Pratiques de prise en charge de l'hypertension artérielle au Centre Hospitalier et Universitaire d' Abomey-Calavi au Bénin / NA

L'hypertension artérielle est une maladie à forte progression reste un problème de santé publique. Mais, les pratiques de sa prise en charge se heurtent à différents obstacles. Cette recherche questionne les problèmes qui caractérisent les pratiques de prise en charge de l'hypertension artérielle au Centre Hospitalier et Universitaire d'Abomey-Calavi au Bénin. Pour y parvenir, nous avons opté pour une analyse basée sur les méthodes quantitatives et qualitatives. L'échantillon est constitué de 130 personnes enquêtées. De l'analyse des résultats collectés, des difficultés éprouvées entre patients et agents de santé dans la prise en charge de l'hypertension artérielle, se caractérise par le manque de relation soignant-soigné. De même, 90% des enquêtés estiment avoir peu de ressources humaines qualifiées et du faible pouvoir d'achat des patients pour faire face aux coûts élevés du traitement de l'hypertension (86,75%). Ainsi, le manque de plateau technique et les frais de consultations spécialisées posent problèmes y compris les suivis de l'éducation hygiéno-diététique. Cet état de fait compromet les pratiques de prise en charge et les formations globales que le système soin est supposé assurer aux usagers qui le fréquentent. Ces résultats suggèrent l'urgence de formations pour le renforcement des capacités pour repérer la précarité et la réorganisation des mesures de prise en charge de l' hypertension artérielle dans le périmètre sanitaire béninois.

Arterial hypertension remains a rapidly growing public health problem. However, management practices face a number of obstacles. This research questions the problems that characterize arterial hypertension management practices at the Centre Hospitalier et Universitaire d'Abomey-Calavi in Benin. To achieve this, we opted for an analysis based on quantitative and qualitative methods. The sample consisted of 130 respondents. From the analysis of the results collected, of the difficulties experienced between patients and health workers in the management of arterial hypertension, most of those surveyed claimed to have a complexity that characterizes the training of health workers. Similarly, 90% of respondents felt that they had few non-cardiologist practitioners, and that patients had little purchasing power to meet the high costs of treating hypertension (86.75%). As a result, the cost of specialized consultations and complementary examinations poses a problem, including follow-up health and diet education. This state of affairs compromises management practices and the comprehensive training that the healthcare system is supposed to provide for its users. These results suggest the urgent need for training to identify precariousness, and the reorganization of hypertension management measures within the Beninese health perimeter.

Prevalence of COVID-19 at the Wahgnion-Gold mining site in Burkina Faso and use of RT-PCR initial cycle threshold to monitor the dynamics of SARS-CoV-2 load

Background: To control the spread of coronavirus disease-19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), it is necessary to adequately identify and isolate infectious patients particularly at the work place. Real time polymerase chain reaction (RT-PCR) assay is the recommended confirmatory method for the diagnosis of SARS-CoV-2 infection. The aim of this study was to determine the prevalence of SARSCoV-2 infection in Burkina Faso and to use the initial cycle threshold (Ct) values of RT-PCR as a tool to monitor the dynamics of the viral load. Methodology: Between September 2021 and February 2022, oropharyngeal and/or nasopharyngeal swab samples of consecutively selected COVID-19 symptomatic and apparently healthy workers from the Wahgnion mining site in the South-western Burkina Faso who consented to the study were collected according to the two weeks shift program and tested for SARS-CoV-2 using RT-PCR assay. Patients positive for the virus were followed-up weekly until tests were negative. Association of the initial RT-PCR Ct values with disease duration was assessed by adjusted linear regression approach. Two-sided p value < 0.05 was considered statistically significant. Results: A total of 1506 (92.9% males) participants were recruited into the study, with mean age and age range of 37.18.7 and 18-68 years respectively. The overall prevalence of SARS-CoV-2 infection was 14.3% (216/1506). Of the 82 patients included in the follow-up study, the longest duration of positive RT-PCR test, from the first positive to the first of the two negative RT-PCR tests, was 33 days (mean 11.6 days, median 10 days, interquartile range 8- 14 days). The initial Ct values significantly correlated with the duration of RT-PCR positivity (with ß=-0.54, standard error=0.09 for N gene, and ß=-0.44, standard error=0.09 for ORF1ab gene, p<0.001). Participants with higher Ct values corresponding to lower viral loads had shorter viral clearance time than those of lower Ct values or higher viral loads. Conclusion: Approximately 1 out of 7 tested miners had SARS-CoV-2 infection and the duration of their RT-PCR tests positivity independently correlated with the initial viral load measured by initial Ct values. As participants with lower initial Ct values tended to have longer disease duration, initial RT-PCR Ct values could be used to guide COVID-19 patient quarantine duration particularly at the work place.

Contexte: Pour contrôler la propagation de la maladie à coronavirus 19 (COVID-19) causée par le syndrome respiratoire aigu sévère coronavirus-2 (SRAS-CoV-2), il est nécessaire d'identifier et d'isoler de manière adéquate les patients infectieux, en particulier sur le lieu de travail. Le test de réaction en chaîne par polymérase en temps réel (RT-PCR) est la méthode de confirmation recommandée pour le diagnostic de l'infection par le SRAS-CoV-2. Le but de cette étude était de déterminer la prévalence de l'infection par le SRAS-CoV-2 au Burkina Faso et d'utiliser les valeurs du seuil initial du cycle (Ct) de la RT-PCR comme outil de suivi de la dynamique de la charge virale. Méthodologie: Entre septembre 2021 et février 2022, des écouvillonnages oropharyngés et/ou nasopharyngés de travailleurs symptomatiques COVID-19 et apparemment en bonne santé sélectionnés consécutivement du site minier de Wahgnion dans le sud-ouest du Burkina Faso qui ont consenti à l'étude ont été prélevés selon les deux programme de quart de semaines et testé pour le SRAS-CoV-2 à l'aide d'un test RT-PCR. Les patients positifs pour le virus ont été suivis chaque semaine jusqu'à ce que les tests soient négatifs. L'association des valeurs Ct initiales de la RT-PCR avec la durée de la maladie a été évaluée par une approche de régression linéaire ajustée. Une valeur p bilatérale < 0,05 a été considérée comme statistiquement significative. Résultats: Un total de 1506 participants (92,9% d'hommes) ont été recrutés dans l'étude, avec un âge moyen et une tranche d'âge de 37,1 à 8,7 ans et de 18 à 68 ans, respectivement. La prévalence globale de l'infection par le SRAS-CoV-2 était de 14,3% (216/1506). Sur les 82 patients inclus dans l'étude de suivi, la plus longue durée de test RT-PCR positif, du premier test positif au premier des deux tests RT-PCR négatifs, était de 33 jours (moyenne 11,6 jours, médiane 10 jours, intervalle interquartile 8-14 jours). Les valeurs Ct initiales étaient significativement corrélées à la durée de positivité de la RT-PCR (avec ß=-0,54, erreur standard=0,09 pour le gène N et ß=-0,44, erreur standard=0,09 pour le gène ORF1ab, p<0,001). Les participants avec des valeurs de Ct plus élevées correspondant à des charges virales plus faibles avaient un temps de clairance virale plus court que ceux avec des valeurs de Ct plus basses ou des charges virales plus élevées. Conclusion: Environ 1 mineur testé sur 7 était infecté par le SRAS-CoV-2 et la durée de la positivité de ses tests RTPCR était indépendamment corrélée à la charge virale initiale mesurée par les valeurs Ct initiales. Comme les participants avec des valeurs Ct initiales inférieures avaient tendance à avoir une durée de maladie plus longue, les valeurs Ct initiales de la RT-PCR pourraient être utilisées pour guider la durée de la quarantaine des patients COVID19, en particulier sur le lieu de travail.

Perspectives of Nigerian doctors on the practice of rebates, fee-splitting, and kickbacks

Background: Fee splitting is a global pandemic in the health-care industry, whereby financial and nonfinancial inducements are offered to health-care practitioners in exchange for guaranteed patient referral, continuous patronage, or preferential usage/prescription of the payer's products. Methods: We surveyed 280 medical doctors from August 2017 to October 2017 to assess their knowledge, perception, and attitude toward fee-splitting using self-administered questionnaires.Results: The majority (89%) of our respondents indicated that they were aware of the existence of fee-splitting in the Nigerian health-care industry. About 34% accept rebates, while 70% admitted to knowing other colleagues who accept rebates. The amount received as rebates was ≤20% of the cost of an investigation. More than half of the respondents (52%) opined that the practice is a nationwide phenomenon. An astonishing 78% of respondents either did not know (61%) or asserted wrongly (17%) that the practice is not a violation Nigerian Medical Council rules. Only 46% affirmed that the practice is unethical. Compared to private hospitals, fee-splitting is less in public hospitals. Sixty-one percent noted that other health-care workers (besides physicians) are also involved. The primary allures of fee-splitting were a quest for an extra source of income (64%), poor/irregular salaries (60%), ignorance of its illegality (56%), and greed (47%). The identified deleterious consequences were unnecessary investigations/procedures, inflated health-care cost, quackery, delayed treatment/prolonged hospital stay, beclouded clinical judgment, and negative public perception.Conclusion: Stricter regulatory enforcement and continuous ethics education are needed to disrupt the widespread fee-splitting culture

Estimation of Maternal and Child Mortality One Year after User-Fee Elimination: an Impact Evaluation and Modelling Study in Burkina Faso

Objective To estimate the impact on maternal and child mortality after eliminating user fees for pregnant women and for children less than five years of age in Burkina Faso. Methods: Two health districts in the Sahel region eliminated user fees for facility deliveries and curative consultations for children in September 2008. To compare health-care coverage before and after this change; we used interrupted time series; propensity scores and three independent data sources. Coverage changes were assessed for four variables: women giving birth at a health facility; and children aged 1 to 59 months receiving oral rehydration salts for diarrhoea; antibiotics for pneumonia and artemesinin for malaria. We modelled the mortality impact of coverage changes in the Lives Saved Tool using several scenarios. Findings Coverage increased for all variables; however; the increase was not statistically significant for antibiotics for pneumonia. For estimated mortality impact; the intervention saved approximately 593 (estimate range 168-1060) children's lives in both districts during the first year. This lowered the estimated under-five mortality rate from 235 deaths per 1000 live births in 2008 to 210 (estimate range 189-228) in 2009. If a similar intervention were to be introduced nationwide; 14 000 t o 19 000 ( estimate range 4000-28 000) children's lives could be saved annually. Maternal mortality showed a modest decrease in all scenarios. Conclusion In this setting; eliminating user fees increased use of health services and may have contributed to reduced child mortality

Accessibility of medicines and primary health care: the impact of the revolving drug fund in Khartoum State

This paper presents a comprehensive evaluation of a country where a revolving drug fund (RDF) has lasted for fifteen years and serves more than three million patients annually; with more than SDG 2.8 million (Sudanese Pound) (US$11.1 million) annual turn over. Regardless of the fact that the supply of medicines and improvement in public health facilities utilization are among the main objectives of user fees policy; there is little information on the effect of RDF on accessibility of essential medicines and its impact on the utilization of public health services where RDF schemes have been introduced. We measured the percentage of prescribed medicines dispensed to patients in selected health facilities (both RDF and non-RDF); the availability of essential medicines in a twelve month period in order to determine whether the cost of the medicines is a barrier to utilization of public health services with RDF scheme in Khartoum State (KS). Structured interviews with users (186); personal observations; and archival as well as statistical records were used to capture data of interest relevant to the study objective. The average availability rate of key items was greater (93) in the RDF facilities compared to 86in non-RDF facilities. RDF records also showed that the availability of medicines in the RDF health facilities ranged from 95 to 100in the twelve months period studied. Data from the household survey; demonstrated that over a third (36) of respondents did not consult public health facilities when a member of a household was ill two weeks prior to the date of interview. Of note; only 9of them said that this was because of unavailability of medicines. This study suggests that the RDF scheme adopted by KS made essential medicines available at its health facilities and increased health services utilization compared to those without RDF scheme. Therefore; sustained availability of low cost medicines near where people live that benefit previously disadvantaged poor population; particularly the vulnerable rural groups is achievable through RDF

User fees in government health units: a health worker's view

Origins of user fees : there have been few more fascinating subjects in human history than man's efforts to seek panacea for disease conditions; to nurse the ailing and to prolong life. The first medicine men; through prayer; magic and natural remedies accidentally discovered and made the cornerstone of the present cosmopolitan therapy; otherwise known as the western medicine. It must nevertheless be remembered that efforts for this virtue had to be rewarded either in cash; labour or in kind. It is only a few practitioners like St. Luke; Cornelius and Panellaeu that offered free medical services to people without charging a single coin. Even Hippocrates who lived more than 2000 years ago and who is deemed to be the father of medicine and by whom our doctors are sworn in during their graduation; used to charge his patients. It was only on a few occasions that he could offer free treatment to the indgent; paupers; prisoners etc. User fees for traditional medicine: In Africa; contribution by the direct beneficiaries or their relatives to the traditional medicine is not new either. The Ngozi Society in western Uganda made payments to get local medicine man; in form of a chicken; goat; cow and occasionally in form of human life represent user-financing of health services in this treatise. A study done around Kampala showed that more than 20of people (and this is an underestimate) visit shrines and pay colossal sums of money or equivalent. This category includes people from all walks of life; priests; businessmen and women; politicians; etc

Community participation in PHC

The Ekwendeni Primary Health Care area covers approximately 35;000 people in 400 square miles. The articles discusses the role of the Village Health Committees [VHCs] and the concept of community cost sharing in effective primary health care

A World Bank country study : Zimbabwe Financing Health Services

The main objectives of the report are to identify options for improving efficiency in the provision of health services in Zimbabwe; and to find more effective ways to mobilize additional resources for the country's rapidly evolving health system. Through the use of national; provincial-district; and health facility-specific data (much of which were collected and analysed for the first time for use in the present report); the authors are able to examine a series of key issues related to (a) allocative and technical efficiency in the health sector; (b) the equitable distribution of financial resources and health services; and (c) the immediate and long-run availability of funding to meet Zimbabwe's changing health needs. The context for the report is one of rising personal incomes (and demand for health care); increasingly severe budgetary constraints; and an epidemiological pattern that includes both traditional childhood and communicable diseases and new challenges in the form of adult chronic disease and AIDS. The authors conclude that; while Zimbabwe has made enormous strides during its first decade of independence (1980-89) in expanding health services; especially to neglected rural areas; much remains to be done in the 1990s to: make services accessible to all segments of the preventive health care such as child immunizations; safe motherhood activities; family planning; and rural water and sanitation; and increase technical efficiency (especially in hospitals) by controlling length of patient stay; staff deployment; drug consumption; and vehicle usage. Continuing to improve access and enhance efficiency are especially important for Zimbabwe at this critical juncture; with the country about to embark on an economic adjustment program that will entail fiscal austerity and could have adverse effects on the poor; if countervailing measures are not adopted. The report also concludes that; with the cash-strapped public sector now providing more than half the health services and health financing in Zimbabwe; non-governmental actors will need to play an increasingly important role in the future. This means that the Government will have to find ways to permit and encourage non-governmental institutions (including church missions; private doctors; and nurses; commercial enterprises; and traditional practitioners) to extend service coverage. Moreover; a wide range of existing but under-exploited sources of heatlh financing in Zimbabwe -- including user fees; private insurance; and municipal and local government revenues -- need to be tapped more fully; in order to stretch scarce central government funding further and ensure that all Zimbabweans will eventually have access to good quality health care services

Improving the implementation of cost recovery for health: lessons from Zimbabwe

This paper summarizes the findings and recommendations of a team of local and foreign consults who were recruited to assess the structure and level of user charges and exemptions from paying fees; evaluate the billing and collection performance of MOH health facilities; and make recommendations on both the fee structure and on billing/collection procedures. The team made several visits to Zimbabwe during the last part of 1990 and the beginning of 1991 to review cost recovery performance and to recommend improvements in pricing; billings and collections procedures

The effects of ESAP and drought on social workers

Under ESAP; the government was called upon to reduce expenditure. As a result; health fees were introduced and school fees in urban primary schools were reintroduced after 10 years of free education. People who normally depend on their agriculture produce had to line up for food aid as drought intensified throughout the country. Details of the Supplementary Feeding Scheme; access to drought relief; agricultural recovery programme; education; social dimensions; health and employment are included

Public/private sector mix for health care

"A baseline survey was carried out in order to establish the current status of the public/private mix in health care services in Zimbabwe. The findings were: 1. the current centralised budgetary and financing structures are not conducive to effective and efficient allocation of scarce financial resources. 2. the use of the ""incremental"" budgeting system which does not take into account important parameters like diseases types and patterns and demographic factors (population size; structure and distribution) leads to deficient and inequitable distribution of resources across the provinces. 3. the policy of free health services for those who earn below a given income threshold has not achieved the intended created implementation problems especially as regards the screaning process of who should pay and who should not. Running two parallel systems where some people pay for health services and others do not has also created inefficient problems; and is administratively expensive to run. 4. the public sector is indirectly subsidizing the private sector in some way which should not be the case e.g private patients occupying beds in public institutions are paying fees which are below actual costs; most doctors trained using public funds desert the public sector before they have served long enough to satisfy government investment in them; tax rebates on health insurance..."

The effects of ESAP and drought on health in Zimbabwe

The report covers increase in health fees; devaluation of the Zimbabwe dollar and its effects on drug supply and hospital equipment; emigration of trained health personnel; food shortages and malnutrition