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Lima RB, de Freitas Miranda-Filho AE, Moura APGE, Nelson-Filho P, da Silva LAB, da Silva RAB. Territorial Disparities in Dental Care for Disabled Persons and Oral Health-Related Indicators: A Population-Level Approach in Brazil's Public Healthcare System from 2014 to 2023. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:632. [PMID: 38791846 PMCID: PMC11121442 DOI: 10.3390/ijerph21050632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
This study evaluated territorial disparities in dental care for disabled persons in Brazil's public healthcare system from 2014 to 2023. The person-year incidence of outpatient dental procedures carried out by special care dentistry specialists and hospitalizations for dental procedures for disabled persons were compared across different regions and against the national estimate. In addition, productivity was correlated with oral health-related indicators. The significance level was set at 5%. The northern region exhibited the highest outpatient productivity, while the southern region showed lower productivity compared to the national estimate (both p-value < 0.05). This pattern was reversed in inpatient productivity (both p-value < 0.05), with the northeastern and central-western regions also below average (both p-value < 0.05). There were no significant correlations between the indicators and inpatient productivity, but outpatient productivity was positively correlated with the proportions of inhabitants who self-rated their general and oral health as "poor" or "very poor", who have never visited a dentist, and who visited a dentist for tooth extraction (all p-values < 0.05). Territorial disparities in dental care for disabled persons were observed within Brazil's public healthcare system, and they were correlated with unfavorable oral health-related indicators at the population level.
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Affiliation(s)
- Ricardo Barbosa Lima
- Graduate Program in Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, SP, Brazil
| | | | - Ana Paula Gomes e Moura
- Graduate Program in Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, SP, Brazil
| | - Paulo Nelson-Filho
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, SP, Brazil
| | - Léa Assed Bezerra da Silva
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, SP, Brazil
| | - Raquel Assed Bezerra da Silva
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, SP, Brazil
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Saaka SA, Pienaah CKA, Stampp Z, Antabe R. Safe sex negotiation and HIV risk reduction among women: A cross-sectional analysis of Burkina Faso 2021 Demographic and Health Survey. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003134. [PMID: 38656996 PMCID: PMC11042694 DOI: 10.1371/journal.pgph.0003134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
Women are biologically more susceptible to the Human Immunodeficiency Virus (HIV) and other sexually transmitted Infections (STIs) because receptive sex is riskier than insertive. Despite condom use being the staple preventive method for HIV infection (over 80% efficacy), in Sub-Saharan African countries like Burkina Faso, a high burden of HIV and the unmet need for condom use coexist. Moreover, even though women in SSA are disproportionately HIV positive, they are reportedly less capable of negotiating condom use for HIV risk reduction. Thus, using the Health Believe Model (HBM), this study explored the factors that influence condom use among women within the context of HIV prevention, with a key interest in condom use negotiation. Using the women's dataset of the 2021 Burkina Faso Demographic and Health Survey and applying logistic regression models, this study examined the factors associated with condom use for HIV risk reduction. Women who had confidence to negotiate condom use with their partners (OR = 1.57, P<0.001, 95%CI: 1.29, 1.91), those with secondary education (OR = 1.38, P<0.05, 95%CI: 1.07 1.77), from richest households (OR = 1.64, P<0.05, 95%CI: 1.08, 2.47), the employed (OR = 1.23, P<0.05, 95%CI: 1.02, 1.49), women with knowledge of sexually transmitted infections (OR = 1.58, P<0.001, 95%CI: 1.26, 1.97), those who have ever been tested for HIV (OR = 1.85, P<0.001, 95%CI: 1.52 2.24), as well as those who knew that a healthy-looking person can have HIV (OR = 2.64, P<0.001, 95%CI: 2.15, 3.24) were all significantly more likely to practice condom use for HIV risk reduction. Also, religion and geographical location of participants significantly predicted condom use for HIV risk reduction in the study context. The ability to negotiate condom use, knowledge of HIV and STIs, the socioeconomic status of women, as well as their geographical location, influence their practice of safer sex for HIV risk reduction in Burkina Faso.
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Affiliation(s)
| | | | - Zakara Stampp
- Department of Geography and Environment, University of Western Ontario, London, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
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Ahmed S, Koudou GB, Bagot M, Drabo F, Bougma WR, Pulford C, Bockarie M, Harrison RA. Health and economic burden estimates of snakebite management upon health facilities in three regions of southern Burkina Faso. PLoS Negl Trop Dis 2021; 15:e0009464. [PMID: 34153048 PMCID: PMC8248599 DOI: 10.1371/journal.pntd.0009464] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/01/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background Snakebite has become better recognized as a significant cause of death and disability in Sub-Saharan Africa, but the health economic consequences to victims and health infrastructures serving them remain poorly understood. This information gap is important as it provides an evidence-base guiding national and international health policy decision making on the most cost-effective interventions to better manage snakebite. Here, we assessed hospital-based data to estimate the health economic burden of snakebite in three regions of Burkina Faso (Centre-Ouest, Hauts Bassins and Sud-Ouest). Methodology Primary data of snakebite victims admitted to regional and district health facilities (eg, number of admissions, mortality, hospital bed days occupied) was collected in three regions over 17 months in 2013/14. The health burden of snakebite was assessed using Disability-Adjusted Life Years (DALYs) calculations based upon hospitalisation, mortality and disability data from admitted patients amongst other inputs from secondary sources (eg, populations, life-expectancy and age-weighting constants). An activity-based costing approach to determine the direct cost of snake envenoming included unit costs of clinical staff wages, antivenom, supportive care and equipment extracted from context-relevant literature. Findings The 10,165 snakebite victims admitted to hospital occupied 28,164 hospital bed days over 17 months. The annual rate of hospitalisation and mortality of admitted snakebite victims was 173 and 1.39/100,000 population, respectively. The estimated annual (i) DALYs lost was 2,153 (0.52/1,000) and (ii) cost to hospitals was USD 506,413 (USD 49/hospitalisation) in these three regions of Burkina Faso. These costs appeared to be influenced by the number of patients receiving antivenom (10.90% in total) in each area (highest in Sud-Ouest) and the type of health facility. Conclusion The economic burden of snake envenoming is primarily shouldered by the rural health centres closest to snakebite victims–facilities that are typically least well equipped or resourced to manage this burden. Our study highlights the need for more research in other regions/countries to demonstrate the burden of snakebite and the socioeconomic benefits of its management. This evidence can guide the most cost-effective intervention from government and development partners to meet the snakebite-management needs of rural communities and their health centres. The World Health Organisation has established a strategy to halve snakebite mortality and morbidity by 2030. Achieving this ambitious target within a decade will require substantial investment from governments of countries most affected by snakebite. The burden of snakebite however, is typically greatest in low-middle income countries with already limited health budgets. Acquiring government support to prioritise snakebite over other prevailing diseases will require evidence of the scale, causes, precise geographies and health economic impacts of snakebite. While the snakebite research community has progressed the delivery of some of these evidence types, it has been weak at providing evidence of the health economic burden of snakebite. Our hospital-based study identifies the health (Disability-Adjusted Life Years) and financial burdens of snakebite to three districts of Burkina Faso. We argue that funding of more health economic research, performed at greater depth and that includes cost-effectiveness of snakebite treatment and other remedial interventions is arguably the most effective tool to advocate for the policy support and investment required of national and international health agencies to deliver WHO’s laudable 2030 target for snakebite.
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Affiliation(s)
- Sayem Ahmed
- The Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- The Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Mathematical Modelling Group, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Guibehi B. Koudou
- The Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Centre Suisse de Recherches Scientifiques, Abidjan, Cote d’Ivoire
| | - Maïwenn Bagot
- The Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - François Drabo
- Ministère de la Santé, Direction de la Promotion de la Santé, Ouagadougou, Burkina Faso
| | - Windtaré R. Bougma
- Ministère de la Santé, Direction de la Prévention de la Santé de la Population, Programme National de lute contre les Maladies Tropicales Négligées, Ouagadougou, Burkina Faso
| | - Caisey Pulford
- The Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- National Infection Service, Public Health England Colindale, London, United Kingdom
- Institute of infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Moses Bockarie
- The Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
| | - Robert A. Harrison
- The Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- The Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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Ouédraogo AL, Zhang J, Tinto H, Valéa I, Wenger EA. A microplanning model to improve door-to-door health service delivery: the case of Seasonal Malaria Chemoprevention in Sub-Saharan African villages. BMC Health Serv Res 2020; 20:1128. [PMID: 33287825 PMCID: PMC7720067 DOI: 10.1186/s12913-020-05972-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022] Open
Abstract
Background Malaria incidence has plateaued in Sub-Saharan Africa despite Seasonal Malaria Chemoprevention’s (SMC) introduction. Community health workers (CHW) use a door-to-door delivery strategy to treat children with SMC drugs, but for SMC to be as effective as in clinical trials, coverage must be high over successive seasons. Methods We developed and used a microplanning model that utilizes population raster to estimate population size, generates optimal households visit itinerary, and quantifies SMC coverage based on CHWs’ time investment for treatment and walking. CHWs’ performance under current SMC deployment mode was assessed using CHWs’ tracking data and compared to microplanning in villages with varying demographics and geographies. Results Estimates showed that microplanning significantly reduces CHWs’ walking distance by 25%, increases the number of visited households by 36% (p < 0.001) and increases SMC coverage by 21% from 37.3% under current SMC deployment mode up to 58.3% under microplanning (p < 0.001). Optimal visit itinerary alone increased SMC coverage up to 100% in small villages whereas in larger or hard-to-reach villages, filling the gap additionally needed an optimization of the CHW ratio. Conclusion We estimate that for a pair of CHWs, the daily optimal number of visited children (assuming 8.5mn spent per child) and walking distance should not exceed 45 (95% CI 27–62) and 5 km (95% CI 3.2–6.2) respectively. Our work contributes to extend SMC coverage by 21–63% and may have broader applicability for other community health programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05972-2.
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Affiliation(s)
- André Lin Ouédraogo
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA, 98109, USA.
| | - Julie Zhang
- Department of Mathematics and Statistics, University of Washington, Seattle, WA, USA.,Department of Statistics, Stanford University, Palo Alto, CA, USA
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé, Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
| | - Innocent Valéa
- Institut de Recherche en Sciences de la Santé, Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
| | - Edward A Wenger
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA, 98109, USA
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Zon H, Pavlova M, Groot W. Regional health disparities in Burkina Faso during the period of health care decentralization. Results of a macro-level analysis. Int J Health Plann Manage 2020; 35:939-959. [PMID: 32310321 PMCID: PMC7386926 DOI: 10.1002/hpm.2979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/09/2019] [Accepted: 03/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Burkina Faso has undertaken decentralization reforms in the health care sector to improve the performance of the health system. This study aimed to analyze the differences in health outcomes by health district's demographic and economic status, and the distribution of health resources during the period of health care decentralization. METHODS A bivariate correlation analysis was conducted using data at the health districts and regions level. Data from the health management information system (HMIS) and national households' surveys were used. RESULTS The results indicate a strong correlation between district's population size and the availability of health resources (P ≤ .05). The health visits per capita and skilled birth attendance are correlated with the economic status of the health district (P ≤ .05). Malnutrition among under-five and maternal mortality was associated with the availability of health personnel and health infrastructures (P ≤ .05). No correlation was found between financial resources and health outcomes. CONCLUSION The results indicated disparities in health among the health districts in Burkina Faso. The ways to address this inequality include more transparent resource allocation, as well as policies to address the socio-economic disparities and financial barriers to health services. Further research is needed to collect relevant data and investigate the effects of decentralization, which was not possible in our study.
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Affiliation(s)
- Hilaire Zon
- National Laboratory of Public HealthMinistry of HealthOuagadougouBurkina Faso
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Top Institute Evidence‐Based Education Research (TIER)Maastricht UniversityMaastrichtthe Netherlands
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