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 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.

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.

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.

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.

Which incentive package will retain regionalized health personnel in Burkina Faso: a discrete choice experiment.

BACKGROUND: The lack of motivation of health workers to practice in rural areas remains a crucial problem for decision-makers, as it deprives the majority of access to health care. To solve the problem, many countries have implemented health worker retention strategies. However, the development of such strategies requires an understanding of the preferences of health workers. The objective of the study was to identify a package for attracting and retaining health workers in underserved areas. METHODS: A cross sectional study was conducted in three health regions of Burkina Faso in 2012. A discrete choice experiment was used to investigate preferences for incentive packages among health workers recruited under the regionalized policy. In-depth interviews and focus group discussions with health workers currently working in the East and Sahel regions and policy makers, and a literature review on attraction and retention in low income countries, were performed to identify the attributes and levels. These attributes were: the regionalized recruitment policy, health insurance, work equipment, housing, and specific incentive compensation. The final design resulted in 16 choice sets. A multinomial logistic regression was used to determine the influence of socio-demographic characteristics on choice of a given option. A probit logistic regression model was then used to analyze the effect of these difference variables on choice, to identify the incentive package best suited to health workers. In total, questionnaires were administered to 315 regional health workers. RESULTS: For all participants, choice of package was strongly influenced by length of commitment under the policy and provision of housing. Sex, number of years in profession, and location also influenced the choice of package. Women are twice more likely to choose a package with free housing and the cancellation of the policy. CONCLUSION: It is important that governments consider health worker preferences in crafting policies to address attraction and retention in underserved areas. In addition, the methodology of discrete choice experiment has been particularly useful, not only for better understanding the factors explaining the reluctance of health workers to work in underserved areas, but also to provide practical advice to the government, to improve its retention policy.