Cost and impact of policies to remove and reduce fees for obstetric care in Benin, Burkina Faso, Mali and Morocco.

BACKGROUND: Across the Africa region and beyond, the last decade has seen many countries introducing policies aimed at reducing financial barriers to obstetric care. This article provides evidence of the cost and effects of national policies focussed on improving financial access to caesarean and facility deliveries in Benin, Burkina Faso, Mali and Morocco. METHODS: The study uses a comparative case study design with mixed methods, including realist evaluation components. This article presents results across 14 different data collection tools, used in 4-6 research sites in each of the four study countries over 2011-13. The methods included: document review; interviews with key informants; analysis of secondary data; structured extraction from medical files; cross-sectional surveys of patients and staff; interviews with patients and observation of care processes. RESULTS: The article finds that the policies have contributed to continued increases in skilled birth attendance and caesarean sections and a narrowing of inequalities in all four countries, but these trends were already occurring so a shift cannot be attributed solely to the policies. It finds a significant reduction in financial burdens on households after the policy, suggesting that the financial protection objectives may have been met, at least in the short term, although none achieved total exemption of targeted costs. Policies are domestically financed and are potentially sustainable and efficient, and were relatively thoroughly implemented. Further, we find no evidence of negative effects on technical quality of care, or of unintended negative effects on untargeted services. CONCLUSIONS: We conclude that the policies were effective in meeting financial protection goals and probably health and equity goals, at sustainable cost, but that a range of measures could increase their effectiveness and equity. These include broadening the exempted package (especially for those countries which focused on caesarean sections alone), better calibrated payments, clearer information on policies, better stewardship of the local health system to deal with underlying systemic weaknesses, more robust implementation of exemptions for indigents, and paying more attention to quality of care, especially for newborns.

Baseline survey of animal trypanosomosis in the region of the Boucle du Mouhoun, Burkina Faso.

In view of gathering baseline information about the prevalence of animal trypanosomosis, the Pan African Tsetse and Trypanosomiasis Eradication Campaign (PATTEC) funded a cross sectional survey in the region of the Boucle du Mouhoun which constitutes the Northern limit of the tsetse distribution in Burkina. This cross sectional study was carried out in 53 villages located in the six provinces of the region. A total of 2002 cattle, 1466 small ruminants and 481 donkeys were sampled. This survey showed that about 25% of the cattle had been treated with trypanocidal drugs within 3 months before the survey compared to 3% and 0.42% for the small ruminants and donkeys, respectively. Parasitological prevalence in cattle was low: 0.77% (95% C.I. 0.30-1.95%). No goats and three donkeys were found infected with trypanosomes. Infections were mainly due to Trypanosoma vivax (75.0%) with cases of Trypanosoma congolense (25.0%). In cattle, the serological prevalence of trypanosomosis, for the entire region of the Boucle du Mouhoun, was 34.2% (95% C.I. 26.1-43.4%). For sheep, goats and donkeys, the prevalence were of 20.9% (95% C.I. 12.2-33.5%), 8.5% (95% C.I. 5.7-12.5%) and 5.8% (95% C.I. 3.9-8.6%), respectively. The age and distance to the river were the two main risk factors associated with seropositivity.

Prevalence case-control study of epilepsy in three Burkina Faso villages.

PURPOSE: To estimate the association between the prevalence of epilepsy and potential risk factors in three Burkina Faso villages. METHODS: Three villages were selected based on local reports of high numbers of epilepsy cases and pig-rearing practices. One person aged 7 or older was selected at random from all households of selected concessions for epilepsy screening and blood sampling. Epilepsy was confirmed by a physician using the ILAE definition. The cross-sectional associations between epilepsy and selected factors and seroresponse to the antigens of Taenia solium were estimated using a Bayesian hierarchical logistic regression. Prevalence odds ratios (POR) and their 95% Bayesian Credible Intervals (95% BCI) were estimated. RESULTS: Of 888 individuals interviewed, 39 of 70 screened positive were confirmed to have epilepsy for a lifetime prevalence of 4.5% (95% CI: 3.3; 6.0). The prevalence of epilepsy was associated with a positive reaction to cysticercosis Ag-ELISA serology (POR = 3.1, 95% BCI = 1.0; 8.3), past pork consumption (POR = 9.7, 95% BCI = 2.5; 37.9), and being salaried or a trader compared to a farmer or housewife (POR = 2.9, 95% BCI = 1.2; 6.4). DISCUSSION: Several factors were associated with prevalent epilepsy, with Ag-ELISA suggesting the presence of neurocysticercosis. The association between epilepsy and some occupations may reflect differences in local attitudes toward epilepsy and should be further explored.

Women who experience obstetric haemorrhage are at higher risk of anaemia, in both rich and poor countries.

OBJECTIVES: Anaemia is a potential long-term sequel of obstetric blood loss, but the increased risk of anaemia in women who experience a haemorrhage compared to those who do not has not been quantified. We sought to quantify this risk and explore the duration of increased risk for these women. METHODS: Systematic review of articles published between 1990 and 2009. Data were analysed by high- and low-income country groupings. Prevalence and incidence ratios, and mean haemoglobin levels were compared. RESULTS: Eleven of 822 studies screened were included in the analysis. Most studies showed a higher prevalence or incidence of anaemia in women who had experienced haemorrhage than in those who did not, irrespective of the timing of measurement post-partum. In high-income countries, women who had a haemorrhage were at 5.68 (95% CI 5.04-6.40) times higher risk of post-partum anaemia than women who did not. In low-income countries, the prevalence of anaemia was 1.58 (95% CI 0.96-2.60) times higher in women who had a haemorrhage than in women who did not, although this ratio was greater when the study including mild anaemia in its definition of anaemia was excluded (1.93, 95% CI 1.42-2.62). Population-attributable fractions ranged from 14.9% to 39.6%. Several methodological issues, such as definitions, exclusion criteria and timing of measurements, hindered the comparability of study results. CONCLUSIONS: Women who experience haemorrhage appear to be at increased risk of anaemia for many months after delivery. This important finding could have serious implications for their health care and management.

Detecting depression after pregnancy: the validity of the K10 and K6 in Burkina Faso.

OBJECTIVE: The K10 and K6 are short rating scales designed to detect individuals at risk for depressive disorder, with or without anxiety. Despite being widely used, they have not yet been validated for detecting postnatal depression. We describe the validity of these scales for the detection of postnatal depression in Burkina Faso. METHOD: The English language version of the K10 questionnaire was translated into West African French and local languages for use in Burkina Faso. Scores for 61 women were compared with the diagnostic interview made by a local psychiatrist within 3 days of administering the K10. RESULTS: Clinical assessment found that 27 (44%) women were probable cases of depression. Internal consistency of K10 and K6 scores, defined by Cronbach's alpha coefficient, was 0.87 and 0.78, respectively, indicating satisfactory reliability. The performance of the scores was not significantly different, with areas under the curve of 0.77 and 0.75 for the K10 and K6, respectively. To estimate prevalence of depression, we suggest cut-offs of > or =14 for the K10 and between > or =9 and > or =11 for the K6 for identifying women at high risk of depression. At > or =14, the K10 has 59% sensitivity, 91% specificity; at > or =10, the K6 has 59% sensitivity and 85% specificity. CONCLUSION: This study suggests that K10 and K6 are reasonably valid measures of depression among postpartum women in Burkina Faso and can be used as relatively cheap tools for estimating prevalence of postnatal depression in developing countries.

Calf morbidity, mortality and parasite prevalences in the cotton zone of Burkina Faso.

The objective of this study is to describe morbidity and mortality in calves <1-year-old and to associate the impact of gastrointestinal and haemoparasitoses on morbidity and mortality by comparing these parameters in ill and well calves in the cotton zone of Burkina Faso. Fifty-nine herds selected in two villages were involved. Calves born between February 1997 and February 1999 were monitored up to 1 year of age or until the end of the study in April 1999. Blood and faecal samples were taken from ill calves and matched with samples taken from well calves (as control) for analysis of haemoparasites and gastrointestinal worms. Infected ill calves were treated with a trypanocidal drug and/or an anthelmintic. Dead calves were necropsied; adult-worm burdens were determined and brain smears taken to detect the presence of Cowdria ruminantium. Diarrhoea was the main clinical observation and most calves shed worm eggs. The EPG for gastrointestinal parasites was higher neither in ill calves nor in diarrhoeal calves. Infections by trypanosome species were observed in ill calves only (prevalences of 8% and 15% in Daboura and Kourouma, respectively). Average PCV in infected calves (28%) was lower than that in non-infected calves (37%). Most ill calves (86%) recovered 2 weeks after the treatment with anthelmintic and/or trypanocide. The post-mortem worm counting in 12 calves revealed that half of necropsied calves had a burden ranging from 2040 to 20,072 helminths. Infection by Babesia bigemina was found in the blood smear of one ill calf and the presence of C. ruminantium was noted in the brain smear of one calf.

Comparative pathogenicity of three genetically distinct types of Trypanosoma congolense in cattle: clinical observations and haematological changes.

The pathology of African bovine trypanosomosis was compared in Zebu cattle subcutaneously inoculated with three clones of trypanosomes corresponding to the three genetically distinct types of Trypanosoma congolense; savannah-type, west African riverine/forest-type and kilifi-type. All inoculated animals became parasitaemic between 7 and 11 days post-infection (dpi). The savannah-type showed consistently higher levels of parasitaemia and lower packed red cell volume percentages and leukocyte counts than the other two types. The syndrome was also more severe in the savannah-type and led inexorably to death between 29 and 54 dpi while animals with the forest or the kilifi-types recovered from earlier symptoms and haematological alterations after 3 months of infection. By the end of the experiment, the animals self-cured from the forest-type infection and the kilifi-type passed under control. The results of the present study indicated clear difference in pathogenicity between the three types of T. congolense; the savannah-type was virulent while the forest-type was of low pathogenicity and the kilifi-type was non-pathogenic.

Importance of Escherichia coli in young beef calves from northwestern Quebec.

The objectives of this study were: (i) to investigate the prevalence of Escherichia coli producing F5 (K99), F41, or F165 fimbriae and STa enterotoxin; (ii) to determine serum antibody levels against these fimbriae; (iii) and to examine the association between bacteriological and serological results and the presence of diarrhea, in beef calves from northwestern Quebec. A total of 373 live three to four week old calves and 27 dead calves were sampled between January and March 1991. No isolates positive for F5 were detected in live calves, and only one E. coli producing STa and F41 was isolated. Escherichia coli producing F41-like surface antigens or F165 fimbriae were isolated from 17.43% and 5.63% of live calves, respectively. Antibodies against F5, F41 and F165 were low. Escherichia coli isolates positive for F41-like surface antigen were most often observed in calves born between January and March. No association was found between bacteriological and serological findings, nor between these findings and diarrhea. Calves born from dams vaccinated against E. coli had higher median antibody levels than those born from unvaccinated dams. No E. coli positive for F5 or F41 fimbriae were isolated from dead calves. Escherichia coli with F41-like surface antigen or F165 were found in 55.56% and 11.11% of ileal samples; 4% and 16% of cecal samples, and 0% and 7.4% of colon samples, respectively. Escherichia coli positive for F41-like surface antigen were detected significantly more frequently in the ileum (chi (2)2df = 31.01, p < 0.001).

A seroepidemiological study of the importance in cow-calf pairs of respiratory and enteric viruses in beef operations from northwestern Quebec.

Serum antibody analyses for bovine herpesvirus type 1 (BHV-1), bovine viral diarrhea virus (BVDV), bovine respiratory syncytial virus (BRSV), bovine coronavirus (BCV), and bovine rotavirus (BRV) were performed on 527 randomly selected cows, before calving, and on 407 three-week-old calves. In cows and calves, BCV and BRV were the most seroprevalent viruses (80% to 100% according to virus and vaccination status). Bovine respiratory syncytial virus was the least seroprevalent in the cows, independent of the vaccination status. In nonvaccinated cows the seroprevalence to BRSV was 36.7%, and 53.5% in cows vaccinated less than two weeks prior to collecting blood, and 67.6% in cows vaccinated two weeks or more prior to blood collection. In their calves, BHV-1 was the least seroprevalent, independent of the vaccination status. The serological status and antibody titers in calves were generally associated with those of the dam. The occurrence of respiratory diseases in the calves was associated with cow and calf serological profiles (BHV-1, BRSV and BCV in the nonvaccinated group, BHV-1, BVDV and BCV in the vaccinated group). The occurrence of diarrhea was not associated with cow and calf serological profiles but was negatively associated with high level calf serum IgG in the nonvaccinated group (odds ratio = 0.73). Bovine coronavirus and BRV were shed by 1.4% and 4.9% of calves in the nonvaccinated group, and by 0% and 9.9% of calves in the vaccinated group, respectively. Bovine rotavirus shedding was associated with fecal diarrheic consistency at the moment of fecal sampling but not with previous occurrence of diarrhea.