Besoins non satisfaits en matière de planification familiale : déterminants individuels et contextuels au Burkina Faso.

INTRODUCTION: In Burkina Faso, despite actions to improve women’s health, the percentage of those with unmet needs in terms of family planning remains high (35.6% in 2015 to 20.2% in 2018 according to projections from the Performance Monitoring and Accountability project [PMA2014-15/Burkina]). METHODS: The study used data from demographic and public health investigations as well as multiple indicator cluster surveys for Burkina Faso in 2010. Two analysis techniques were used: a Multiple Correspondence Analysis, then an Ascending Hierarchical Classification (AHC). A multi-level logistic regression model was used to estimate the net effects of individual and environmental factors associated with these unmet needs. RESULTS: The analysis of the random effects shows that the propensity of having unmet needs in terms of family planning varies considerable from one household to another and from one enumeration zone to another. The net effects also show that women between the ages of 35 and 49 are 6.94 times at risk of having unmet needs in terms of limiting births than for those aged 20 to 34. For the unmet need of spacing births, this risk is estimated at 69% less high for women between 35 to 49 years of age than for those aged 15 to 19. CONCLUSION: It is necessary to strengthen local awareness programs geared towards women and their spouses about the benefits and the importance of family planning, while taking into account their sociodemographic characteristics (age, parity, ethnic background, living environment).

Integrating childhood TB: applying the care delivery value chain to improve pediatric HIV/TB services in Togo, West Africa.

The World Health Organization has prioritized integrating tuberculosis (TB) and human immunodeficiency virus (HIV) services. Diagnosis of HIV/TB coinfection in children remains a challenge worldwide for numerous reasons. The care delivery value chain (CDVC) is an effective tool that can be applied as a systemic framework for assessing health care delivery. Our objective was to apply the CDVC framework to improve pediatric HIV/TB care at an HIV center in northern Togo that serves over 130 children and 1000 adults living with HIV. Using the CDVC framework, gaps in HIV/TB care were identified, and services related to screening and diagnosis were prioritized to implement 3 distinct quality improvement cycles. Primary outcomes included percentage of children screened for TB by medical providers and percentage of diagnostic sample results received at the HIV clinic for children and adults. Improvements in the TB diagnostic process were observed, resulting in a change of sputum sample results received for both children and adults from 25% at baseline to >88% at 3 months. Given the relative low associated costs, this QI approach may be applicable and feasible in other settings to target screening and diagnosis of TB for children living with HIV worldwide.

Assessing the Integrated Community-Based Health Systems Strengthening initiative in northern Togo: a pragmatic effectiveness-implementation study protocol.

BACKGROUND: Over the past decade, prevalence of maternal and child morbidity and mortality in Togo, particularly in the northern regions, has remained high despite global progress. The causes of under-five child mortality in Togo are diseases with effective and low-cost prevention and/or treatment strategies, including malaria, acute lower respiratory infections, and diarrheal diseases. While Togo has a national strategy for implementing the integrated management of childhood illness (IMCI) guidelines, including a policy on integrated community case management (iCCM), challenges in implementation and low public sector health service utilization persist. There are critical gaps to access and quality of community health systems throughout the country. An integrated facility- and community-based initiative, the Integrated Community-Based Health Systems Strengthening (ICBHSS) initiative, seeks to address these gaps while strengthening the public sector health system in northern Togo. This study aims to evaluate the effect and implementation strategy of the ICBHSS initiative over 48 months in the catchment areas of 21 public sector health facilities. METHODS: The ICBHSS model comprises a bundle of evidence-based interventions targeting children under five, women of reproductive age, and people living with HIV through (1) community engagement and feedback; (2) elimination of point-of-care costs; (3) proactive community-based IMCI using community health workers (CHWs) with additional services including family planning, HIV testing, and referrals; (4) clinical mentoring and enhanced supervision; and (5) improved supply chain management and facility structures. Using a pragmatic type II hybrid effectiveness-implementation study, we will evaluate the ICBHSS initiative with two primary aims: (1) determine effectiveness through changes in under-five mortality rates and (2) assess the implementation strategy through measures of reach, adoption, implementation, and maintenance. We will conduct a mixed-methods assessment using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. This assessment consists of four components: (1) a stepped-wedge cluster randomized control trial using a community-based household survey, (2) annual health facility assessments, (3) key informant interviews, and (4) costing and return-on-investment assessments for each randomized cluster. DISCUSSION: Our research is expected to contribute to continuous quality improvement initiatives, optimize implementation factors, provide knowledge regarding health service delivery, and accelerate health systems improvements in Togo and more broadly. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03694366 , registered 3 October 2018.