Household energy choice for domestic cooking: distribution and factors influencing cooking fuel preference in Ouagadougou.

Many studies have highlighted the link between indoor air pollution from the burning of solid fuels for cooking and heating and the occurrence of various health problems particularly in women and children under 5 years. In developing countries, solid fuels remain the main sources of energy. The purpose of this study aims to describe the distribution of household cooking fuel types and to analyze the factors influencing household cooking energy choice in Ouagadougou. A cross-sectional survey was conducted in 2017 in 3 neighborhoods of Ouagadougou. A total of 1734 household were randomly selected. We performed a multivariable logistic regression and a multinomial logistic regression to measure the relationship between selected determinants and households' primary cooking fuel. 59.53% of the households of Ouagadougou reported using solid fuels as the main cooking fuel. Wood is the most common primary cooking fuel used (43.93%), followed by LPG (40.41%) and then charcoal (15.60%). About 84% combine at least 2 types of energy for cooking. Cooking fuel choice is strongly influenced by the socioeconomic status, the family size, and also by the woman's educational attainment, her age and the main cooking fuel used in her parents' house. Actions aimed at reducing the impact of solid fuel use in the environment or health must consider these factors.

Primary Cooking Fuel Choice and Respiratory Health Outcomes among Women in Charge of Household Cooking in Ouagadougou, Burkina Faso: Cross-Sectional Study.

Background: Approximately 3 billion people, worldwide, rely primarily on biomass for cooking. This study aimed to investigate the association between respiratory symptoms among women in charge of household cooking and the type of fuel used for cooking. Methods: A community-based cross-sectional survey was conducted. A total of 1705 women that were randomly selected, completed the survey. We also performed a bivariate and a multivariate analysis to verify the possible associations between respiratory symptoms in women in charge of household cooking and the type of cooking fuel used. Results: Dry cough, breathing difficulties, and throat irritation frequencies were statistically high in biomass fuel users when compared to liquefied petroleum gas (LPG) users. It was also the case for some chronic respiratory symptoms, such as sputum production, shortness of breath, wheezing, wheezing with dyspnea, wheezing without a cold, waking up with shortness of breath, waking up with coughing attacks, and waking up with breathing difficulty. After adjustment for the respondents' and households' characteristics; dry cough, breathing difficulties, sneezing, nose tingling, throat irritation, chronic sputum production, wheezing, wheezing with dyspnea, wheezing without a cold, waking up with shortness of breath, waking up with coughing attacks, and waking up with breathing difficulty were symptoms that remained associated to biomass fuel compared to LPG. Women who used charcoal reported the highest proportion of all the chronic respiratory symptoms compared to the firewood users. However, this difference was not statistically significant except for the wheezing, waking up with coughing attacks, and waking up with breath difficulty, after adjustment. Conclusion: Exposure to biomass smoke is responsible for respiratory health problems in women. Charcoal, which is often considered as a clean fuel compared to other biomass fuels and often recommended as an alternative to firewood, also presents health risks, including increased respiratory morbidity in women. Effective and efficient energy policies are needed to accelerate the transition to clean and sustainable energies.

[Indoor air pollution and acute respiratory infection prevalence in infants in Ouagadougou.] / Pollution de l'air intérieur et prévalence des infections respiratoires aiguës chez les enfants à Ouagadougou.

In Burkina Faso, women and their young children are the most exposed to the effects of indoor air pollution. This study investigated the risk factors associated with air pollution during meal cooking in the occurrence of Acute Respiratory Infections (ARI) in children under 5 years of age. This is a cross-sectional study that took place in two sectors of the city of Ouagadougou (sectors 15 and 17) in Burkina Faso. The study involved 608 households. The data was collected using an interview guide and an observation grid. The data was entered with Epi data 3.1 software and analyzed with Stata / SE 12.0. The associations between the variables were expressed in Odds Ratio (OR) and their confidence intervals were estimated at 95%. The prevalence of ARI was 3.5% in children under 5 years of age. In bivariate analysis, with low-standing habitats, the use of traditional and / or improved stoves, appeared to be a risk factor for ARI. In multivariate analysis, only the use of the combination ? improved stoves + wood ? was found to be significantly associated with ARI in the last 2 weeks before the study (OR = 14.703, 95% CI: 1.156 -186.887). This requires strengthening the promotion of the use of gas and conducting studies on the effectiveness of improved stoves in reducing exposure to pollutants.

Removal of user fees no guarantee of universal health coverage: observations from Burkina Faso.

In theory, the removal of user fees puts health services within reach of everyone, including the very poor. When Burkina Faso adopted the DOTS strategy for the control of tuberculosis, the intention was to provide free tuberculosis care. In 2007-2008, interviews were used to collect information from 242 smear-positive patients with pulmonary tuberculosis who were enrolled in the national tuberculosis control programme in six rural districts. The median direct costs associated with tuberculosis were estimated at 101 United States dollars (US$) per patient. These costs represented 23% of the mean annual income of a patient's household. During the course of their care, three quarters of the interviewed patients apparently faced "catastrophic" health expenditure. Inadequacies in the health system and policies appeared to be responsible for nearly half of the direct costs (US$ 45 per patient). Although the households of patients developed coping strategies, these had far-reaching, adverse effects on the quality of lives of the households' members and the socioeconomic stability of the households. Each tuberculosis patient lost a median of 45 days of work as a result of the illness. For a population living on or below the poverty line, every failure in health-care delivery increases the risk of "catastrophic" health expenditure, exacerbates socioeconomic inequalities, and reduces the probability of adequate treatment and cure. In Burkina Faso, a policy of "free" care for tuberculosis patients has not met with complete success. These observations should help define post-2015 global strategies for tuberculosis care, prevention and control.

En théorie, la suppression des frais d'utilisation des services de santé met ces derniers à la portée de tous, y compris des plus pauvres. Lorsque le Burkina Faso a adopté la stratégie DOTS de lutte contre la tuberculose, son intention était de fournir un traitement gratuit contre la tuberculose. En 2007-2008, on a recouru à des entretiens pour recueillir des informations auprès de 242 patients à frottis positifs, atteints de tuberculose pulmonaire et inscrits dans le programme national de lutte antituberculeuse, dans six districts ruraux. Le coût médian direct associé à la tuberculose était estimé à 101 dollars des États-Unis (US$) par patient. Ces coûts représentaient 23% du revenu annuel moyen du ménage d'un patient. Au cours de leur prise en charge, les trois quarts des patients interrogés auraient apparemment fait face à des dépenses de santé «catastrophiques¼. Les insuffisances du système et les politiques de santé semblent être responsables de près de la moitié des coûts directs (45 US$ par patient). Bien que les ménages des patients aient développé des stratégies d'adaptation, ces coûts ont eu des effets importants et néfastes sur la qualité de vie des membres des ménages et sur leur stabilité socio-économique. La médiane du nombre de journées de travail perdues en raison de la maladie était de 45 jours. Pour une population vivant au niveau ou sous le seuil de pauvreté, chaque défaut de prestation de soins augmente le risque de dépenses de santé «catastrophiques¼, exacerbe les inégalités socio-économiques et réduit la probabilité de traitement adéquat et de guérison. Au Burkina Faso, une politique de soins «gratuits¼ pour les patients atteints de la tuberculose n'a pas remporté un succès total. Ces observations devraient aider à définir des stratégies globales pour le traitement, la prévention et la lutte contre la tuberculose après 2015.

En teoría, la eliminación de las tarifas a los usuarios pone los servicios sanitarios al alcance de todos, incluidas las personas muy pobres. Cuando Burkina Faso adoptó la estrategia DOTS para el control de la tuberculosis, la intención era brindar atención sanitaria gratuita contra dicha enfermedad. En los años 2007 y 2008, se emplearon entrevistas para recoger información de 242 pacientes bacilíferos de tuberculosis pulmonar que se inscribieron en el programa nacional para el control de la tuberculosis en seis distritos rurales. Se calculó que los costes directos medios asociados con la tuberculosis ascendieron a 101 dólares estadounidenses (US$) por paciente. Estos costes representaron el 23% de los ingresos anuales medios en el hogar del paciente. Al parecer, tres cuartas partes de los pacientes entrevistados tuvieron que hacer frente a gastos sanitarios «catastróficos¼ durante el transcurso de la atención sanitaria. Las deficiencias en el sistema y las políticas sanitarias parecen ser responsables de casi la mitad de todos los costes directos (45 US$ por paciente). Aunque los hogares de los pacientes desarrollaron estrategias de supervivencia, éstas tuvieron efectos adversos de largo alcance en la calidad de vida de los miembros del hogar, así como en la estabilidad socioeconómica del mismo. Cada paciente de tuberculosis se ausentó de su trabajo una media de 45 días como consecuencia de la enfermedad. Para una población que vive por debajo del límite de la pobreza, cualquier fallo en la prestación de servicios sanitarios aumenta el riesgo de tener que hacer frente a gastos sanitarios «catastróficos¼, agrava las desigualdades socioeconómicas y reduce la probabilidad de recibir un tratamiento apropiado y recuperarse. En Burkina Faso, la estrategia de atención sanitaria «gratuita¼ para los pacientes con tuberculosis no ha tenido un éxito absoluto. Las presentes observaciones deberían ayudar a definir las estrategias globales a partir del año 2015 para la atención sanitaria, la prevención y el control de la tuberculosis.

Patients are paying too much for tuberculosis: a direct cost-burden evaluation in Burkina Faso.

BACKGROUND: Paying for health care may exclude poor people. Burkina Faso adopted the DOTS strategy implementing "free care" for Tuberculosis (TB) diagnosis and treatment. This should increase universal health coverage and help to overcome social and economic barriers to health access. METHODS: Straddling 2007 and 2008, in-depth interviews were conducted over a year among smear-positive pulmonary tuberculosis patients in six rural districts of Burkina Faso. Out-of-pocket expenses (direct costs) associated with TB were collected according to the different stages of their healthcare pathway. RESULTS: Median direct cost associated with TB was US$101 (n = 229) (i.e. 2.8 months of household income). Respectively 72% of patients incurred direct costs during the pre-diagnosis stage (i.e. self-medication, travel, traditional healers' services), 95% during the diagnosis process (i.e. user fees, travel costs to various providers, extra sputum smears microscopy and chest radiology), 68% during the intensive treatment (i.e. medical and travel costs) and 50% during the continuation treatment (i.e. medical and travel costs). For the diagnosis stage, median direct costs already amounted to 35% of overall direct costs. CONCLUSIONS: The patient care pathway analysis in rural Burkina Faso showed substantial direct costs and healthcare system delay within a "free care" policy for TB diagnosis and treatment. Whether in terms of redefining the free TB package or rationalizing the care pathway, serious efforts must be undertaken to make "free" health care more affordable for the patients. Locally relevant for TB, this case-study in Burkina Faso has a real potential to document how health programs' weaknesses can be identified and solved.