A community-based targeting approach to exempt the worst-off from user fees in Burkina Faso.

BACKGROUND: To contend with the risk of exclusion created by user fees, those implementing the Bamako Initiative (BI) were asked to organise exemption schemes for the indigent. But those exemption schemes were never put in place in Africa due to difficulties identifying the indigent. An action research was implemented to test the hypothesis that a community-based process for selecting beneficiaries of user-fee exemptions in an African environment of BI organisation is feasible. METHODS: This study was carried out in 10 primary health centres (CSPS) in Burkina Faso. Village selection committees (VSC) made lists of those worst-off, and the lists were validated by village chiefs, mayors, and health committees (COGES). A process evaluation was implemented using documentation analysis, accounting calculation, focus groups and in-depth interviews. RESULTS: The 124 VSCs selected 566 persons. The 10 COGESs retained 269 persons (48%), ie 2.81 per 1000 inhabitants. Except for one CSPS, the annual profits from the user fee schemes could support on average six times more indigents than the mean number selected by the VSCs. CONCLUSIONS: In the rural African context, villagers are capable of selecting those who should be exempted from user fees according to their own perspective. Thanks to the BI, health centres have a certain financial capacity to take care of the indigent. In a community-based targeting approach using endogenous resources generated from BI profits, local perceptions of the health centres' financial viability, coupled with the hierarchical social context, led to a very restrictive selection of candidates for exemption.

[Epidemiology and prognostic factors for sickle cell retinopathy in Ouagadougou (Burkina Faso)]. / Etude épidémiologique et facteurs pronostiques de la rétinopathie drépanocytaire à Ouagadougou (Burkina Faso).

INTRODUCTION: The frequency of sickle cell disease varies from 5% to 20% in Africa. PATIENTS AND METHOD: This retrospective study investigated 173 patients in an ambulatory setting from August 2000 to July 2006. The study included 98 women and 75 men, aged 15-62 years, with a mean age of 26.7 years. RESULTS: Only 89 patients (71 SC and 18 SS) were seen in ophthalmology, 44 (49%) had sickle cell retinopathy with 26 (29%) cases nonproliferative and 18 cases proliferative (20%). Among the 71 SC patients, 35 (50%) had sickle cell retinopathy, with 40% the proliferative form. Of the 18 SS patients, nine had a retinopathy (50%), with four cases proliferative. DISCUSSION: Retinopathy is a frequent complication of sickle cell disease, which can lead to blindness, and its management better accessibility to the ophthalmologic examination and preventive treatment by laser photo coagulation.

[Lacquer cracks complicated with choroidal neovascularization in pseudoxanthoma elasticum: the first case report in Burkina Faso]. / Stries angioïdes compliquées de néovascularisation choroïdienne dans le cadre d'un pseudoxanthome élastique: 1er cas décrit au Burkina Faso.

Lacquer cracks are breaks in the Bruch membrane by alteration of the elastic layer. They are often associated with pseudoxanthoma elasticum. The authors report the first case in Burkina Faso involving a 51-year-old woman who was seen for visual acuity loss. She had pseudoxanthoma elasticum associated with lacquer cracks complicated by choroidal neovascularization in both eyes. She was treated with laser photocoagulation of the neovessels in the left eye, and no recurrence was reported after 6 months.

[Cataract in Burkina Faso: factors of choice between modern and traditional surgical procedures]. / Cataracte au Burkina Faso: facteurs de choix entre chirurgie moderne ou traditionnelle.

Despite advances in cataract surgery, many peoples in the Sub-Saharan region are still treated by the traditional lens couching technique. The purpose of this study is to investigate the factors leading to the choice of lens couching for cataract treatment. A total 34 patients (40 eyes) from the northern Burkina Faso who underwent lens couching were examined and interviewed. Most patients (56%) did not understand the etiology of cataracts and attributed the disease to fate. Nor did they know of any other cataract treatment than lens couching. Only 13 patients (38.2%) would recommend modern cataract treatment and 52% suggested that health workers should come out into the villages and operate as traditional healers do. In spite of its potentially dramatic complications, lens couching is still the only method of cataract treatment known in some communities of Burkina Faso. Public information campaigns are needed to put an end to the ancestral practice of lens couching.

Trachoma, flies and environmental factors in Burkina Faso.

The presence of flies is one of the earliest risk factors for trachoma and it has been suggested that flies could act as vectors for transmission of chlamydiae. A national trachoma survey was conducted in 1997 in Burkina Faso to (i) study the relationship between trachoma occurrence, flies, dirty faces and some environmental factors, and (ii) investigate the role of flies in the presence of trachoma. The country was stratified into eight groups of provinces and a random sample of 30 clusters was selected in each group. All children aged < 10 years were examined for the diagnosis of active trachoma (trachomatous inflammation which was follicular and/or intense) and the dirtiness of the face and the presence of flies on the face were recorded. The children's carers were questioned about the number of baths given and daily face-washing. Household heads were asked about ownership of cattle and small ruminants. The presence of latrines, a stable, and garbage collection inside the yard was noted. Among 16,514 children examined, 27.0% had active trachoma and 3.3% intense inflammatory trachoma. Flies were present on 11.2% of children's faces and 82.4% and 19.7% of these children had active and intense inflammatory trachoma, respectively. Among the 30.2% of children with dirty faces, 70.2% had active and 10.2% intense inflammatory trachoma. In multivariate analysis, at least one daily bath showed a protective effect on both active and intense inflammatory trachoma. Face-washing twice daily was found to be significantly protective for active trachoma in some regions. A strong association was demonstrated between the presence of flies and dirty faces (odds ratio = 334, 95% confidence interval 202-546). The presence of flies on children's faces, dirty faces and trachoma appeared to be strongly associated. Although the presence of flies may be a marker of socio-economic status and is probably linked with other trachoma risk factors, our data indicated that interventions targeting fly control should be an important issue in controlling trachoma.