Optimizing primary health care in Burkina Faso: an approach informed by EQUIST / Optimisation des soins de santé primaires au Burkina Faso : une approche éclairée par l'outil EQUIST

Introduction: Burkina Faso has made access to primary health care a national priority by including it in the 2021-2030 national health development plan. Purpose of research: Our study aimed to analyze the causes of inequalities in access to primary health care, priority interventions and strategies for strengthening primary health care, and their potential impact on reducing maternal and infant mortality. Results: Diarrheal diseases, malaria, and pneumonia are the main causes of inequalities in infant and child deaths in rural areas. As for maternal deaths, abortion and its complications are the main causes of inequalities in deaths associated with hypertensive disorders. The Sahel, Boucle du Mouhoun, Center-North, East, and Cascades regions are the geographical areas where interventions are essential to reduce inequalities in maternal, neonatal, infant and child deaths and malnutrition. Conclusions: The national priorities have included all the high-impact interventions for strengthening primary health care identified in our study. Interventions must prioritize the populations in rural areas, the most affected and high-impact geographical regions. This requires the involvement and empowerment of beneficiary communities and the consideration of the fragile safety context.

Introduction: Le Burkina Faso a fait de l'accès aux soins de santé primaires (SSP) une priorité nationale en l'inscrivant dans le plan national de développement sanitaire 2021-2030. But de l'étude: Notre étude visait à analyser les causes des inégalités d'accès aux SSP, les interventions prioritaires et les stratégies pour leur renforcement ainsi que leurs impacts potentiels sur la réduction de la mortalité maternelle et infantile. Résultats: Les maladies diarrhéiques, le paludisme et la pneumonie constituent les principales causes d'inégalités de décès infanto-juvénile en milieu rural. Quant aux décès maternels, l'avortement et ses complications étaient les principales causes d'inégalités des décès, associées aux troubles hypertensives. Les régions du Sahel, Boucle du Mouhoun, Centre-Nord, Est et les Cascades sont les zones géographiques où les interventions sont indispensables pour réduire les inégalités de décès maternels, néonataux, infanto-juvéniles et la malnutrition. Conclusion: Les priorités nationales ont pris en compte l'ensemble des interventions à haut impact de renforcement des SSP identifiées dans notre étude. La mise en œuvre des interventions doit prioriser les populations des milieux ruraux, les régions géographiques les plus affectés et ayant un haut impact. Ceci passe par l'implication et l'autonomisation des communautés bénéficiaires et la prise en compte du contexte de fragilité sécuritaire.

Individual and Contextual Factors Associated With Malaria Among Children 6-59 Months in Burkina Faso.

Objective: This study aims to understand the individual and contextual factors associated with malaria among children aged 6-59 months in Burkina Faso. Methods: This cross-sectional study used secondary data extracted from the Burkina Faso Malaria Indicator Survey 2017-2018. Descriptive analysis was used to analyse socio-demographic characteristics. We performed a multilevel logistic regression model to highlight individual and contextual factors of children's exposure to malaria. Results: Our analysis included 5,822 children aged 6-59 months. Of these, 15% had a positive rapid diagnostic test. Factors associated with malaria among children 6-59 months were age, maternal education, household wealth, rural residence, and region. The variability in malaria exposure was 16% attributable to the strata level and 23% to the primary sampling unit level. Some factors, such as the family's socio-economic status, access to hospital care, and place of living, were positively associated withs malaria cases in children. Conclusion: The study identified some individual and contextual determinants of malaria among children aged 6-59 months in Burkina Faso. Taking them into account for the design and implementation of policies will undeniably help in the fight against malaria in Burkina Faso.

Factors associated with mothers' health care-seeking behaviours for childhood fever in Burkina Faso: findings from repeated cross-sectional household surveys.

INTRODUCTION: Fever is one of the most frequent reasons for paediatric consultations in Burkina Faso, but health care-seeking behaviours and the factors associated with health care-seeking in the event of childhood fever are poorly documented. This study aims to analyse the health care-seeking behaviours and the factors associated with health care-seeking for childhood fever in Burkina Faso. METHODS: This study used the data from the baseline and endline surveys conducted to evaluate the impact of the Performance-Based Financing program in Burkina Faso. Univariate and multivariate binary logistic regression analyses were used to identify the factors associated with appropriate healthcare-seeking for childhood fever. Odds ratios were estimated to assess the strength of associations and 95% confidence intervals (CIs) were used for significance tests. Data were cleaned, coded and analysed using Stata software version 16.1. RESULTS: Among the children under five who had a fever, 75.19% and 79.76% sought appropriate health care in 2013 and 2017, respectively. Being 24-59 months old (AOR: 0.344, 95% CI 0.182-0.649 in 2013 and AOR: 0. 208, 95% CI 0.115-0.376 in 2017), living in a very wealthy household (AOR: 2.014, 95% CI 1.149-3.531 in 2013 and AOR: 2.165, 95% CI 1.223-3.834 in 2017), having a mother with a secondary or higher level of education or having made at least four antenatal care visits were significantly associated with seeking appropriate health care for childhood fever. Living in an area where the health facility is safe was also significantly associated with seeking appropriate care for childhood fevers. CONCLUSIONS: The findings underscore the need to concentrate efforts aiming at sensitizing the population (especially women of childbearing age) to improve sanitation and the use of family planning (household composition), skilled antenatal care and postnatal care to help reduce the prevalence of fever in children under five and improve the use of medical healthcare for childhood fever.

Factors Associated With Home Births in Benin and Mali: Evidence From the Recent Demographic and Health Surveys.

Introduction: Identifying and understanding the factors associated with homebirths can contribute to improving maternal and child health and achieving the Sustainable Development Goals (SDGs). This study aimed to perform a comparative analysis of the factors associated with homebirths in Benin and Mali. Method: This study is based on the most recent data from the Demographic Health Surveys conducted in Mali and Benin in 2018. The dependent variable was homebirth, and the explanatory variables were the individual characteristics of the woman, the distance to the health center, the place of residence, the number of prenatal consultations had, the frequency of media exposure, and the use of the Internet. The primary survey unit (PSU) was considered in the analysis to measure the effect of context on the choice of the place of delivery. Further, descriptive statistics and multilevel logistic regression analysis were used in the study. Results: Educational level was associated with homebirth in Benin and Mali; Women with either no education or primary education are more likely to give birth at home. Women who didn't live close to a health facility were more likely to give birth at home than those who didn't face this problem in both countries. Not making visits for antenatal care (ANC) increases the odds of having a homebirth by 31.3 times (CI = 24.10-40.70) in Benin and 12.91 times (CI = 10.21-16.33) in Mali. Similarly, women who went on 1-2 ANC visits were more likely to give birth at home compared with women who made five or more ANC visits in both countries. The number of children per woman was also a significant factor in both countries. Women who often or regularly paid attention to the media messages were less likely to give birth at home compared with those who did not follow relevant media inputs (aOR = 0.42 [CI = 0.26-0.67] in Benin and aOR = 0.65 [CI = 0.50-0.85] in Mali). Conclusion: Increasing the demand and uptake of women's health services by improving the availability and quality of services and establishing community health centers could help reduce the incidence of homebirths that can be risky and, thus, combat maternal and infant mortality.

Determinants of Antenatal Care Utilization Among Childbearing Women in Burkina Faso.

Introduction: Antenatal care (ANC) is one of the pillars of maternal and child health programs aimed at preventing and reducing maternal and child morbidity and mortality. This study aims to identify the factors associated with ANC use, considering both health care demand and supply factors in the single analysis. Methods: We used data from the endline survey conducted to evaluate the impact of the performance-based financing (PBF) program in Burkina Faso in 2017. This study was a blocked-by-region cluster random trial using a pre-post comparison design. The sample was derived in a three-stage cluster sampling procedure. Data collection for the endline surveys included a household survey and a facility-based survey. Women of childbearing age who gave birth at least once in the past 2 years prior to this survey and residing in the study area for more than 6 months were included in this study. Multilevel statistical techniques were used to examine individual and contextual effects related to health care demand and supply simultaneously and thus measure the relative contribution of the different levels to explaining factors associated with ANC use. Results: The working women were five times [odd ratio (OR): 5.41, 95% confidence intervals (CI) 4.36-6.70] more likely to report using ANC services than the women who were not working (OR: 5.41, 95% CI 4.36-6.70). Women living in a community with high poverty concentration were 32.0% (OR: 0.68, 95% CI 0.50-0.91) less likely to use ANC services than those in a community with low poverty concentration. Women living in a community with a medium concentration of women's modern contraceptive use were almost two times (OR: 1.88, 95% CI 1.70-2.12) more likely to use ANC services than those living in a community with a low concentration of women's modern contraceptive use. Women living in the health area where the level of ANC quality was high were three times (OR: 2.96, 95% CI 1.46-6.12) more likely to use ANC services than those in the health area where the ANC quality was low. Conclusion: Policies that increase the opportunity for improving the average ANC quality at the health facility (HF), the level of women's modern contraceptive use and women employment would likely be effective in increasing the frequency of use of antenatal services.

The first year of the COVID-19 pandemic in the ECOWAS region.

Objective: to analyse the pandemic after one year in terms of the evolution of morbidity and mortality and factors that may contribute to this evolution. Design: This is a secondary analysis of data gathered to respond to the COVID-19 pandemic. The number of cases, incidence rate, cumulative incidence rate, number of deaths, case fatality rate and their trends were analysed during the first year of the pandemic. Testing and other public health measures were also described according to the information available. Settings: The 15 States members of the Economic Community of West African States (ECOWAS) were considered. Results: As of 31st March 2021, the ECOWAS region reported 429,760 COVID-19 cases and 5,620 deaths. In the first year, 1,110.75 persons were infected per million, while 1.31% of the confirmed patients died. The ECOWAS region represents 30% of the African population. One year after the start of COVID-19 in ECOWAS, this region reported 10% of the cases and 10% of the deaths in the continent. Cumulatively, the region has had two major epidemic waves; however, countries show different patterns. The case fatality rate presented a fast growth in the first months and then decreased to a plateau. Conclusion: We learn that the context of COVID-19 is specific to each country. This analysis shows the importance of better understanding each country's response. During this first year of the pandemic, the problem of variants of concern and the vaccination were not posed. Funding: The study was funded by the International Development Research Centre (IDRC) under CATALYSE project.

The first year of the COVID-19 pandemic in the ECOWAS region

Objective: to analyse the pandemic after one year in terms of the evolution of morbidity and mortality and factors that may contribute to this evolution Design: This is a secondary analysis of data gathered to respond to the COVID-19 pandemic. The number of cases, incidence rate, cumulative incidence rate, number of deaths, case fatality rate and their trends were analysed during the first year of the pandemic. Testing and other public health measures were also described according to the information available. Settings: The 15 States members of the Economic Community of West African States (ECOWAS) were considered. Results: As of 31st March 2021, the ECOWAS region reported 429,760 COVID-19 cases and 5,620 deaths. In the first year, 1,110.75 persons were infected per million, while 1.31% of the confirmed patients died. The ECOWAS region represents 30% of the African population. One year after the start of COVID-19 in ECOWAS, this region reported 10% of the cases and 10% of the deaths in the continent. Cumulatively, the region has had two major epidemic waves; however, countries show different patterns. The case fatality rate presented a fast growth in the first months and then decreased to a plateau. Conclusion: We learn that the context of COVID-19 is specific to each country. This analysis shows the importance of better understanding each country's response. During this first year of the pandemic, the problem of variants of concern and the vaccination were not posed.

Religious Leaders' Knowledge of Family Planning and Modern Contraceptive Use and Their Involvement in Family Planning Programmes in Burkina Faso: A Qualitative Study in Dori in the Sahel Region.

INTRODUCTION: It is necessary to understand religious leaders' perceptions of modern contraceptive use and their role in influencing fertility behaviour for the successful adoption of family planning, especially in societies where the religious leaders' opinions can have a significant influence on individuals' reproductive decisions. This study, therefore, aimed to assess religious leaders' knowledge of family planning and their involvement in family planning programmes in the Sahel region of Burkina Faso. METHODS: This is a qualitative study comprising in-depth individual interviews with twenty-one religious' leaders in the town of Dori in the Sahel region of Burkina Faso. An interview guide was used for data collection. This interview guide was developed based on the central themes and sub-themes determined for the research, namely, the religious leaders' knowledge of modern contraception, the inclusion of information on modern contraception during religious activities and the relationship between religious leaders and reproductive health services. All interviews were recorded and transcribed in French using Microsoft Word. The verbatims were then coded for content analysis. The analysis method chosen was that of thematic analysis. RESULTS: The results of the study showed that religious leaders had good knowledge about family planning including modern contraceptive methods and fertility regulation through birth spacing. Regarding their involvement in family planning programme, religious leaders said they were not involved enough. However, the results of the study showed that leaders are reluctant to promote the use of FP methods. CONCLUSION: Although religious leaders are knowledgeable about family planning, they are still reluctant to promote the use of modern contraceptive methods in their communities. To do so, efforts are needed to sensitise and mobilise them in family planning programmes. The cooperation of local religious leaders will help promote family planning and improve Burkina Faso's performance on the Sustainable Development Goals through the achievement of the demographic dividend in the country.

Use of Modern Contraceptive Methods in Burkina Faso: What are the Obstacles to Male Involvement in Improving Indicators in the Centre-East and Centre-North Regions?

INTRODUCTION: In Burkina Faso, despite several efforts to improve contraceptive uptake, contraceptive prevalence remains low. Studies suggest that the low levels of family planning (FP) practices can be partially attributed to the low participation of men in reproductive health programmes. Involving men in FP programmes in Burkina Faso is thus imperative, but the obstacles to this are poorly documented. This study has two objectives to explore the perspectives of men and women on barriers to contraceptive use and to identify the strategies to increase male involvement in family planning. METHODS: It is a qualitative study using 20 focus groups and 52 in-depth individual interviews in two regions (North Central Region and Central East Region) with a sample of 29 adult men and 23 women who were married and had children or not. Interviews were conducted in Moore (the national language commonly spoken in both regions). All interviews were recorded and transcribed into French using Microsoft Word. Then, content analysis was carried out using the constant comparison method to identify the major themes. RESULTS: The results show that men's attitudes are still a significant barrier to women's use of modern contraceptives. The reasons women do not use contraception and men do not adhere to FP programmes include lack of method knowledge, negative beliefs and perceptions about modern contraceptive methods, and the side effects of contraceptives. Cultural norms and preferences for large families are also common barriers to FP. However, the results showed that men's awareness of FP, communication between spouses, and access to FP services can promote men's adherence to FP programmes in the Centre-East and Centre-North regions of Burkina Faso. CONCLUSION: Efforts should be made to improve educational standards, especially for men, and reorient FP services to make them more accessible to men.

Determinants of under-5 mortality in Burkina Faso.

BACKGROUND: The aim of this article is to determine the factors associated with under-5 mortality and their evolution from 1993 to 2010 and to analyse the contributors of socioeconomic inequalities in mortality of children under-5 years during the same period. DATA AND METHODS: The data used in this study were derived from the four rounds of Demographic and Health Survey (DHS) conducted in Burkina Faso in 1993, 1998 and 2010. Concentration measurement, logistics regression and Oaxaca-Blinder decomposition method were used to analyse data. RESULTS: Multivariate analysis revealed that being the first child (odds ratio = 1.8 for 1993, 1.7 for 1998, 1.2 for 2003 and 1.3 for 2010) or a twin (odds ratio = 4.5 for 1993, 2.8 for 1998, 2.7 for 2003 and 4.8 for 2010) were also significantly associated with the probability of dying. The variable (parity) was the main contributor to the part of the inequality due to differences in group characteristics and that would be due to the fact that women from poor households have greater parity compared to those from rich households. CONCLUSION: For a reduction in mortality and inequalities related to mortality, the implementation of actions in favour of poor households and promotion of family planning programmes for birth spacing will be required.

Integration of postpartum care into child health and immunization services in Burkina Faso: findings from a cross-sectional study.

BACKGROUND: The Missed Opportunities for Maternal and Infant Health (MOMI) project, which aimed at upgrading maternal and infant postpartum care (PPC), implemented a package of interventions including the integration of maternal PPC in infant immunization services in 12 health facilities in Kaya Health district in Burkina Faso from 2013 to 2015. This paper assesses the coverage and the quality of combined mother-infant PPC in reproductive, maternal, newborn and child health services (RMNCH). METHODS: We conducted a mixed methods study with cross-sectional surveys before and after the intervention in the Kaya health and demographic surveillance system. On the quantitative side, two household surveys were performed in 2012 (N = 757) and in 2014 (N = 754) among mothers within one year postpartum. The analysis examines the result of the intervention by the date of delivery at three key time points in the PPC schedule: the first 48 h, days 6-10 and during weeks 6-8 and beyond. On the qualitative side, in depth interviews, focus group discussions and observations were conducted in four health facilities in 2012 and 2015. They involved mothers in the postpartum period, facility and community health workers, and other stakeholders. We performed a descriptive analysis and a two-sample test of proportions of the quantitative data. The qualitative data were recorded, transcribed and analysed along the themes relevant for the intervention. RESULTS: The findings show that the WHO guidelines, in terms of content and improvement of maternal PPC, were followed for physical examinations and consultations. They also show a significant increase in the coverage of maternal PPC services from 50% (372/752) before the intervention to 81% (544/672) one year after the start of the intervention. However, more women were assessed at days 6-10 than at later visits. Integration of maternal PPC was low, with little improvements in history taking and physical examination of mothers in immunization services. While health workers are polyvalent, difficulties in restructuring and organizing services hindered the integration. CONCLUSION: Unless a comprehensive strategy of integration within RMNCH services is implemented to address the primary health care challenges within the health system, integration will not yield the desired results.

A cross-sectional mixed study of the opportunity to improve maternal postpartum care in reproductive, maternal, newborn, and child health services in the Kaya health district of Burkina Faso.

OBJECTIVE: To propose a rationale to improve maternal postpartum care in reproductive, maternal, newborn, and child health (RMNCH) services. METHODS: We conducted a cross-sectional mixed study in the Kaya health district in Burkina Faso based on two data collection exercises conducted between December 2012 and May 2013. A household survey of 757 mothers in their first year after delivery was processed. It was complemented with a qualitative analysis using in-depth interviews with key informants, focus group discussions with mothers, and participant observation. RESULTS: Postpartum services showed serious weaknesses. Overall, 52% (n=384) of mothers did not receive any maternal postpartum care; however among them, 47% (n= 349) received infant postpartum care. CONCLUSION: We suggest the integration of maternal postpartum care in RMNCH services as a key step to improving postpartum care. The intervention would require the overcoming of challenges related to the quality and cost of services, and to reaching the poor populations with low education and a high parity.

Home births in the context of free health care: The case of Kaya health district in Burkina Faso.

OBJECTIVE: To identify the factors associated with home births in the Kaya health district in Burkina Faso, where child delivery was free of charge between 2007 and 2011. METHODS: Both qualitative and quantitative data were collected from the Kaya Health and Demographic Surveillance System (Kaya HDSS) among women who delivered at home or in a health facility between January 2008 and December 2010. Multilevel logistic regression was applied to quantitative data, while the qualitative data were analyzed thematically based on emerging themes, subthemes, and patterns across group and individual cases. RESULTS: The findings indicate that 12% (n=311) of childbirths occurred at home (n=2560). Key factors associated with home birth were age, distance from the household to the primary health center, and prenatal visits. The qualitative analysis showed that immediate child delivery, previous experience of giving birth at home, negative experiences with health centers, fear of cesarean delivery, and lack of transport are key predictors of home births. CONCLUSION: Though relevant, addressing the financial barrier to health care is not enough. Additional measures are necessary to further reduce the rate of home births.

Women's Education and Health Inequalities in Under-Five Mortality in Selected Sub-Saharan African Countries, 1990-2015.

BACKGROUND: The aim of the study was to analyse trends in the relationship between mother's educational level and mortality of children under the year of five in Sub-Saharan Africa, from 1990 to 2015. DATA AND METHODS: Data used in this study came from different waves of Demographic and Health Surveys (DHS) of Sub-Saharan countries. Logistic regression and Buis's decomposition method were used to explore the effect of mother's educational level on the mortality of children under five years. RESULTS: Although the results of our study in the selected countries show that under-five mortality rates of children born to mothers without formal education are higher than the mortality rates of children of educated mothers, it appears that differences in mortality were reduced over the past two decades. In selected countries for our study, we noticed a significant decline in mortality among children of non-educated mothers compared to the decrease in mortality rates among children of educated mothers during the period of 1990-2010. The results show that the decline in mortality of children under five years was much higher among the children born to mothers who have never received formal education-112 points drop in Malawi, over 80 in Zambia and Zimbabwe, 65 points in Burkina Faso, 56 in Congo, 43 in Namibia, 27 in Guinea, Cameroon, and 22 to 15 in Niger. However, we noted a variation in results among the countries selected for the study-in Burkina Faso (OR = 0.7), in Cameroon (OR = 0.8), in Guinea (OR = 0.8) and Niger (OR = 0.8). It is normally observed that children of mothers with 0-6 years of education are about 20% more likely to survive until their fifth year compared to children of mothers who have not been to school. Conversely, the results did not reveal significant differences between the under-five deaths of children born to non-educated mothers and children of low-level educated mothers in Congo, Malawi and Namibia. CONCLUSION: The decline in under-five mortality rates, during last two decades, can be partly due to the government policies on women's education. It is evident that women's educational level has resulted in increased maternal awareness about infant health and hygiene, thereby bringing about a decline in the under-five mortality rates. This reduction is due to improved supply of health care programmes and health policies in reducing economic inequalities and increasing access to health care.

Trends and risk factors for childhood diarrhea in sub-Saharan countries (1990-2013): assessing the neighborhood inequalities.

BACKGROUND: Diarrheal diseases are a major cause of child mortality and one of the main causes of medical consultation for children in sub-Saharan countries. This paper attempts to determine the risk factors and neighborhood inequalities of diarrheal morbidity among under-5 children in selected countries in sub-Saharan Africa over the period 1990-2013. DESIGN: Data used come from the Demographic and Health Survey (DHS) waves conducted in Burkina Faso (1992-93, 1998-99, 2003, and 2010), Mali (1995, 2001, 2016, and 2012), Nigeria (1990, 1999, 2003, 2008, and 2013), and Niger (1992, 1998, 2006, and 2012). Bivariate analysis was performed to assess the association between the dependent variable and each of the independent variables. Multilevel logistic regression modelling was used to determine the fixed and random effects of the risk factors associated with diarrheal morbidity. RESULTS: The findings showed that the proportion of diarrheal morbidity among under-5 children varied considerably across the cohorts of birth from 10 to 35%. There were large variations in the proportion of diarrheal morbidity across countries. The proportions of diarrheal morbidity were higher in Niger compared with Burkina Faso, Mali, and Nigeria. The risk factors of diarrheal morbidity varied from one country to another, but the main factors included the child's age, size of the child at birth, the quality of the main floor material, mother's education and her occupation, type of toilet, and place of residence. The analysis shows an increasing trend of diarrheal inequalities according to DHS rounds. In Burkina Faso, the value of the intraclass correlation coefficient (ICC) was 0.04 for 1993 DHS and 0.09 in 2010 DHS; in Mali, the ICC increased from 0.04 in 1995 to 0.16 in 2012; in Nigeria, the ICC increased from 0.13 in 1990 to 0.19 in 2013; and in Niger, the ICC increased from 0.07 in 1992 to 0.11 in 2012. CONCLUSIONS: This suggests the need to fight against diarrheal diseases on both the local and community levels across villages.

High infant mortality rate, high total fertility rate and very low female literacy in selected African countries.

AIM: This study focused on the top 10 selected African countries with key interventions such as high infant mortality rate, high total fertility rate and female literacy rate. METHODS: The World Bank's 2013 data were used. Descriptive analyses were performed. RESULTS: Findings show that Sierra Leone (107.2), Angola (102) and Central Africa Republic (96.1) reported the highest infant mortality rate per 1000 live births. The total fertility rates in Niger (7.6), Mali (6.8) and Somalia (6.6) were higher than other comparable countries. CONCLUSIONS: Health care service providers need to pay more attention during pregnancy periods, improve number of field visits, identify pregnant women and promote 100% antenatal care if this is done practically, these countries will reduce and ultimately eliminate infant mortality.

Decomposing Wealth-Based Inequalities in Under-Five Mortality in West Africa.

BACKGROUND: This study aimed to analysis the inequalities of mortality of children under 5 years in West Africa by examining the determinants and contributing factors to the overall inequality concentration in these countries. METHOD: Data used came from the DHS surveys conducted in the six countries in West Africa: Burkina Faso (2010), Benin (2006), Cote d'Ivoire 2011), Ghana (2008), Mali (2006), Nigeria (2008) and Niger (2012). The concentration index (CI) and Generalized Linear Model (GLM) with logit link were used to access inequality. RESULTS: The results show that in all countries, the poorest Q1 have the highest proportions of deaths: Nigeria (31.4%), Cote d'Ivoire (30.4%) and Ghana (36.4%), over 30% of deaths of children under 5 years are among the children of the poorest (Q1) and the absolute differences of proportions Q1-Q5 are more than 20 points (25.8 in Ghana and 23.6 in Nigeria). The contributing factors of inequalities of child mortality were birth order, maternal age, parity and household size. Our findings also showed that the intensity of inequality varies from one country to another. CONCLUSION: The most important conclusion of this study is to reduce mortality in children under 5 years, it is needed to reduce economic and social inequalities and improve the country's economic and social condition. There is a need for monitoring and assessment inequalities by leading causes of death and morbidity among children in the region in order to advance in understanding the gaps and finding a way to reduce them in West Africa countries.

Abolishing Fees at Health Centers in the Context of Community Case Management of Malaria: What Effects on Treatment-Seeking Practices for Febrile Children in Rural Burkina Faso?

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

Promoting family planning use after childbirth and desire to limit childbearing in Ethiopia.

BACKGROUND: In Ethiopia the average fertility rate in rural areas is about 6 children per woman, while it is 2.4 children per woman in urban areas. It is with this concept in mind that the investigators of this study wanted to correlate the promotion of after-child-birth-use of family planning and desire to limit childbearing in Ethiopia. Postpartum amenorrhea signifies the interval between childbirth and the return of menstruation. OBJECTIVES: The specific objective is to examine the desire to limit family size, along with cases of sterilized, fecund, postpartum amenorrhoea, declared in-fecund and menopausal women within the study area. METHODS: The study is based on the analysis of secondary data obtained from the 2011 Ethiopian Demographic and Health Survey (EDHS). This study is concentrated on couples because we need to know more about married people's desire to limit their family size. The bivariate, ANOVA, and multivariate analyses were used to analyse the association. RESULTS: The total number of respondents was 6,745 (78.3% rural and 21.7% urban), with 93.6% of them being currently married and 6.4% of them living with a partner. The mean duration of amenorrhea among women who gave birth in the five years preceding the survey is 16 months. Women with equal numbers of sons and daughters were found to be 75.4% (OR=0.25) less likely to desire more children, compared to women with more sons than daughters. CONCLUSION: Achievable resolutions include increasing females' ages at marriage, avoiding unwanted teenage pregnancies, completely eradicating home delivery, and inspiring young people to use modern methods of family planning to achieve Millennium Development Goals 4 & 5.

No effect of user fee exemption on perceived quality of delivery care in Burkina Faso: a case-control study.

BACKGROUND: Although many developing countries have developed user fee exemption policies to move towards universal health coverage as a priority, very few studies have attempted to measure the quality of care. The present paper aims at assessing whether women's satisfaction with delivery care is maintained with a total fee exemption in Burkina Faso. METHODS: A quasi-experimental design with both intervention and control groups was carried out. Six health centres were selected in rural health districts with limited resources. In the intervention group, delivery care is free of charge at health centres while in the control district women have to pay 900 West African CFA francs (U$2). A total of 870 women who delivered at the health centre were interviewed at home after their visit over a 60-day range. A series of principal component analyses (PCA) were carried out to identify the dimension of patients' satisfaction. RESULTS: Women's satisfaction loaded satisfactorily on a three-dimension principal component analysis (PCA): 1-provider-patient interaction; 2-nursing care services; 3-environment. Women in both the intervention and control groups were satisfied or very satisfied in 90% of cases (in 31 of 34 items). For each dimension, average satisfaction was similar between the two groups, even after controlling for socio-demographic factors (p = 0.436, p = 0.506, p = 0.310, respectively). The effects of total fee exemption on satisfaction were similar for any women without reinforcing inequalities between very poor and wealthy women (p ≥ 0.05). Although the wealthiest women were more dissatisfied with the delivery environment (p = 0.017), the poorest were more highly satisfied with nursing care services (p = 0.009). CONCLUSION: Contrary to our expectations, total fee exemption at the point of service did not seem to have a negative impact on quality of care, and women's perceptions remained very positive. This paper shows that the policy of completely abolishing user fees with organized implementation is certainly a way for developing countries to engage in universal coverage while maintaining the quality of care.