed using the spatial scan statistics to identify spatial clusters of SARS-CoV-2 infection. Results A total of 861 pregnant women were enrolled between May 4 and June 29, 2022. 58/861 (6.7%) participants reported having received COVID-19 vaccine. None of the participants had been diagnosed with COVID-19 during their pregnancy. SARS-CoV-2 antibodies were detected in 607/802 (75.7%; 95% CI 72.56%–78.62%) of unvaccinated participants. Several urban and rural spatial clusters of SARS-CoV-2 cases were identified in Allada and one urban spatial cluster was identified in Natitingou. Unvaccinated participants from Allada with at least one previous morbidity were at a three-times higher risk of presenting SARS-CoV-2 antibodies (OR = 2.89; 95%CI 1.19%-7.00%). Conclusion Three out of four pregnant women had SARS-CoV-2 antibodies, suggesting a high virus circulation among pregnant women in Benin, while COVID-19 vaccination coverage was low. Pregnant women with comorbidities may be at increased risk of SARS-CoV-2 infection. This population should be prioritized for COVID-19 diagnosis and vaccination in order to prevent its deleterious effects. Trial registration NCT06170320 (retrospectively registered on December 21, 2023).

Background: Vaccination against SARS-CoV-2 has been deployed in France since January 2021. Without specific action for different population subgroups, the inverse equity hypothesis postulates that people in the most deprived neighbourhoods will be the last to benefit. The article aims to study whether the inverse care law has been verified in the context of vaccination against SARS-CoV-2 from a vaccination centre of a hospital in the Paris region. Methods: We performed a spatial analysis using primary data from the vaccination centre of the Avicenne Hospital in Bobigny from January 8th to September 30th, 2021. Primary data variables include the vaccinated person's date, age, and postal address. Secondary data calculates access times between residential neighbourhoods and the vaccination centre and social deprivation index. We performed flow analysis, k-means aggregation, and mapping. Results: 32,712 people were vaccinated at the study centre. Vaccination flow to the hospital shows that people living in the most disadvantaged areas were the last to be vaccinated. The number of people immunized according to the level of social deprivation then scales out with slightly more access to the vaccination centre for the most advantaged. The furthest have travelled more than 100 km, and more than 1h45 of transport time to get to this vaccination centre. Conclusion: The study confirms the inverse equity hypothesis and shows that vaccination preparedness strategies must consider equity issues. Public health interventions should be implemented according to proportionate universalism and use community health, health mediation, and outreach activities for more equity.

While breast cancer is the most common cancer globally, not all women have access to quality care. Long considered a disease of high-income countries, low- and middle-income countries are now facing a major public health issue regarding cancer. This is the case in sub-Saharan Africa, where access to quality breast cancer treatment is often lacking. This context leads some women to travel abroad, particularly to France, hoping to save their lives. This article aims to examine the experiences, the social cost and the perceptions associated with therapeutic mobility for breast cancer in France. To this end, this study uses a qualitative method based on nineteen biographical interviews with women from sub-Saharan Africa with breast cancer who have migrated to France seeking for treatment. It shows that these women often face significant difficulties throughout their care and life paths in France. Main issues lay in accessing care, housing insecurity, loneliness, and administrative instability. This reflects how the double biographical disruption, caused by cancer and migration, impact entire disease trajectories, from entry to care to post-breast cancer period. With this research, we suggest extending the concept of social death to the issue of women who have undergone therapeutic mobility for their breast cancer in France. Highlighting the experiences of women who remain almost invisible in the public arena, this article analyses poorly heard realities and shows how social inequalities in health can be found even in reconstructing oneself after breast cancer.

Abstract Background Zambia has invested in several healthcare financing reforms aimed at achieving universal access to health services. Several evaluations have investigated the effects of these reforms on the utilization of health services. However, only one study has assessed the distributional incidence of health spending across different socioeconomic groups, but without differentiating between public and overall health spending and between curative and maternal health services. Our study aims to fill this gap by undertaking a quasi-longitudinal benefit incidence analysis of public and overall health spending between 2006 and 2014. Methods We conducted a Benefit Incidence Analysis (BIA) to measure the socioeconomic inequality of public and overall health spending on curative services and institutional delivery across different health facility typologies at three time points. We combined data from household surveys and National Health Accounts. Results Results showed that public (concentration index of − 0.003; SE 0.027 in 2006 and − 0.207; SE 0.011 in 2014) and overall (0.050; SE 0.033 in 2006 and − 0.169; SE 0.011 in 2014) health spending on curative services tended to benefit the poorer segments of the population while public (0.241; SE 0.018 in 2007 and 0.120; SE 0.007 in 2014) and overall health spending (0.051; SE 0.022 in 2007 and 0.116; SE 0.007 in 2014) on institutional delivery tended to benefit the least-poor. Higher inequalities were observed at higher care levels for both curative and institutional delivery services. Conclusion Our findings suggest that the implementation of UHC policies in Zambia led to a reduction in socioeconomic inequality in health spending, particularly at health centres and for curative care. Further action is needed to address existing barriers for the poor to benefit from health spending on curative services and at higher levels of care.

Background. In Benin, due to the unavailability of comprehensive data on road crashes, road safety policies are mainly based on partial statistics provided by the police. These remain unreliable in terms of injury severity and risk factors. This study aims to determine the factors influencing the severity of injuries after a road crash in Benin. Methods. The present nested case-control study, matched for age and sex, was based on a hospital cohort of road crash victims set up in five hospitals in Benin between July 2019 and January 2020. A sample of severely injured patients according to the Abbreviated Injury Scale (cases) was compared to non-severely injured patients (controls). Results. The severe crash occurred mainly during the night between 8 p.m. and midnight (36.2% of cases vs. 24.4% of controls) and on main roads (57.8% of cases vs. 34.7% of controls). Factors associated with injury severity were the time of the crash: night between 8 p.m. and midnight [Adjusted Odd Ratio (AOR): 2.1; CI 95%: 1.4-3.2], major roads (national interstate roads and national roads) (AOR: 2.8; CI 95%: 2.0-4.0) and non-work-related travel (AOR: 1.8; CI 95%: 1.2-2.7). Conclusions. Factors associated with road crash severity in Benin were night-time, main roads, and non-work related travel. Raising user awareness about compliance with traffic rules and improving public lighting, especially along main roads could help reduce the number of serious injuries.

Introduction During the COVID-19 crisis, researchers had to collect data remotely. Telephone surveys and interviews can quickly gather data from a distance without heavy expense. Although interviewer-administered telephone surveys (IATS) can accommodate the needs of international public health research, the literature on their use during infectious disease outbreaks is scarce. This scoping review aimed to map the characteristics of IATS during infectious disease outbreaks.Methods IATS conducted principally during infectious disease outbreaks and answered by informants at least 18 years old were searched from PubMed and EBSCO. There was a manual addition of relevant documents identified during an initial search. Overall trends were reported using different groupings, including WHO regions, and study details were compared before and during the COVID-19 pandemic.Results 70 IATS published between 2003 and 2022 were identified. 57.1% were conducted during the COVID-19 pandemic. Among 30 IATS conducted before the COVID-19 pandemic in the world, only 3.3% were carried out in low-income and middle-income countries (LMICs). This percentage of studies in LMICs out of all the IATS rose to 32.5% during the pandemic. The share of qualitative studies grew from 6.7% before the COVID-19 outbreak to 32.5% during the outbreak. IATS performed during the COVID-19 pandemic focused on more diverse, specific population groups, such as patients and healthcare professionals. Mobile phones are increasingly used for IATS over time.Conclusion IATS are used globally with high frequency in the Western Pacific Region and high-income countries. Technical and financial challenges continue to exist, and assessments of inclusiveness and representativeness should be carefully conducted. A lack of details related to methods was observed, and this scoping review urges researchers using this data collection method in the future to specify how they executed IATS for better use and more efficient deployment.

Objectives In low-income settings with limited access to diagnosis, COVID-19 information is scarce. In September 2020, after the first COVID-19 wave, Mali reported 3086 confirmed cases and 130 deaths. Most reports originated from Bamako, with 1532 cases and 81 deaths (2.42 million inhabitants). This observed prevalence of 0.06% appeared very low. Our objective was to estimate SARS-CoV-2 infection among inhabitants of Bamako, after the first epidemic wave. We assessed demographic, social and living conditions, health behaviours and knowledges associated with SARS-CoV-2 seropositivity.Settings We conducted a cross-sectional multistage household survey during September 2020, in three neighbourhoods of the commune VI (Bamako), where 30% of the cases were reported.Participants We recruited 1526 inhabitants in 3 areas, that is, 306 households, and 1327 serological results (≥1 years), 220 household questionnaires and collected answers for 962 participants (≥12 years).Primary and secondary outcome measures We measured serological status, detecting SARS-CoV-2 spike protein antibodies in blood sampled. We documented housing conditions and individual health behaviours through questionnaires among participants. We estimated the number of SARS-CoV-2 infections and deaths in the population of Bamako using the age and sex distributions.Results The prevalence of SARS-CoV-2 seropositivity was 16.4% (95% CI 15.1% to 19.1%) after adjusting on the population structure. This suggested that ~400 000 cases and ~2000 deaths could have occurred of which only 0.4% of cases and 5% of deaths were officially reported. Questionnaires analyses suggested strong agreement with washing hands but lower acceptability of movement restrictions (lockdown/curfew), and mask wearing.Conclusions The first wave of SARS-CoV-2 spread broadly in Bamako. Expected fatalities remained limited largely due to the population age structure and the low prevalence of comorbidities. Improving diagnostic capacities to encourage testing and preventive behaviours, and avoiding the spread of false information remain key pillars, regardless of the developed or developing setting.Ethics This study was registered in the registry of the ethics committee of the Faculty of Medicine and Odonto-Stomatology and the Faculty of Pharmacy, Bamako, Mali, under the number: 2020/162/CA/FMOS/FAPH.

Abstract Background Since climate change, pandemics and population mobility are challenging healthcare systems, an empirical and integrative research to studying and help improving the health systems resilience is needed. We present an interdisciplinary and mixed-methods research protocol, ClimHB, focusing on vulnerable localities in Bangladesh and Haiti, two countries highly sensitive to global changes. We develop a protocol studying the resilience of the healthcare system at multiple levels in the context of climate change and variability, population mobility and the Covid-19 pandemic, both from an institutional and community perspective. Methods The conceptual framework designed is based on a combination of Levesque’s Health Access Framework and the Foreign, Commonwealth and Development Office’s Resilience Framework to address both outputs and the processes of resilience of healthcare systems. It uses a mixed-method sequential exploratory research design combining multi-sites and longitudinal approaches. Forty clusters spread over four sites will be studied to understand the importance of context, involving more than 40 healthcare service providers and 2000 households to be surveyed. We will collect primary data through questionnaires, in-depth and semi-structured interviews, focus groups and participatory filming. We will also use secondary data on environmental events sensitive to climate change and potential health risks, healthcare providers’ functioning and organisation. Statistical analyses will include event-history analyses, development of composite indices, multilevel modelling and spatial analyses. Discussion This research will generate inter-disciplinary evidence and thus, through knowledge transfer activities, contribute to research on low and middle-income countries (LMIC) health systems and global changes and will better inform decision-makers and populations.

Abstract Background Malawi is one of a handful of countries that had resisted the implementation of user fees, showing a commitment to providing free healthcare to its population even before the concept of Universal Health Coverage (UHC) acquired global popularity. Several evaluations have investigated the effects of key policies, such as the essential health package or performance-based financing, in sustaining and expanding access to quality health services in the country. Understanding the distributional impact of health spending over time due to these policies has received limited attention. Our study fills this knowledge gap by assessing the distributional incidence of public and overall health spending between 2004 and 2016. Methods We relied on a Benefit Incidence Analysis (BIA) to measure the socioeconomic inequality of public and overall health spending on curative services and institutional delivery across different health facility typologies. We used data from household surveys and National Health Accounts. We used a concentration index (CI) to determine the health benefits accrued by each socioeconomic group. Results Socioeconomic inequality in both public and overall health spending substantially decreased over time, with higher inequality observed in overall spending, non-public health facilities, curative health services, and at higher levels of care. Between 2004 and 2016, the inequality in public spending on curative services decreased from a CI of 0.037 (SE 0.013) to a CI of 0.004 (SE 0.011). Whiles, it decreased from a CI of 0.084 (SE 0.014) to a CI of 0.068 (SE 0.015) for overall spending in the same period. For institutional delivery, inequality in public and overall spending decreased between 2004 and 2016 from a CI of 0.032 (SE 0.028) to a CI of -0.057 (SE 0.014) and from a CI of 0.036 (SE 0.022) to a CI of 0.028 (SE 0.018), respectively. Conclusions Through its free healthcare policy, Malawi has reduced socioeconomic inequality in health spending over time, but some challenges still need to be addressed to achieve a truly egalitarian health system. Our findings indicate a need to increase public funding for the health sector to ensure access to care and financial protection.

Abstract Objective To estimate the out-of-pocket expenditures linked to Road Traffic Injuries in Ouagadougou, Burkina Faso, as well as the prevalence of catastrophic expenditures among those out-of-pocket payments, and to identify the socio-economic determinants of catastrophic expenditures due to Road Traffic Injuries. Methods We surveyed every admission at the only trauma unit of Ouagadougou between January and July 2015 at the time of their admission, 7 days and 30 days later. We estimate a total amount of out-of-pocket expenditures paid by each patient. We considered an expense as catastrophic when it represented 10% at least of the annual global consumption of the patient’s household. We used linear models to determine if socio-economic characteristics were associated to a greater or smaller ratio between out-of-pocket payment and global annual consumption. Findings We surveyed 1323 Road injury victims three times (admission, Days 7 and 30). They paid in average 46,547 FCFA (83.64 US dollars) for their care, which represent a catastrophic expenditure for 19% of them. Less than 5% of the sample was covered by a health insurance scheme. Household economic status is found to be the first determinant of catastrophic health expenditure occurrence, exhibiting a significant and negative on the ratio between road injury expenditures and global consumption. Conclusion Our findings highlight the importance of developing health insurance schemes to protect poor households from the economic burden of road traffic injuries and improve equity in front of health shocks.

Background: In Sub-Saharan Africa, psychiatric care for severe mental disorders is scarce. This is especially true for people living in chronic poverty in rural areas. The way in which people with psychotic manifestations are socially perceived and treated remains under-researched, limiting the possibility of adapting services to their needs. Methods: In May 2017, 29 semi-structured individual interviews with indigent people reporting psychotic-like experiences and 8 focus groups with members of their community were conducted in the rural region of Diébougou (Burkina Faso). Indigents were questioned on their subjective interpretation regarding these experiences. Community members were asked about their perceptions of people manifesting psychotic-like experiences. A thematic analysis was carried out. Results: Three distinct conceptions of psychotic-like experiences were identified. First, these experiences were often understood as a reflection of a mental disorder involving evil supernatural entities. Second, some people were considered as possessing a faculty that conferred supernatural powers that could be used for healing purposes. Finally, psychotic-like experiences might also reflect a temporary disturbance for which no significant repercussions were raised. Conclusions: This study suggests that certain manifestations qualified as psychotic according to the biomedical nosology seem to be considered differently from communities' perspectives. These experiences were frequently interpreted as being personal and not requiring medical attention or even as socially valuable faculties. Although psychotic-like experiences were not always perceived negatively, people who experienced them were reluctant to talk about them. This suggests that a form of stigmatization is associated with psychotic-like experiences.

This study was an explanatory, sequential, mixed-methods design conducted in Senegal. We collected quantitative data from December 24, 2020, to January 16, 2021, and qualitative data from February 19 to March 30, 2021. We conducted a telephone survey among a marginal quota sample of 607 people over 18 years old. We performed descriptive, bivariate, and multivariate analyses with R software for the quantitative phase; and performed manual content analyses for the qualitative phase. We surveyed 607 people for the quantitative phase and interviewed 30 people for the qualitative phase. Individuals who hesitated or refused to be vaccinated represented 12.9% and 32.8%, respectively. Vaccine hesitancy was related to gender, living in large cities, having a poor attitude toward the vaccine, thinking that the vaccine would not help protect them from the virus, being influenced by people important to them, and lacking information from health professionals. Vaccine refusal was related to living in large cities, having a poor attitude toward the vaccine, thinking that the vaccine would not help protect them from the virus, thinking that the vaccine could endanger their health, trusting opinions of people who were important to them, and lacking information from health professionals. The results of the study show that the factors associated with COVID-19 vaccine hesitancy and refusal are diverse and complex. Addressing these factors will help to ensure better vaccination coverage. Governments and health authorities should intensify their efforts to promote vaccine confidence and reduce misinformation.

Pts with HM may have low or delayed specific immune response after usual vaccination due to immune deficiency, associated to the disease or to the therapy. In this real-life study, 235 pts vaccinated with BNTCV (BioNTech Pfizer) were monitored for 2 years, starting 06/20 in a single Institution.Patients ’population and follow-up. 235 patients including 225 with HM initially received 2 doses of BNTCV (IM) with 3 weeks between the 2 first doses, including 98 lymphomas (L), 28 monoclonal gammopathies with undetermined significance (MGUS), 34 multiple myelomas (MM), 34 myeloproliferative disorders (MPD), 27 chronic lymphocytic leukemias (CLL), 4 acute leukemias and 10 non-malignant hemopathies. The first 43 pts had initial follow-up by telemedicine system connecting the pt to the Institute, developed by La Valeriane Inc. (Montpellier, France), 24/24h, 7 days. Seroconversion was assessed by analyzing IgG anti-Spike protein antibody (AcAS) every 3-4 weeks after the first vaccination and then, every 3-4 months, by SARS-CoV-2 IgG II Quant® Assay (Abbott, France) and Elecsys® Anti-SARS-CoV-2 S (Roche Diagnostics, France), in duplicate with the 2 assays, by 2 independent labs. Additional boosts of vaccine were administered in case of seronegativity or when the level of antibody was 38°C) for at least 2 days, headache, or general pain. The satisfaction survey of monitoring system was good. Adherence to vaccination was excellent (only one refusal/235 pts).AcAS follow-up 15 Results were discordant (12 with Abbott +, Roche -, and 3 with Abbott - Roche +). Semi-quantitative rapid test (BIOSIS HEALING, Beijing China) was compared to Abbott with good concordance on 97 samples. After 2 doses of BNTCV, 72% of the pts were seroconverted, (median, range) (59, 3-319) BAU/mL, Abbott), including 62% CLL (121), 66% L (39), 91% MGUS (204), 61% MM (15) and 81% SMD (50). 50% of the pts receiving daratumumab (median 8 BAU/mL, 1-20) and only 38% of the pts receiving rituximab (median 0, 0-20) were seroconverted, as compared to 71% of the pts receiving other treatment or 80% (42, 2-210) with no therapy (161, 29-637) (p

Abstract In France, more than 10 million women at ”average” risk of breast cancer (BC), are included in the organized BC screening. Existing predictive models of BC risk are not adapted to the French population. Thus, we set up a new score in the French Hérault region and looked for subgroups at a graded level of risk in women at ”average” risk. We recruited a retrospective cohort of women, aged 50 to 60, who underwent the organized BC screening, and included 2241 non-cancer women and 527 who developed a BC during a 12-year follow-up period (2006-2018). The risk factors identified were high breast density (ACR BI-RADS grading)(B vs A: HR = 1.41, 95%CI [1.05; 1.9], p = 0.023; C vs A: HR = 1.65 [1.2; 2.27], p = 0.02 ; D vs A: HR = 2.11 [1.25;3.58], p = 0.006), a history of maternal breast cancer (HR = 1.61 [1.24; 2.09], p < 0.001), and socioeconomic difficulties (HR 1.23 [1.09; 1.55], p = 0.003). While early menopause (HR = 0.36 [0.13; 0.99], p = 0.003) and an age at menarche after 12 years (HR = 0.77 [0.63; 0.95], p = 0.047) were protective factors. We identified 3 groups at risk: lower, average, and higher, respectively. A low threshold was characterized at 1.9% of 12-year risk and a high threshold at 4.5% 12-year risk. Mean 12-year risks in the 3 groups of risk were 1.37%, 2.68%, and 5.84%, respectively. Thus, 12% of women presented a level of risk different from the average risk group, corresponding to 600,000 women involved in the French organized BC screening, enabling to propose a new strategy to personalize the national BC screening. On one hand, for women at lower risk, we proposed to reduce the frequency of mammograms and on the other hand, for women at higher risk, we suggested intensifying surveillance.

Abstract Background All prevention efforts currently being implemented for COVID-19 are aimed at reducing the burden on strained health systems and human resources. There has been little research conducted to understand how SARS-CoV-2 has affected health care systems and professionals in terms of their work. Finding effective ways to share the knowledge and insight between countries, including lessons learned, is paramount to the international containment and management of the COVID-19 pandemic. The aim of this project is to compare the pandemic response to COVID-19 in Brazil, Canada, China, France, Japan, and Mali. This comparison will be used to identify strengths and weaknesses in the response, including challenges for health professionals and health systems. Methods We will use a multiple case study approach with multiple levels of nested analysis. We have chosen these countries as they represent different continents and different stages of the pandemic. We will focus on several major hospitals and two public health interventions (contact tracing and testing). It will employ a multidisciplinary research approach that will use qualitative data through observations, document analysis, and interviews, as well as quantitative data based on disease surveillance data and other publicly available data. Given that the methodological approaches of the project will be largely qualitative, the ethical risks are minimal. For the quantitative component, the data being used will be made publicly available. Discussion We will deliver lessons learned based on a rigorous process and on strong evidence to enable operational-level insight for national and international stakeholders.

In the framework of assessment policies aimed at reducing the vulnerability of risks’ subjected territories, the concept of representation is an essential component for understanding the population's attitude towards risks. This representation is influenced by socio-spatial factors. Thus, this study examines the representations of the risk of flooding by the sea in the coastal commune of Port-Gentil, the economic capital of Gabon. To this end, a geo-localised questionnaire survey was conducted among 771 heads of household in their homes. In this study we sought to examine how the inhabitants of Port-Gentil represent the risk of flooding by the sea, as well as the socio-spatial factors influencing this representation in this African city with multiple risks. The results of the study show that (1) the risk of flooding from the sea does not seem to be the main concern of the inhabitants; (2) the representation of the feeling of exposure to the main declared risks is significantly influenced by residential factors such as the time spent in the commune, whether they own a dwelling or not and the standing of the dwelling; (3) spatially, the location of the household is a determining factor in the representation of the risks. Our results suggest that the representations of inhabitants must be taken into account in the implementation of risk management policies in Port-Gentil. They allow us to direct the discourse towards populations that tend to ignore their exposure to risks, particularly to risks that are not very obvious, such as flooding from the sea.

Because of limited data on dengue virus in Burkina Faso, we conducted 4 consecutive age-stratified longitudinal serologic surveys, ≈6 months apart, among persons 1–55 years of age, during June 2015–March 2017, which included a 2016 outbreak. The seroconversion rate before the serosurvey enrollment was estimated by binomial regression, taking age as the duration of exposure, and assuming constant force of infection (FOI) over age and calendar time. We calculated FOI between consecutive surveys and rate ratios for potentially associated characteristics based on seroconversion using the duration of intervals. Among 2,897 persons at enrollment, 66.3% were IgG-positive, and estimated annual FOI was 5.95%. Of 1,269 enrollees participating in all 4 serosurveys, 438 were IgG-negative at enrollment. The annualized FOI ranged from 10% to 20% (during the 2016 outbreak). Overall, we observed high FOI for dengue. These results could support decision-making about control and preventive measures for dengue.

Abstract In this commentary, we present a follow-up of two articles published in 2017 and 2018 about road traffic crashes, which is an important public health issue in Africa and Burkina Faso. The first article reported on a research project, conducted in partnership with local actors involved in road safety, carried out in Ouagadougou in 2015. Its aim was to test the effectiveness, acceptability, and capacity of a surveillance system to assess the number of road traffic crashes and their consequences on the health of crash victims. Several knowledge translation activities were carried out to maximize its impact and were reported in the 2018 article published in HRPS: monthly reports presenting the research data, large-format printed maps distributed to the city’s police stations, and a deliberative workshop held at the end of the research project. The present commentary presents our efforts to deepen our understanding of the impacts of the knowledge translation strategy, based on follow-up interviews, 18 months after the workshop, with the heads of the road traffic crash units in Ouagadougou police stations (n = 5). Several benefits were reported by respondents. Their involvement in the process prompted them to broaden their knowledge of other ways of dealing with the issue of road crashes. This led them, sometimes with their colleagues, to intervene differently: more rapid response at collision sites, increased surveillance of dangerous intersections, user awareness-raising on the importance of the highway code, etc. However, sustaining these actions over the longer term has proven difficult. Several lessons were derived from this experience, regarding the importance of producing useful and locally applicable research data, of ensuring the acceptability of the technologies used for data collection, of using collaborative approaches in research and knowledge translation, of ensuring the visibility of actions undertaken by actors in the field, and of involving decision-makers in the research process to maximize its impacts.

Hematological malignancies (HMs) have heterogeneous serological responses after vaccination due to disease or treatment. The aim of this real-world study was to analyze it after Pfizer-BioNT162b2 mRNA vaccination in 216 patients followed up for 1 year. The first 43 patients had an initial follow-up by a telemedicine (TM) system with no major events reported. The anti-spike IgG antibodies were checked 3–4 weeks post-first vaccination and every 3–4 months, by two standard bioassays and a rapid serological test (RST). Vaccine boosts were given when the level was p < 0.001), particularly for patients receiving rituximab. Patients with gammaglobulin levels < 5 g/L had reduced seroconversion compared to higher levels (p = 0.019). The median levels were 228 BAU/mL post-second dose if seroconverted post-first and second, or if seroconverted only post-second dose. A total of 68% of post-second dose negative patients were post-third dose positive. A total of 16% received TC, six with non-severe symptomatic COVID-19 within 15–40 days. Personalized serological follow-up should apply particularly to patients with HMs.

Abstract Background Measuring progress towards financial risk protection for the poorest is essential within the framework of Universal Health Coverage. The study assessed the level of out-of-pocket expenditure and factors associated with excessive out-of-pocket expenditure among the ultra-poor who had been targeted and exempted within the context of the performance-based financing intervention in Burkina Faso. Ultra-poor were selected based on a community-based approach and provided with an exemption card allowing them to access healthcare services free of charge. Methods We performed a descriptive analysis of the level of out-of-pocket expenditure on formal healthcare services using data from a cross-sectional study conducted in Diébougou district. Multivariate logistic regression was performed to investigate the factors related to excessive out-of-pocket expenditure among the ultra-poor. The analysis was restricted to individuals who reported formal health service utilisation for an illness-episode within the last six months. Excessive spending was defined as having expenditure greater than or equal to two times the median out-of-pocket expenditure. Results Exemption card ownership was reported by 83.64% of the respondents. With an average of FCFA 23051.62 (USD 39.18), the ultra-poor had to supplement a significant amount of out-of-pocket expenditure to receive formal healthcare services at public health facilities which were supposed to be free. The probability of incurring excessive out-of-pocket expenditure was negatively associated with being female (β = − 2.072, p = 0.00, ME = − 0.324; p = 0.000) and having an exemption card (β = − 1.787, p = 0.025; ME = − 0.279, p = 0.014). Conclusions User fee exemptions are associated with reduced out-of-pocket expenditure for the ultra-poor. Our results demonstrate the importance of free care and better implementation of existing exemption policies. The ultra-poor’s elevated risk due to multi-morbidities and severity of illness need to be considered when allocating resources to better address existing inequalities and improve financial risk protection.

The inhabitants of the city of Ouagadougou, the capital of Burkina Faso, suffer significant damage every year due to floods, which constitute a major risk for the country. To mitigate the impact of these phenomena, a good understanding of the criteria involved in the vulnerability of populations is necessary. This article sets out to analyse the populations of Ouagadougou’s vulnerability to floods, with the objective of drawing up and spatially representing the social vulnerability profile of populations. It is part of phase 2 of the Raincell Africa project, which aims to understand the social vulnerability of Sahelian populations to the risks of urban flooding. The study is based on a quantitative approach developed by means of a socio-demographic survey of 2137 households in the city of Ouagadougou. Statistical processing of the survey data using factor analysis and Hierarchical Agglomerative Clustering revealed eight vulnerability profiles in the city. The spatial distribution of these profiles indicates greater vulnerability in the margins of the city, characterized by unplanned settlements. This high exposure of informal settlements to flooding is linked to socio-demographic characteristics such as the level of education, risky behaviours in terms of urbanization and the populations’ false perception of danger. These elements must necessarily be taken into account for better flood management.

While the first case of COVID-19 was declared on March 2 2020 in Senegal, the government banned the attendance of places of worship on 14 March, as a first measure. On March 23, it introduced a curfew, a ban on movement between regions, and the closure of markets. The objective of this study is to measure and understand the acceptability of these four governmental measures as well as the level of public trust in the state to fight the pandemic. We carried out a mixed-method research. The acceptability variables were defined using the theoretical framework of acceptability (TFA). At the quantitative level, we carried out a telephone survey (June/July 2020) at the national level (n = 813) with a sampling strategy by marginal quotas. We conducted a qualitative survey (August/September 2020) with a nested sample (n = 30). The results show a relatively high acceptability of the measures but a heterogeneity of responses. People considered curfews to be much more important (85.7% [83.2%; 88.0%]) than the closure of places of worship (55.4%; [51.9%; 58.7%]), which is least in line with the values and positive affective attitude. Several positive unintended effects of the curfew were stated (security and social/family cohesion). People over the age of 60 have more confidence in the government to fight the pandemic than people under the age of 25, although not significant (7.72 ± 3.12 vs. 7.07 ± 3.11, p = 0.1); and they are more in favour of the closure of places of worship. The more regions are affected by the pandemic, the less confidence respondents report in the government and the less they perceive the measures as effective. The results confirm the importance of government communication and trust in the state to strengthen the acceptability of pandemic measures. Important differences in acceptability show the need to adapt measures and their explanations, instead of unqualified universal action.

Abstract Background Several studies highlighted the impact of community-based interventions whose purpose was to reduce the vectors’ breeding sites. These strategies are particularly interesting in low-and-middle-income countries which may find it difficult to sustainably assume the cost of insecticide-based interventions. In this case study we determine the spatial distribution of a community-based intervention for dengue vector control using different entomological indices. The objective was to evaluate locally where the intervention was most effective, using spatial analysis methods that are too often neglected in impact assessments. Methods Two neighbourhoods, Tampouy and Juvenat in Ouagadougou, Burkina Faso, were chosen among five after a survey was conducted, as part of an assessment related to the burden of dengue. As part of the community-based intervention conducted in Tampouy between August and early October 2016, an entomological survey was implemented in two phases. The first phase consisted of a baseline entomological characterization of potential breeding sites in the neighbourhood of Tampouy as well as in Juvenat, the control area. This phase was conducted in October 2015 at the end of the rainy season. The mosquito breeding sites were screened in randomly selected houses: 206 in Tampouy and 203 in Juvenat. A second phase took place after the intervention, in October 2016. The mosquito breeding sites were investigated in the same yards as during the baseline phase. We performed several entomological analyses to measure site productivity as well as before and after analysis using multilevel linear regression. We used Local Indicators of Spatial Association (LISAs) to analyse spatial concentrations of larvae. Results After the intervention, it is noted that LISAs at Tampouy reveal few aggregates of all types and the suppression of those existing before the intervention. The analysis therefore reveals that the intervention made it possible to reduce the number of concentration areas of high and low values of pupae. Conclusions The contribution of spatial methods for assessing community-based intervention are relevant for monitoring at local levels as a complement to epidemiological analyses conducted within neighbourhoods. They are useful, therefore, not only for assessment but also for establishing interventions. This study shows that spatial analyses also have their place in population health intervention research.

Abstract Background Dengue is increasing in its global presence with an estimated 4 billion people at-risk of infection in at least 128 countries. Despite the promising results of EcoHealth and community mobilization approaches to Aedes reduction, more evidence of their efficacy on reducing dengue risk is needed. The principal research question is to determine if interventions based upon community mobilization reduce the risk of dengue virus infection among children 3 to 9 years old compared to usual dengue control practice in Fortaleza, Brazil. Methods The present study will follow a pragmatic cluster randomized controlled trial (cRCT) design with randomization at the census tract level with equal allocation to the two arms. In each arm, there will be 34 clusters of 86 children between 3 to 9 years old for an expected total of 5848 children enrolled in the study, assuming a risk reduction of 29.5% based upon findings from a previous multi-site cRCT. The primary outcomes are rates of anti-dengue Immunoglobulin G (IgG) seroconversion and adult female Aedes density. The intervention is based upon a participatory health research approach, Socializing Evidence for Participatory Action (SEPA), where the research evidence is used to foster community engagement and ownership of the health issue and solution. Following allocation, intervention communities will develop and implement their own solutions that will likely include a wide variety of collective events and media approaches. Data collection activities over a period of 3 years include household visits for blood collection, household surveys, and entomological surveys; and qualitative activities including focus groups, in-depth interviews, and document analysis to evaluate the process, acceptability, fidelity, and sustainability of the intervention. Study participants will be aware of their assignment and all research staff will be blinded although the intervention assignment will likely be revealed to field staff through interaction with participants. Discussion The results of our study will provide evidence on community mobilization as an intervention for dengue control. We anticipate that if community mobilization is effective in Fortaleza, the results of this study will help develop evidence-based vector control programs in Brazil, and also in other countries struggling with Aedes-transmitted diseases. Trial registration ISRCTN66131315, registration date: 1 October 2018.

BackgroundHealth systems are complex systems involving a vast range of actors. In West Africa, they are often not accessible or responsive. Burkina Faso has widely expressed, in its public health policy, the need to improve both access to quality care and health system responsiveness. There is also a strong wish to give more voice to citizens. To support Burkinabè institutions in achieving these goals, we have developed an action research (AR) protocol. ObjectiveThis paper presents the protocol that will address citizens’ participation in health policies and their empowerment through the expression of opinions, for accountability, as well as the strengthening of the health system using information and communication technologies (ICTs). MethodsOur approach will consist of (1) enabling people to express their opinions on the health system by means of a toll-free (TF) service coupled with an interactive voice server (IVS); (2) building an information base with anonymous and reliable data; and (3) conducting information awareness-raising activities, including knowledge transfer (KT) and advocacy, social integration activities, development of OpenData platforms, and the capitalization and media coverage of governance issues. For this purpose, the AR project will be implemented in Burkina Faso. The design uses a concurrent mixed-methods approach. This AR project will evaluate the acceptability, process, effectiveness, and economic costs of the device’s implementation. We will also analyze the potential for the data collected by the device to be used to improve practices. ResultsData collection is in progress; the TF number was officially launched on July 1, 2020, and data collection is planned to continue throughout 2021. By using mixed methods, our AR will be approached from a variety of perspectives. Mixed methods will support us in combining the partial insights into sophisticated realities from qualitative inquiries with the data analyses produced by quantitative research. ConclusionsThis AR is expected to add knowledge on how to increase the empowerment of the population, especially the most vulnerable, to participate in democratic processes and enjoy and exercise their human rights. This protocol recommends implementing a low-cost, contextually adapted technology, associated with an evidence-based approach and carried out on a significant scale. The originality of this approach lies in the fact that it introduces a real AR dimension with local communities and nongovernmental organizations (NGOs), combined with an integrated strategy of KT and application throughout the project for all stakeholders. International Registered Report Identifier (IRRID)DERR1-10.2196/28780

# Introduction The aim of this study was to assess the capacity of Burkina Faso's health services to care for road accident victims, from the crash site up to their recovery and rehabilitation. # Methods We performed a situation analysis rooted in the literature findings, an overview of administrative documents, followed by the analysis of pre-hospital, hospital and post-hospital care. We also performed monitoring visits and interviewed a number of stakeholders, aiming to understand the current situation and identify the most important knowledge gaps, required for the development of policy and implementation of the holistic intervention plan. # Results The study identified numerous and strong deficiencies across the total care of road accident victims management spectrum. The results suggest that a broad-scope intervention is needed, although even smaller-scale effects on elements of total care may yield improvements in specific areas. We also detected a substantial need for more primary studies that can provide relevant data for policy. # Conclusion This study identified numerous problems, which need to be further explored and quantified, before a more systematic intervention can be applied across the country, aiming to reduce the negative health consequences of road accidents.

# Background The telephone is being put to work in the quest for universal health coverage in sub-Saharan Africa. Multiple mobile health pilot projects are being deployed. The use of mobile technologies including citizens in the formulation, analysis, and revision of public health policies in sub-Saharan Africa is recent. This citizen m-participation could influence the democratic engagement of citizens and leaders in the planning, budgeting, and transparency of local governance processes of health systems. # Methods We conducted a scoping review. A total of 995 papers were initially identified, 37 documents were finally included in the final synthesis after a review of the abstract and full text by two researchers. # Results Despite multiple challenges, the social, technological, and instrumental feasibility of citizen m-participation in health decision-making processes is real. The documents highlight the contribution of m-Citizen Participation to the ongoing construction of a robust health democracy. However, government commitment and leadership for this innovation remain weak. This slows down the processes of inclusion and empowerment of patients on their health needs. # Conclusions Evidence suggests that citizen m-participation is relevant to the inclusion of citizens in health decision-making processes. However, research is limited. We recommend participatory action research mechanisms focused on citizen inclusion in health decision-making processes in sub-Saharan Africa to expand the knowledge base on this innovation.

Background In Africa, health systems are poorly accessible, inequitable, and unresponsive. People rarely have either the confidence or the opportunity to express their opinions. In Burkina Faso, there is a political will to improve governance and responsiveness to create a more relevant and equitable health system. Given their development in Africa, information and communication technologies (ICTs) offer opportunities in this area. Methods This article presents the results of an evaluation of a toll-free call service coupled with an interactive voice server (TF-IVS) tested in Ouagadougou, Burkina Faso, to assess its relevance for improving health systems governance. The approach consisted of a 2-phased action research project to test 2 technologies: recorded messages and touch keypad. Using a concurrent mixed approach, we assessed the technological, social, and instrumental relevance of the service. Results The call service is available everywhere, 24 hours per day, seven days per week. The equipment and its physical location were not adequately protected against technological hazards. Of the 278 days of operation, 49 were non-functional. In 8 months, there were 13 877 calls, which demonstrated the popularity of ICTs and the ease of access to telephone networks and mobile technologies. The TF-IVS was free, anonymous, and multilingual, which fostered the expression of public opinion. However, cultural context (religion, ethnic culture) and fear of reprisals may have had a negative influence. In the end, questions remained regarding people’s capacity to use this innovative service. In the first trial, 49% of callers recorded their message and in the second, 48%. Touch key technology appeared more relevant for automated and real-time data collection and analysis, but there was no comprehensive strategy for translating the information collected into a response from healthcare actors or the government. Conclusion This study showed the relevance and feasibility of implementing a TF-IVS to strengthen health system responsiveness in one of the world’s poorest countries. Public opinion expressed through data collected in real-time is helpful for improving system responsiveness to meet care needs and enhance equity. However, the strategy for developing this tool must take into account the implementation context and the activities needed to influence the mechanisms of social responsibility (eg, information provision, citizen action, and state response).

We evaluated the effectiveness of a community-based intervention for dengue vector control in Ouagadougou, the capital city of Burkina Faso. Households in the intervention (n = 287) and control (n = 289) neighborhoods were randomly sampled and the outcomes collected before the intervention (October 2015) and after the intervention (October 2016). The intervention reduced residents’ exposure to dengue vector bites (vector saliva biomarker difference −0.08 [95% CI −0.11 to −0.04]). The pupae index declined in the intervention neighborhood (from 162.14 to 99.03) and increased in the control neighborhood (from 218.72 to 255.67). Residents in the intervention neighborhood were less likely to associate dengue with malaria (risk ratio 0.70 [95% CI 0.58–0.84]) and had increased knowledge about dengue symptoms (risk ratio 1.44 [95% CI 1.22–1.69]). Our study showed that well-planned, evidence/community-based interventions that control exposure to dengue vectors are feasible and effective in urban settings in Africa that have limited resources.

Climate change is projected to induce extreme and irregular rainfall patterns in the West African Sahel region, affecting household food security and income. Children are among the worst affected population groups. Previous studies focusing on rainfall irregularities in specified periods have revealed how child health and nutritional status are impacted, especially in rural settings. However, the aggregated effect of rainfall over a lifetime on chronic child undernutrition remains poorly understood. We conducted a multilevel regression using a 2017 household survey from rural Burkina Faso containing 12 919 under-five-year-old children and their corresponding household rainfall data. The rainfall data originated from the Climate Hazards Infrared Precipitation with Stations monthly dataset with a native resolution of 4.8 km (0.05°). We show that an increase in rainfall below 75 mm monthly average tends to produce poor nutritional outcomes (regression coefficient = −0.11***; 95% CI = −0.13, −0.10; p < 0.001) in rural Burkina Faso children. We found a consistent negative relationship between different sex and household wealth groups, but not age groups. Vulnerable younger children were more affected by the adverse effects of increased rainfall, while older children seemed to handle it better. Our methodological approach tracing the impact of rainfall over children’s lifetimes makes a meaningful contribution to the portfolio of tools for studying the complex relationship between climate change and health outcomes. Our work confirms that rainfall is a risk factor for chronic child undernutrition, highlighting the need for adaptation strategies that boost household and community resilience to counteract the harmful impacts of climate change on child nutritional status.

Abstract Background Vector-borne diseases (VBDs) continue to represent a global threat, with “old” diseases like malaria, and “emergent” or “re-emergent” ones like Zika, because of an increase in international trade, demographic growth, and rapid urbanization. In this era of globalization, surveillance is a key element in controlling VBDs in urban settings, but surveillance alone cannot solve the problem. A review of experiences is of interest to examine other solution elements. The objectives were to assess the different means of VBD surveillance in urban environments, to evaluate their potential for supporting public health actions, and to describe the tools used for public health actions, the constraints they face, and the research and health action gaps to be filled. Main body For this scoping review we searched peer-reviewed articles and grey literature published between 2000 and 2016. Various tools were used for data coding and extraction. A quality assessment was done for each study reviewed, and descriptive characteristics and data on implementation process and transferability were analyzed in all studies. After screening 414 full-text articles, we retained a total of 79 articles for review. The main targets of the articles were arboviral diseases (65.8%) and malaria (16.5%). The positive aspects of many studies fit within the framework of integrated vector management. Public awareness is considered a key to successful vector control programs. Advocacy and legislation can reinforce both empowerment and capacity building. These can be achieved by collaboration within the health sector and with other sectors. Research is needed to develop well designed studies and new tools for surveillance and control. Conclusions The need for surveillance systems in urban settings in both developing and developed countries was highlighted. Countries face the same challenges relating to human, financial, and structural resources. These findings also constitute a wake-up call for governments, academia, funders, and World Health Organization to strengthen control programs and enhance VBD research in urban environments.

BACKGROUND:In Africa, the magnitude of dengue virus (DENV) transmission is largely unknown. In Burkina Faso, several outbreaks have been reported and data are often based on findings from outbreak investigations. METHODS:To better understand dengue epidemiology and clinical characteristics in Burkina Faso, a fever surveillance study was conducted among patients aged 1-55 years, who presented with non-malarial febrile illness at five primary healthcare facilities in Ouagadougou, Burkina Faso from December 2014 to February 2017, encompassing a 3-month dengue outbreak in September-November 2016. Acute and convalescent blood samples were collected within an interval of 10-21 days between visits. Acute samples were tested with dengue rapid diagnostic tests (RDT) and a selected subset with RT-PCR, and all acute/convalescent samples with IgM/IgG ELISA. RESULTS:Among 2929 non-malarial febrile patients, 740 (25%) were dengue-positive based on RT-PCR and/or IgM/IgG ELISA; 428 out of 777 patients (55%) and 312 out of 2152 (14%) were dengue-positive during outbreak and non-outbreak periods, respectively. There were 11% (316/2929) and 4% (129/2929) patients showing positive for NS1 and IgM, on the RDT, respectively. DENV 2 predominated during the outbreak, whereas DENV 3 predominated before the outbreak. Only 25% of dengue-positive cases were clinically diagnosed with suspected dengue. The odds of requiring observation for ≤3 days (versus routine outpatient care) were 11 times higher among dengue-positive cases than non-dengue cases. In adjusted analyses, dengue-positivity was associated with rash and retro-orbital pain (OR = 2.6 and 7.4, respectively) during the outbreak and with rash and nausea/vomiting (OR = 1.5 and 1.4, respectively) during the non-outbreak period. CONCLUSION:Dengue virus is an important pathogen in Burkina Faso, accounting for a substantial proportion of non-malarial fevers both during and outside outbreak, but is only infrequently suspected by clinicians. Additional longitudinal data would help to further define characteristics of dengue for improved case detection and surveillance.

Road accidents among children are now a major public health problem worldwide. According to a WHO report (2015), 186 300 children die on the roads worldwide, and the most at risk of death live in low- and middle-income countries (WHO 2015). The sub-Saharan African region has the highest number of road accidents among children with 32% of deaths (Li, Alonge, and Hyder 2016). They are the most vulnerable to road crash risk because of their physical and cognitive attributes still in development (Cloutier and Apparicio 2008). Ouagadougou, the capital of Burkina Faso, has experienced, and continues to experience, rapid spatial dynamics. The commuting between the periphery and the city centre is very important and generates dense traffic. These mobilities, through the different modes of transport, represent a risk of road accidents for vulnerable users such as children. Little research has been done on children’s exposure to road crash risks. The objective is to analyse the individual characteristics of children and the residential areas urban environment in relation to road accident risk among children under 15 years of age in their daily activities (play and going to and from school) in Ouagadougou. This research aims to understand their vulnerability in their daily mobility on the Ouagadougou territory. We conducted a study in 12 elementary schools in the city of Ouagadougou between April and May 2017 with students under 15 years of age in the first (CE1) and second year (CE2) of elementary classes, and in the first year (CM1) and second year (CM2) of middle classes. The surveyed schools were randomly selected by district. Authorization was requested and granted from the Ministry of National Education and Literacy regional directorate for a survey of students in these schools. Students were interviewed individually using a questionnaire. Each student randomly selected came out of the classroom in turn to answer different questions. Collected data were entered into the Sphinx data processing and analysis software. The data analysis was performed on XLSTAT 2018 software. As for the qualitative data collection method, it is based on direct observation technique including a form on the different types of facilities around schools. More than 500 children (523) were surveyed. Boys (31%) are more involved in accidents than girls (25%). State-employed fathers (41%) and not working fathers (33%) have more children involved in road accidents. At the mother level, it is students (33%) and state employees (31%) who have more children involved in accidents. Children residing in unplanned areas (36%) are more involved in road accidents than those in unplanned areas (18%). Children are more likely to be involved in an accident if they prefer to play on the street in front of the housing yard (31%) and if they prefer to play inside the housing yard (30%). Nearly 28% of children have already had a road accident and 70% of them have been injured. Facilities around schools to reduce the risk of children being involved in road accidents are non-existent. Thus, in all the schools surveyed, no speed bumps were built to reduce the speeds of motorized users, nor were there any warning signs to alert road users of the presence of a school. In addition, schools near major roads (main roads) do not have crossing guards to help children cross. It is important to reduce the risk of accidents among children by providing facilities around schools and in densely populated areas. These results reveal a high exposure of children to accident risks in subdivided areas compared to un-divided areas in Ouagadougou. Monitoring children during their street play and planning policies that take children’s road safety into account are necessary to reduce the risk.

Background: A severe outbreak of dengue occurred in Burkina Faso in 2016, with the most cases reported in Ouagadougou, that highlights the necessity to implement vector surveillance system. This study aims to estimate the risk of arboviruses transmission and the insecticide susceptibility status of potential vectors in four sites in Burkina Faso.Methods: From June to September 2016, house-to-house cross sectional entomological surveys were performed in four cities stretching along a southwest-to-northeast railway transect. The household surveys analyzed the presence of Aedes spp. larvae in containers holding water and the World Health Organization (WHO) larval abundance indices were estimated. WHO tube assays was used to evaluate the insecticide susceptibility within Aedes populations from these localities.Results: A total of 31,378 mosquitoes' larvae were collected from 1,330 containers holding water. Aedes spp. was the most abundant (95.19%) followed by Culex spp. (4.75%). Aedes aegypti a key vector of arboviruses (ARBOV) in West Africa was the major Aedes species found (98.60%). The relative larval indices, house index, container and Breteau indexes were high, up to 70, 35, and 10, respectively. Aedes aegypti tended to breed mainly in discarded tires and terracotta jars. Except in Banfora the western city, Ae. aegypti populations were resistant to deltamethrin 0.05% in the other localities with low mortality rate under 20% in Ouagadougou whereas they were fully susceptible to malathion 5% whatever the site. Intermediate resistance was observed in the four sites with mortality rates varying between 78 and 94% with bendiocarb 0.1%.Conclusions: This study provided basic information on entomological indices that can help to monitor the risks of ARBOV epidemics in the main cities along the railway in Burkina Faso. In these cities, all larval indices exceeded the risk level of ARBOV outbreak. Aedes aegypti the main species collected was resistant to deltamethrin 0.05% and bendiocarb 0.1% whereas they were fully susceptible to malathion 5%. The monitoring of insecticide resistance is also important to be integrated to the vector surveillance system in Burkina Faso.

Climate change is one of today's major challenges, and among the causes of population movement and international migration. Climate migrants impact health systems and how their ability to respond and adapt to their needs and patterns. To date, the resilience of health systems in the context of climate change has barely been explored. The purpose of this article is to show the importance of studying the relationship between climate change, migration, and the resilience of health systems from an interdisciplinary perspective. Resilience is an old concept, notably in the field of psychology, and is increasingly applied to the study of health systems. Yet, no research has analysed the resilience of health systems in the context of climate change. While universal health coverage is a major international goal, little research to date focused on the existing links between climate, migration, health systems and resilience. We propose an interdisciplinary approach relying on the concept of health system resilience to study adaptive and transformative strategies to articulate climate change, migration and health systems.

The particular concern of HIV health care policies is with the transmission of the virus from mother to infant, from delivery until cessation of breastfeeding. PMTCT care seeks to help women reduce the risk by providing suitable services. In Burkina Faso, the authorities have chosen to bring health care facilities physically closer to HIV-positive women by increasing provision and thereby reducing the distance of access to them. Our purpose is to define the area in which these health care practices take place and the factors that determine them. 30 women were monitored for this study, from pregnancy until the infant reached six months of age, in Ouagadougou, the capital of Burkina Faso. The results show the women’s active involvement in attending PMTCT services. They travel long distances in a difficult physical environment, often using precarious means of transport. But the relationship between the distances from place of residence and health care is unexpected. The observations are at variance with research studies which show that the distance from health care facilities is not a criterion of attendance. While urban studies present distance as a neutral factor in the context of the use of care health services, our research shows distance as a criterion for attendance. Regardless the means of transport used, women travel long distances for PMTCT follow-up, as opposed to usual care.

Road traffic accidents are the major cause of mortality among people aged 15-29 years in Africa. World Health Organisation (WHO) and the World Bank launched a Decade of Action for Road Safety in 2011 with the goal of halving the number of injuries and deaths on the roads. No progress has been reported in Low and Middle Income Countries (LMICs) and the number of deaths remains very high. To reach the target set, there is a need for interventions in several areas. This scoping review proposes to produce a synthesis by identifying the kinds of interventions and outcomes which have been carried out on the African continent. Using the scoping studies method, 23 articles were selected and analysed. The study shows that interventions were developed in four fields: road safety policy, health education, safety equipment and data collection. It shows also that there were records of interventions in only twelve countries, mostly in Eastern and Southern Africa. The main conclusion of this study reveals both a lack of road safety interventions and shortcomings in the assessment of those performed and selected for our study.

La relation entre mobilité et extension urbaine a donné naissance à plusieurs modèles de ville. Les pratiques d’aménagement, fortement dépendantes de l’automobile, ont participé au processus d’étalement urbain caractéristique des pays du nord. Ce modèle observé également dans les capitales africaines repose toutefois sur des modes de déplacements très variés, sources d’une grande vulnérabilité pour les usagers et d’un nombre élevé de traumatismes issus des accidents de la route. Cet article vise à comprendre en quoi l’aménagement urbain participe de cette vulnérabilité dans la capitale du Burkina Faso, Ouagadougou. L’étude repose sur la géolocalisation des lieux d’accidents et des entrevues réalisées auprès des acteurs communaux. Les résultats montrent un lien fort entre étalement urbain et importance des accidents de la route de façon originale puisqu’ils sont caractéristiques des axes revêtus. Le développement de l’habitat est au coeur des politiques urbaines, la question de la mobilité est beaucoup plus récente, imposée par la croissance démographique. Cependant, la politique des transports en commun reste embryonnaire, le moyen de déplacement privilégié est le deux roues. Le pouvoir local ne semble pas avoir pour vocation de protéger les populations vulnérables en circulation, la valeur dominante en matière de conception du réseau routier reposant sous la garantie d’une mobilité toujours plus fluide et négligeant la sécurité routière. L’extension du réseau bitumé apparaît donc comme un facteur favorable à la multiplication des accidents de la route au Burkina Faso.

Background: In the early 2000s, electronic surveillance systems began to be developed to collect and transmit data on infectious diseases in low-income countries (LICs) in real-time using mobile technologies. Such surveillance systems, however, are still very rare in Africa. Among the non-infectious epidemics to be surveilled are road traffic injuries, which constitute major health events and are the fifth leading cause of mortality in Africa. This situation also prevails in Burkina Faso, whose capital city, Ouagadougou, is much afflicted by this burden. There is no surveillance system, but there have been occasional surveys, and media reports of fatal crashes are numerous and increasing in frequency. Objective: The objective of this article is to present the methodology and implementation of, and quality of results produced by, a prototype of a road traffic crash and trauma surveillance system in the city of Ouagadougou. Methods: A surveillance system was deployed in partnership with the National Police over a six-month period, from February to July 2015, across the entire city of Ouagadougou. Data were collected by all seven units of the city’s National Police road crash intervention service. They were equipped with geotracers that geolocalized the crash sites and sent their positions by SMS (short message service) to a surveillance platform developed using the open-source tool Ushahidi. Descriptive statistical analyses and spatial analyses (kernel density) were subsequently performed on the data collected. Results: The process of data collection by police officers functioned well. Researchers were able to validate the data collection on road crashes by comparing the number of entries in the platform against the number of reports completed by the crash intervention teams. In total, 873 crash scenes were recorded over 3 months. The system was accessible on the Internet for open consultation of the map of crash sites. Crash-concentration analyses were produced that identified ‘hot spots’ in the city. Nearly 80% of crashes involved two-wheeled vehicles. Crashes were more numerous at night and during rush hours. They occurred primarily at intersections with traffic lights. With regard to health impacts, half of the injured were under the age of 29 years, and 6 persons were killed. Conclusions: This pilot study demonstrated the feasibility of developing simple surveillance systems, based on mHealth, in LICs.

A pedestrian is mainly exposed in urban area to traffic accident when crossing the street. A pedestrian in a trip spent time during a crossing in a micro-environment characterized by the volume and the speed of the flows of vehicles. The objectives of the research are: 1. to define the methodology to collect by survey and to code in a GIS, information about the trip and the crossings made on the urban network by a pedestrian and to match it with information on traffic flows on the street network,2. to test this methodology on a sample of trips made by adult pedestrians in order to quantify the length of the trip, the number of crossings, the part of crossings made at mid-block or junctions on a specific urban setting, la ville nouvelle de Villeneuve d'Ascq.

Industrial accidents are a major risk in many countries. Despite this observation, effective preventive action is not being developed and studies of the behaviors of vulnerable populations remain under-explored. According to safety instructions, residents must take shelter and remain indoors but other behaviors may be observed such as: running away from the affected area, panicking, or following people around. In order to assess the attitudes of people and the effects of local contingencies that could interfere with official advice in the event of a toxic cloud, a specific agent-based model called TOXI-CITY has been developed. The aim of this explorative model is to determine whether a minimum number of well-informed agents (i.e. those who follow the emergency protocol) can save a maximum number of uninformed and impressionable ones. Simulations indicate that the initial number of agents and the spatial configuration of the grid strongly influence final survival rates. A non-linear pattern emerged: survival rates increase when well-informed agent rates are low (below 30%) while increasing the percentage of informed agents (from 70%) seems to improve only slightly the chances of survival.

Cet article présente une méthode de cartographie participative réalisée auprès d’habitants de Ouagadougou (Burkina Faso) sur la base de focus groups. Ces ateliers ont été conçus pour alimenter une réflexion méthodologique sur l’accès à l’espace urbain dans la capitale burkinabè. Cette méthode, qui mêle démarches qualitative, quantitative et spatiale, a consisté à réunir des habitants de différents quartiers de la ville et à les interroger sur leurs pratiques et représentations spatiales. Les données recueillies retranscrites pendant le focus group sur un SIG, sont ensuite proposées aux habitants sous formes de cartes projetées sur l’écran, sur lesquelles ceux-ci sont invités à réagir. Ces ateliers permettent de construire une conception fine des représentations des habitants et proposent une hiérarchisation alternative des espaces.