[Factors associated with post-term pregnancy at the Yalgado Ouédraogo University Hospital: case-control study]. / Facteurs associés à la grossesse post-terme au Centre Hospitalier Universitaire Yalgado Ouédraogo: étude cas-témoins.

Introduction: post-term pregnancy is a risky situation for the fetus and the mother. In our context, few data exist on the subject. This aims to determine the associated factors of post-term pregnancy in order to contribute to a reduction in maternal and fetal morbidity and mortality. Methods: we conducted a matched case-control study in the department of gynaecology-obstetrics of the Yalgado Ouédraogo University Hospital. Data were collected between 1st January 2014 and 31st August 2014. Cases were patients who delivered at 41 weeks of amenorrhoea and above and controls were those who delivered between 37 and 41 weeks of amenorrhoea. Results: the study included 153 cases and 153 controls. Risk factors with statistically significant association with post-term pregnancy were high maternal socioeconomic status (adjusted odds ratio (AOR)=3.17; 95% CI [1.13; 9.07]) primiparity (AOR=1.45; 95% CI [1.07; 2.51]), and previous post-term pregnancy (AOR=7.02; 95% CI [2.08; 23.79]). Conclusion: early recognition of risk factors for post-term pregnancy will help health workers identify women with high-risk pregnancies.

Expanding the Single-Visit Approach for Cervical Cancer Prevention: Successes and Lessons From Burkina Faso.

BACKGROUND: Cervical cancer accounts for 23% of cancer incidence and 22% of cancer mortality among women in Burkina Faso. These proportions are more than 2 and 5 times higher than those of developed countries, respectively. Before 2010, cervical cancer prevention (CECAP) services in Burkina Faso were limited to temporary screening campaigns. PROGRAM DESCRIPTION: Between September 2010 and August 2014, program implementers collaborated with the Ministry of Health and professional associations to implement a CECAP program focused on coupling visual inspection with acetic acid (VIA) for screening with same-day cryotherapy treatment for eligible women in 14 facilities. Women with larger lesions or lesions suspect for cancer were referred for loop electrosurgical excision procedure (LEEP). The program trained providers, raised awareness through demand generation activities, and strengthened monitoring capacity. METHODS: Data on program activities, service provision, and programmatic lessons were analyzed. Three data collection tools, an individual client form, a client registry, and a monthly summary sheet, were used to track 3 key CECAP service indicators: number of women screened using VIA, proportion of women who screened VIA positive, and proportion of women screening VIA positive who received same-day cryotherapy. RESULTS: Over 4 years, the program screened 13,999 women for cervical cancer using VIA; 8.9% screened positive; and 65.9% received cryotherapy in a single visit. The proportion receiving cryotherapy on the same day started at a high of 82% to 93% when services were provided free of charge, but dropped to 51% when a user fee of $10 was applied to cover the cost of supplies. After reducing the fee to $4 in November 2012, the proportion increased again to 78%. Implementation challenges included difficulties tracking referred patients, stock-outs of key supplies, difficulties with machine maintenance, and prohibitive user fees. Providers were trained to independently monitor services, identify gaps, and take corrective actions. CONCLUSIONS: Following dissemination of the results that demonstrated the acceptability and feasibility of the CECAP program, the Burkina Faso Ministry of Health included CECAP services in its minimum service delivery package in 2016. Essential components for such programs include provider training on VIA, cryotherapy, and LEEP; provider and patient demand generation; local equipment maintenance; consistent supply stocks; referral system for LEEP; non-prohibitive fees; and a monitoring data collection system.

Effects of an intervention initiated by a national society to improve postabortion care in rural facilities in Burkina Faso.

OBJECTIVE: To evaluate the results of an intervention by the Societé de Gynécologues et Obstétriciens du Burkina (SOGOB) to improve postabortion care (PAC) in rural areas of Burkina Faso. METHODS: From June 1, 2012, to May 31, 2013, SOGOB increased capacity for PAC by providing training in health care and equipment to 45 rural health facilities. Performance in PAC in the year before intervention (June 1, 2011, to May 31, 2012) was compared with that in the year following intervention (June 1, 2013, to May 31, 2014). RESULTS: The number of cases of incomplete abortion managed within a year increased from 1812 before the intervention to 2738 afterwards. Before capacity building, none of the health facilities was using misoprostol for management of incomplete abortion. After capacity building, misoprostol was used in 805 (29.4%) cases. The use of inappropriate methods to empty the uterus decreased (27.5% [498/1812] vs 1.4% [38/2738]; P<0.001). The frequencies of uterine perforation and pelvic infection also decreased (P≤0.01 for both). In the year after implementation, 2035 (78.3%) of 2600 women had taken up a family planning method before leaving the facility. CONCLUSION: SOGOB's intervention has improved the quality of PAC in rural health facilities in Burkina Faso.

Respectful maternity care in three health facilities in Burkina Faso: the experience of the Society of Gynaecologists and Obstetricians of Burkina Faso.

The Society of Gynaecologists and Obstetricians of Burkina Faso (SOGOB) conducted a project to reinforce skills in respectful maternity care among its members and health workers at three facilities. The participatory process allowed health workers to self-diagnose quality of care, recognize their own responsibility, propose solutions, and pledge respectful care commitments that were specific for each unit. Key commitments included good reception; humanistic clinical examination; attentive listening and responsiveness to patient needs; privacy, discretion, and confidentiality; availability; and comfort. These commitments can potentially be modified after each evaluation by SOGOB. Poor working conditions were found to negatively impact on quality of care. High staff turnover, frequent technical malfunctions, and inadequate infrastructure were identified as issues that require future focus to ensure improvements in quality of care are sustainable. Programs that aim to improve the maternity experience by linking good practice with humanistic care merit rollout to all healthcare facilities in Burkina Faso.

Sublingual [corrected] misoprostol as first-line care for incomplete abortion in Burkina Faso.

OBJECTIVE: To explore 400-µg sublingual misoprostol as primary treatment in lower-level facilities with no previous experience providing postabortion care. METHODS: Women presenting with incomplete abortion were offered a single dose of 400-µg sublingual misoprostol. Incomplete abortion was defined as uterine size consistent with fewer than 12 weeks of gestation, open cervical os, and reports of past or present history of vaginal bleeding. Women returned to the clinic 1 week after misoprostol administration for follow-up. At that time, they were discharged if the uterine evacuation was a success or were offered a second follow-up visit or surgical completion if still incomplete. RESULTS: One-hundred women received misoprostol; outcome data were unavailable for 1 woman. Complete uterine evacuation was achieved for 97 (98.0%) women. Satisfaction was high, with nearly all women indicating that they were "satisfied" (n=57 [57.6%]) or "very satisfied" (n=41 [41.4%]) with their experience. Adverse effects were considered "tolerable" by 72 of 97 (74.2%) women. Ninety-seven of 99 (98.0%) participants indicated that they would choose misoprostol for incomplete abortion care in the future and 95 of 97 (97.9%) stated that they would recommend it to a friend. CONCLUSION: Misoprostol is a viable option for treatment of incomplete abortion at mid-level facilities.