1,721,030 research outputs found
Feasibility of introducing an onsite test for syphilis in the package of antenatal care at the rural primary health care level in Burkina Faso
Full text linkPhilosophiae Doctor - PhDBackground: Syphilis transmission remains a global problem with an estimated 12 million people infected each year. Ninety percent of syphilis cases occur in low income countries. Syphilis is a serious source of adverse pregnancy outcomes for both mother and infant. Ideally, syphilis screening should be provided as part of a package of maternal and newborn health-care services. This thesis reports on a pilot intervention study to develop, implement and evaluate a point of care test for syphilis in antenatal care services in rural Burkina Faso. Methods: This study used a pre post intervention mixed methods quasi-experimental design with a group of health facilities offering ANC services (primary health centers in rural area) as the sampling units. This study was conducted in three phases, which consisted of a situational analysis using qualitative methods (Phase 1), selecting an appropriate test through evaluating 4 candidate tests and the participatory design and implementation of an intervention that included onsite training, provision of supplies and medicines, quality control and supervision (Phase 2), and an evaluation combining review of record tools, interviews, time motion study and estimating incremental costs (Phase 3). The conceptual framework draws on multilevel assessment (MLA), policy triangle framework, MRC framework for designing complex interventions and the Normalization Process Model (NPM). Methods included document review, seventy five interviews were conducted with health providers, district managers, facility managers, traditional healers, pregnant women, community health workers, and Non-Governmental Organizations (NGO) managers in phase I and fourteen in phase III, non-participant observation, time-motion study, incremental cost analysis, and sensitivity, specificity and ease of use analysis of four candidate point-of care tests. Data were collected between 2012 and 2014. Qualitative data were analyzed through thematic analysis supported by Nvivo software. Quantitative data were analyzed through descriptive statistics such as frequency, mean and median supported by SPSS. Findings: Phase I identified barriers to implementation and uptake of syphilis testing at health provider and community levels. The most important barriers at provider level included fragmentation of services, poor communication between health workers and clients, failure to prescribe syphilis test, and low awareness of syphilis burden. Cost of testing, distance to laboratory and lack of knowledge about syphilis were identified as barriers at community level. Phase II: Alere DetermineTM Syphilis was the most sensitive of the four point-of-care tests evaluated. The components of the intervention were successfully implemented in the selected health facilities. Overall, phase III showed that it is feasible and acceptable to introduce a point of care test for syphilis in antenatal care services at primary health care level using the available staff. The intervention was reported as acceptable, but of 812 pregnant women who came for their first visit 39% were screened during the study period. Rural facilities had higher coverage (66.8%) than the urban ones (25.6%). Quality control found no discordance between the rapid test and TPHA results. The average cost of ANC per unscreened pregnant woman was 3.11 USD (±0.14) vs 5.06 USD (±0.16) per screened woman. The main cost driver was the material costs notably the test itself. The test’s cost is comparable to HIV test costs, but funder support for integrating this additional test is less readily available than for HIV tests. Conclusions: The findings suggested that an intervention that introduces point of care test for syphilis at antenatal care services is feasible, acceptable, and of comparable costs to HIV screening in pregnancy. Nonetheless, instructions and supervision need to be clearer to achieve optimal levels of screening and quality control, and barriers identified by health workers need to be overcome. The point-of care test for syphilis is likely to be acceptable by health workers as a routine service and incorporated as a normal practice in Burkina Faso context.This research was made financially possible by the UNICEF/UNDP/World Bank/WHO
Special Programme for Research and Training in Tropical Diseases (TDR); and the African Doctoral Dissertation Research Fellowship (ADDRF 2012) award offered by the African Population and Health Research Center (APHRC) in partnership with the International Development Research Centre (IDRC)
Feasibility of introducing an onsite test for syphilis in the package of antenatal care at the rural primary health care level in Burkina Faso
No full textPhilosophiae Doctor - PhDBackground: Syphilis transmission remains a global problem with an estimated 12 million people infected each year. Ninety percent of syphilis cases occur in low income countries. Syphilis is a serious source of adverse pregnancy outcomes for both mother and infant. Ideally, syphilis screening should be provided as part of a package of maternal and newborn health-care services. This thesis reports on a pilot intervention study to develop, implement and evaluate a point of care test for syphilis in antenatal care services in rural Burkina Faso. Methods: This study used a pre post intervention mixed methods quasi-experimental design with a group of health facilities offering ANC services (primary health centers in rural area) as the sampling units. This study was conducted in three phases, which consisted of a situational analysis using qualitative methods (Phase 1), selecting an appropriate test through evaluating 4 candidate tests and the participatory design and implementation of an intervention that included onsite training, provision of supplies and medicines, quality control and supervision (Phase 2), and an evaluation combining review of record tools, interviews, time motion study and estimating incremental costs (Phase 3). The conceptual framework draws on multilevel assessment (MLA), policy triangle framework, MRC framework for designing complex interventions and the Normalization Process Model (NPM). Methods included document review, seventy five interviews were conducted with health providers, district managers, facility managers, traditional healers, pregnant women, community health workers, and Non-Governmental Organizations (NGO) managers in phase I and fourteen in phase III, non-participant observation, time-motion study, incremental cost analysis, and sensitivity, specificity and ease of use analysis of four candidate point-of care tests. Data were collected between 2012 and 2014. Qualitative data were analyzed through thematic analysis supported by Nvivo software. Quantitative data were analyzed through descriptive statistics such as frequency, mean and median supported by SPSS. Findings: Phase I identified barriers to implementation and uptake of syphilis testing at health provider and community levels. The most important barriers at provider level included fragmentation of services, poor communication between health workers and clients, failure to prescribe syphilis test, and low awareness of syphilis burden. Cost of testing, distance to laboratory and lack of knowledge about syphilis were identified as barriers at community level. Phase II: Alere DetermineTM Syphilis was the most sensitive of the four point-of-care tests evaluated. The components of the intervention were successfully implemented in the selected health facilities. Overall, phase III showed that it is feasible and acceptable to introduce a point of care test for syphilis in antenatal care services at primary health care level using the available staff. The intervention was reported as acceptable, but of 812 pregnant women who came for their first visit 39% were screened during the study period. Rural facilities had higher coverage (66.8%) than the urban ones (25.6%). Quality control found no discordance between the rapid test and TPHA results. The average cost of ANC per unscreened pregnant woman was 3.11 USD (±0.14) vs 5.06 USD (±0.16) per screened woman. The main cost driver was the material costs notably the test itself. The test’s cost is comparable to HIV test costs, but funder support for integrating this additional test is less readily available than for HIV tests. Conclusions: The findings suggested that an intervention that introduces point of care test for syphilis at antenatal care services is feasible, acceptable, and of comparable costs to HIV screening in pregnancy. Nonetheless, instructions and supervision need to be clearer to achieve optimal levels of screening and quality control, and barriers identified by health workers need to be overcome. The point-of care test for syphilis is likely to be acceptable by health workers as a routine service and incorporated as a normal practice in Burkina Faso context.This research was made financially possible by the UNICEF/UNDP/World Bank/WHO
Special Programme for Research and Training in Tropical Diseases (TDR); and the African Doctoral Dissertation Research Fellowship (ADDRF 2012) award offered by the African Population and Health Research Center (APHRC) in partnership with the International Development Research Centre (IDRC)
First Report on the Co-Occurrence and Clustering Profiles of Cardiovascular Lifestyle Risk Factors among Adults in Burkina Faso
No full textThe co-occurrence of cardiovascular risk factors is usually associated with a higher risk of cardiovascular disease (CVD) or cancer. This study aimed to determine the prevalence of the co-occurrence and its determinants and to identify the clustering profiles of lifestyle risk factors among the adult population in Burkina Faso. Among 4692 participants, 4377 adults from the first STEPS survey conducted in Burkina Faso were considered in this analysis. Four lifestyle risk factors (smoking, alcohol consumption, inadequate fruit and vegetable intake and low physical activity) were analysed. The clustering was evaluated using the observed/expected (O/E) ratio approach. To identify the determinants of co-occurrence, we performed a modified Poisson regression. The prevalence of the co-occurrence of two or more cardiovascular lifestyle risk factors was 46.4% (95% CI: 43.1–49.7). The main determinants of the co-occurrence were being male (adjusted prevalence ratio (aPR): 1.27 (95% CI: 1.16–1.38)), advanced age (55–64 years old: aPR: 1.45 (95% CI: 1.31–1.60)) and a high level of education (aPR: 1.29 (95% CI: 1.09–1.52)). The clustering profile for lifestyle risk factors was tobacco consumption combined with alcohol consumption (O/E: 2.77 (95% CI: 2.12–3.56)), and concurrent involvement in all four lifestyle risk factors (O/E = 1.51 (95% CI: 1.19–1.89)). This first population-based report on the co-occurrence of lifestyle risk factors calls for action to tailor health-promoting interventions to increase healthy lifestyle behaviors. The identified CVD-risk clustering should be considered as an important step in this strategy development in Burkina Faso
Distribution de l'Insulin Growth Factor-I (IGF-I) chez les enfants de moins de 5 ans au Burkina Faso et évolution chez l'enfant en réhabilitation nutritionnelle
No full textObjectif : Ce travail se veut une contribution à l’amélioration de la santé des enfants du Burkina Faso et de l’Afrique en général. Il vise à l’identification de meilleures stratégies de diagnostic et de pronostic des enfants atteints de malnutrition. Méthodes : Dans une première étape, nous avons validé une méthode permettant la quantification de l’IGF-I à partir de sang prélevé sur papier buvard chez des enfants de moins de cinq ans, dont les valeurs d’IGF-I sont très basses. Une collecte des échantillons de sang sur tube (sérum), sur papier buvard à la température de 4 °C et sur papier buvard à la température ambiante (30-35 °C) a été réalisée auprès de 13 enfants burkinabè âgés de 0 à 59 mois qui ont consulté au service de Pédiatrie du CHU Yalgado Ouedraogo de Ouagadougou et au Centre Médical de Kossodo à Ouagadougou. Les mesures de l’IGF-I ont été effectuées sur IGF-I RIA, après séparation des protéines porteuses en utilisant la chromatographie sur Sep-Pack. · Nous avons ensuite réalisé une étude transversale en population auprès générale auprès de 400 enfants en bonne santé apparente à Ouagadougou (Burkina Faso). La collecte de sang s’est faite sur papier buvard. · Enfin, nous avons mené une étude de cohorte auprès des enfants admis dans 2 centres de réhabilitation et d’éducation nutritionnelle à Ouahigouya dans le Nord du Burkina Faso. Les enfants ont été suivis de l’admission à leur sortie et les données anthropométriques ainsi que des échantillons de sang sur papier buvard ont été collectés à l’admission, au 7ème Jour et au 14ème Jour. Résultats : L’étude de validation a montré qu’il existe une excellente corrélation entre les taux sériques d’IGF-I et les taux d’IGF-I sur papier buvard conservés à 4 °C ou à la température ambiante d’une zone tropicale (30 – 35 °C). · L’étude transversale en population a permis d’obtenir les valeurs de référence de l’IGF-I chez les enfants de moins de 5 ans au Burkina Faso. Les concentrations moyennes d’IGF-I sont plus élevées chez les filles que chez les garçons. De la naissance à 24 mois, l’IGF-I décroît et après 24 mois, il y a une augmentation de l'IGF-I chez les filles comme chez les garçons. · Les résultats de l’étude de cohorte en milieu hospitalier ont montré des valeurs de l’IGF-I très basses à l’admission. Ensuite, nous avons observé une augmentation des valeurs d’IGF-I au 7ème jour et cette augmentation a continué jusqu’au 14ème jour. Une corrélation significative a été observée entre le gain pondéral et le gain d’IGF-I au 7ème jour et au 14ème jour. Conclusion : Les études que nous avons réalisées démontrent qu’il est possible d’utiliser le papier buvard pour la collecte des échantillons de sang dans le cadre des études épidémiologiques dans les pays où les contraintes matérielles ne permettent pas toujours de maintenir une chaîne de froid efficace pour la conservation des échantillons sanguins et chez de très jeunes enfants chez lesquels il est très malaisé d’obtenir des échantillons de sang par ponction veineuse. Les valeurs de référence de l’IGF-I établies peuvent être utiles pour le diagnostic et la surveillance nutritionnels ainsi que pour les évaluations des pathologies endocriniennes chez les enfants de moins de 5 ans dans le contexte d’un pays tropical comme le Burkina Faso. Mais des études complémentaires pourraient mettre en évidence la valeur pronostic d’une récupération faible ou importante de l’IGF-I après un épisode de malnutrition sévère. Il est plausible que la perte plus ou moins importante d’un potentiel de croissance lors d’une période de malnutrition sévère soit un indicateur de mauvais développement à l’adolescence ou à l’âge adulte.(ESP 3) -- UCL, 200
Low prevalence of high blood pressure in pregnant women in Burkina Faso: a cross-sectional study
No full textBACKGROUND: High blood pressure (HBP) during pregnancy causes maternal and fetal mortality. Studies regarding its prevalence and associated factors in frontline level health care settings are scarce. We thus aimed to evaluate the prevalence of HBP and its associated factors among pregnant women at the first level of the health care system in Burkina Faso. METHODS: This cross-sectional study was conducted in six health facilities between December 2018 and March 2019. HBP was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Multivariable logistic regression analysis was performed to identify factors associated with HBP. RESULTS: A total of 1027 pregnant women were included. The overall prevalence of HBP was 1.4% (14/1027; 95% confidence interval [CI] 0.7–2.3), with 1.6% (7/590; 95% CI 0.8–3.3) in rural and 1.2% (7/437; 95% CI 0.6- 2.5) in semi-urban areas. The prevalence was 0.7% (3/440; 95% CI 0.2–2.1) among women in the first, 1.5% (7/452; 95% CI 0.7–3.2) in the second and 3% (4/135; 95% CI 1.1–7.7) in the third trimester. In the multivariable analysis, pregnancy trimester, maternal age, household income, occupation, parity, and residential area were not associated with HBP during pregnancy. CONCLUSION: The prevalence of HBP among pregnant women at the first level of health system care is significantly lower compared to prevalence’s from hospital studies. Public health surveillance, primary prevention activities, early screening, and treatment of HDP should be reinforced in all health facilities to reduce the burden of adverse pregnancy outcomes in Burkina Faso
Systemic exposure to rifampicin in patients with tuberculosis and advanced HIV disease during highly active antiretroviral therapy in Burkina Faso
No full textIntegrating maternal postpartum care to child clinics and immunization services : effects on utilization, content and cost of services in Kaya health district, Burkina Faso
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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