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Kim HJ, Bruni E, Gorodetska G, Van den Bergh R, Bezer L, Artykutsa S, Andriamiseza N, Habicht J. Typology and implications of verified attacks on health care in Ukraine in the first 18 months of war. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003064. [PMID: 38781240 PMCID: PMC11115218 DOI: 10.1371/journal.pgph.0003064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/13/2024] [Indexed: 05/25/2024]
Abstract
Attacks on health care are part of the spectrum of threats that health care endures during conflict. Protecting health care services against attacks depends on understanding the nature and types of attacks that occur during conflict. The World Health Organisation has implemented the Surveillance System for Attacks on Health Care (SSA) in Ukraine since 2020, and the system has continued to monitor and report on attacks on health care during the war in Ukraine. This study aims to analyse the data reported through the SSA for the first 18 months of the war. This paper involves a retrospective, descriptive study based on the analysis of publicly available SSA data of all incidents of attacks on health care in Ukraine reported through the SSA between February 24th 2022 and August 24th 2023. Out of the 1503 verified attacks, 37% occurred in the initial six weeks of the war. Attacks involving violence with heavy weapons were among the most common incidents reported (83%). The reported attacks were associated with a total of 113 deaths and 211 injuries among health care workers and patients: 32 (2%) attacks were associated with a death of a health care worker or patient, and 63 (4%) were associated with an injury. Health transports facing attacks had a higher probability of experiencing casualties than other health resources (p<0.0001, RR 3.1, 95%CI 1.9-4.9). In conclusion, the burden of attacks on health care in Ukraine was high and sustained over the course of the first 18 months of the war. Reported casualties were not homogenously distributed among attack incidents, but occurred in a set of high-casualty incidents. Health transports were found to be particularly vulnerable. In addition to continued calls for a cessation of hostilities, prevention, protection, mitigation, and reconstruction strategies are urgently required.
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Affiliation(s)
- Hyo-Jeong Kim
- Attacks on Health Care Initiative, WHO, Geneva, Switzerland
| | | | | | | | - Lamia Bezer
- WHO Country Office for Ukraine, Kyiv, Ukraine
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Kante AM, Youssoufa LO, Mounkaila A, Mahamadou Y, Bamogo A, Jiwani SS, Hazel E, Maïga A, Munos MK, Walton S, Tam Y, Walker N, Akseer N, Jue Wong H, Moussa M, Dagobi AE, Jessani NS, Amouzou A. Challenges in reducing maternal and neonatal mortality in Niger: an in-depth case study. BMJ Glob Health 2024; 9:e011732. [PMID: 38770808 PMCID: PMC11085984 DOI: 10.1136/bmjgh-2023-011732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/22/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Recent modelled estimates suggest that Niger made progress in maternal mortality since 2000. However, neonatal mortality has not declined since 2012 and maternal mortality estimates were based on limited data. We researched the drivers of progress and challenges. METHODS We reviewed two decades of health policies, analysed mortality trends from United Nations data and six national household surveys between 1998 and 2021 and assessed coverage and inequalities of maternal and newborn health indicators. Quality of care was evaluated from health facility surveys in 2015 and 2019 and emergency obstetric assessments in 2011 and 2017. We determined the impact of intervention coverage on maternal and neonatal lives saved between 2000 and 2020. We interviewed 31 key informants to understand the factors underpinning policy implementation. RESULTS Empirical maternal mortality ratio declined from 709 to 520 per 100 000 live births during 2000-2011, while neonatal mortality rate declined from 46 to 23 per 1000 live births during 2000-2012 then increased to 43 in 2018. Inequalities in neonatal mortality were reduced across socioeconomic and demographic strata. Key maternal and newborn health indicators improved over 2000-2012, except for caesarean sections, although the overall levels were low. Interventions delivered during childbirth saved most maternal and newborn lives. Progress came from health centre expansion, emergency care and the 2006 fee exemptions policy. During the past decade, challenges included expansion of emergency care, continued high fertility, security issues, financing and health workforce. Social determinants saw minimal change. CONCLUSIONS Niger reduced maternal and neonatal mortality during 2000-2012, but progress has stalled. Further reductions require strategies targeting comprehensive care, referrals, quality of care, fertility reduction, social determinants and improved security nationwide.
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Affiliation(s)
- Almamy Malick Kante
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Aida Mounkaila
- Direction des Statistiques Sanitaires, Ministère de la Santé Publique, Niamey, Niger
| | - Yahaha Mahamadou
- Direction des Statistiques Sanitaires, Ministère de la Santé Publique, Niamey, Niger
| | - Assanatou Bamogo
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Safia S Jiwani
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Hazel
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abdoulaye Maïga
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melinda Kay Munos
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shelley Walton
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yvonne Tam
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neff Walker
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nadia Akseer
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Heather Jue Wong
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Nasreen S Jessani
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Knowledge, Impact and Policy Unit, Institute of Development Studies, Brighton, UK
| | - Agbessi Amouzou
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Zombré D, Diarra D, Touré L, Bonnet E, Ridde V. Improving healthcare accessibility for pregnant women and children in the context of health system strengthening initiatives and terrorist attacks in Central Mali: a controlled interrupted time series analysis. BMJ Glob Health 2024; 7:e012816. [PMID: 38697656 PMCID: PMC11107806 DOI: 10.1136/bmjgh-2023-012816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/22/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION The Health and Social Development Program of the Mopti Region (PADSS2) project, launched in Mali's Mopti region, targeted Universal Health Coverage (UHC). The project addressed demand-side barriers by offering an additional subsidy to household contributions, complementing existing State support (component 1). Component 2 focused on supply-side improvements, enhancing quality and coverage. Component 3 strengthened central and decentralised capacity for planning, supervision and UHC reflection, integrating gender mainstreaming. The study assessed the impact of the project on maternal and child healthcare use and explored how rising terrorist activities might affect these health outcomes. METHODS The impact of the intervention on assisted births, prenatal care and curative consultations for children under 5 was analysed from January 2016 to December 2021. This was done using an interrupted time series analysis, incorporating a comparison group and spline regression. RESULTS C1 increased assisted deliveries by 0.39% (95% CI 0.20 to 0.58] and C2 by 1.52% (95% CI 1.36 to 1.68). C1-enhanced first and fourth antenatal visits by 1.37% (95% CI 1.28 to 1.47) and 2.07% (95% CI 1.86 to 2.28), respectively, while C2 decreased them by 0.53% and 1.16% (95% CI -1.34 to -0.99). For child visits under 5, C1 and C2 showed increases of 0.32% (95% CI 0.20 to 0.43) and 1.36% (95% CI 1.27 to 1.46), respectively. In areas with terrorist attacks, child visits decreased significantly by 24.69% to 39.86% compared with unexposed areas. CONCLUSION The intervention had a limited impact on maternal and child health, falling short of expectations for a health system initiative. Understanding the varied effects of terrorism on healthcare is key to devising strategies that protect the most vulnerable in the system.
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Affiliation(s)
- David Zombré
- Evaluation and Data Analytics, Recherche pour la santé et le développement 04 BP 8398 Ouagadougou 04, Arrondissement 6, Secteur 28, Ouagadougou, Burkina Faso
| | - Dansiné Diarra
- Faculté d'Histoire et de Géographie, Université des Sciences Sociales et de Gestion de Bamako, Bamako, Mali
| | - Laurence Touré
- Association Malienne de Recherche et Formation en Anthropologie des dynamiques locales, MISELI, BP E5448, Bamako, Mali
| | - Emmanuel Bonnet
- Résiliences, Institut de recherche pour le developpement, bondy, Seine Saint Denis, France
| | - Valery Ridde
- CEPED, IRD, Paris, France
- ISED, UCAD, Dakar, Senegal
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Doutchi M, Ghousmane A, Zampaligre F, Moussa B, Ishagh EK, Talatou Marc O, Oumarou B, Kaya MS, Diawara GA, Camara AM, Moussa S, Bienvenu K, Toko J, Harouna H, Moussa H, Kofi N, Tamuzi JL, Katoto PDMC, Wiysonge CS, Melanga Anya BP. Health transformation toward universal healthcare coverage amidst conflict: examining the impact of international cooperation in Niger. Front Public Health 2024; 12:1303168. [PMID: 38515600 PMCID: PMC10956617 DOI: 10.3389/fpubh.2024.1303168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/05/2024] [Indexed: 03/23/2024] Open
Abstract
Background Approximately 70% of Sub-Saharan African countries have experienced armed conflicts with significant battle-related fatalities in the past two decades. Niger has witnessed a substantial rise in conflict-affected populations in recent years. In response, international cooperation has aimed to support health transformation in Niger's conflict zones and other conflict-affected areas in Sub-Saharan Africa. This study seeks to review the available evidence on health interventions facilitated by international cooperation in conflict zones, with a focus on Niger. Methods We conducted a systematic literature review (SLR) adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted from 2000 to 4 September 2022 using MeSH terms and keywords to identify relevant studies and reports in Sub-Saharan Africa and specifically in Niger. Databases such as PubMed (Medline), Google Scholar, Google, and gray literature were utilized. The findings were presented both narratively and through tables and a conceptual framework. Results Overall, 24 records (10 studies and 14 reports) that highlighted the significant role of international cooperation in promoting health transformation in conflict zones across Sub-Saharan Africa, including Niger, were identified. Major multilateral donors identified were the World Health Organization (WHO), United Nations Children's Fund (UNICEF), United Nations Fund for Population Activities (UNFPA), World Bank, United States Agency for International Development (USAID), European Union, European Commission Humanitarian Aid (ECHO), Global Fund, and Global Alliance for Vaccines and Immunization (GAVI). Most supports targeted maternal, newborn, child, adolescent, and youth health, nutrition, and psycho-social services. Furthermore, interventions were in the form of public health initiatives, mobile clinic implementation, data management, human resource capacity building, health information systems, health logistics, and research funding in conflict zones. Conclusion This literature review underscores the significant engagement of international cooperation in strengthening and transforming health services in conflict-affected areas across Sub-Saharan Africa, with a particular focus on Niger. However, to optimize the effectiveness of healthcare activities from short- and long-term perspectives, international partners and the Ministry of Public Health need to re-evaluate and reshape their approach to health intervention in conflict zones.
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Affiliation(s)
| | | | | | - Bizo Moussa
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | - El Khalef Ishagh
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | | | - Batouré Oumarou
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | | | | | | | - Seyni Moussa
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | | | - Joseph Toko
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | - Hamidou Harouna
- Direction de la Surveillance et la Réponse aux Epidémies du Ministère de la Santé Publique, de la Population et des Affaires Sociale, Chargé de la Surveillance, Niamey, Niger
| | - Haladou Moussa
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | - N’Zue Kofi
- Bureau de l'Organisation Mondiale de la Santé (OMS), Niamey, Niger
| | - Jacques Lukenze Tamuzi
- Department of Public Health, Université de Zinder, Zinder, Niger
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Patrick D. M. C. Katoto
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa
- Centre for Tropical Diseases and Global Health, Department of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
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Hedström J, Herder T. Women's sexual and reproductive health in war and conflict: are we seeing the full picture? Glob Health Action 2023; 16:2188689. [PMID: 36927249 PMCID: PMC10026773 DOI: 10.1080/16549716.2023.2188689] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
It is well established that women's sexual and reproductive health (SRHR) is negatively affected by war. While global health research often emphasises infrastructure and systematic factors as key impediments to women's SRHR in war and postwar contexts, reports from different armed conflicts indicate that women's reproduction may be controlled both by state and other armed actors, limiting women's choices and access to maternal and reproductive health care even when these are available. In addition, it is important to examine and trace disparities in sexual reproductive health access and uptake within different types of wars, recognising gendered differences in war and postwar contexts. Adding feminist perspectives on war to global health research explanations of how war affects women's sexual and reproductive health might then contribute to further understanding the complexity of the different gendered effects war and armed conflicts have on women's sexual and reproductive health.
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Affiliation(s)
- Jenny Hedström
- Department of War Studies and Military History, Swedish Defence University, Stockholm, Sweden
| | - Tobias Herder
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Ouedraogo M, Sanou D, Kere IWZ, Sankara S, Thiombiano-Coulibaly N, Ouedraogo O, Zoungrana B, Hama-Ba F, Savadogo A. Sahel terrorist crisis and development priorities: case of financial allocations for the control of non-communicable diseases in Burkina Faso. Front Public Health 2023; 11:1253123. [PMID: 37900015 PMCID: PMC10601467 DOI: 10.3389/fpubh.2023.1253123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
In Africa, nearly 46% of all mortality will be attributed to non-communicable diseases (NCDs) by 2030. While the cost of inaction far exceeds the cost of action against NCDs, global funding for the prevention and control of NCDs is minimal. The objective of this was to explore the Ministry of Health budget allocations for NCDs from 2010 to 2020 as well as the effect of the terrorism crisis on these allocations. The methodology was based on the budget tracking tool developed by the Scaling Up Nutrition Movement. Twenty-nine budget lines related to the prevention and/or control of NCDs have been identified. About 29.9 million USD were allocated to the fight against NCDs with an absorption rate of more than 98%.There is an upward trend of allocated budget characterized by an exponential increase from the development of the national integrated strategic plan for the fight against NCDs (2016-2020). In 2017, an increase of 184% compared to 2016 was observed. However, the efforts were challenged by the emergence of the terrorist threat which triggered in January 2016, leading to a drastic reduction in allocations for NCDs in favor likely of defense and security priorities as well as addressing the needs of internally displaced persons. A trend analysis suggests that the NCDs budget significantly decrease as the country global terrorist index increase. Further analysis is needed to better understand the implication on NCD incidence, and identify advocacy opportunities for mitigating the negative impact of the terrorist treat on NCDs and other development issues.
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Affiliation(s)
- Moussa Ouedraogo
- Doctoral School of Sciences and Technology, Laboratory of Applied Biochemistry and Immunology (LABIA), Joseph Ki-ZERBO University, Ouagadougou, Burkina Faso
- Nutrition Directorate, Ministry of Health, Ouagadougou, Burkina Faso
| | - Dia Sanou
- FAO, Subregional Office, Eastern Africa, Addis Ababa, Ethiopia
| | - Ines Wendlassida Zaheira Kere
- Doctoral School of Sciences and Technology, Laboratory of Applied Biochemistry and Immunology (LABIA), Joseph Ki-ZERBO University, Ouagadougou, Burkina Faso
| | - Souleymane Sankara
- Doctoral School of Sciences and Technology, Laboratory of Applied Biochemistry and Immunology (LABIA), Joseph Ki-ZERBO University, Ouagadougou, Burkina Faso
| | | | | | - Bassibila Zoungrana
- Doctoral School of Sciences and Technology, Laboratory of Applied Biochemistry and Immunology (LABIA), Joseph Ki-ZERBO University, Ouagadougou, Burkina Faso
| | - Fatoumata Hama-Ba
- Food Technology Department, Institute for Research in Applied Sciences and Technologies, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Aly Savadogo
- Doctoral School of Sciences and Technology, Laboratory of Applied Biochemistry and Immunology (LABIA), Joseph Ki-ZERBO University, Ouagadougou, Burkina Faso
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Cooper S, Bicaba F, Tiendrebeogo CO, Bila A, Bicaba A, Druetz T. Vaccination coverage in rural Burkina Faso under the effects of COVID-19: evidence from a panel study in eight districts. BMC Health Serv Res 2023; 23:1016. [PMID: 37735414 PMCID: PMC10512531 DOI: 10.1186/s12913-023-10029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Improving infant immunization completion and promoting equitable vaccination coverage are crucial to reducing global under-5 childhood mortality. Although there have been hypotheses that the impact of the COVID-19 pandemic would decrease the delivery of health services and immunization campaigns in low- and middle-income countries, the available evidence is still inconclusive. We conducted a study in rural Burkina Faso to assess changes in vaccination coverage during the pandemic. A secondary objective was to examine long-term trends in vaccination coverage throughout 2010-2021. METHODS Using a quasi-experimental approach, we conducted three rounds of surveys (2019, 2020, 2021) in rural Burkina Faso that we pooled with two previous rounds of demographic and household surveys (2010, 2015) to assess trends in vaccination coverage. The study population comprised infants aged 0-13 months from a sample of 325 households randomly selected in eight districts (n = 736). We assessed vaccination coverage by directly observing the infants' vaccination booklet. Effects of the pandemic on infant vaccination completion were analyzed using multi-level logistic regression models with random intercepts at the household and district levels. RESULTS A total of 736 child-year observations were included in the analysis. The proportion of children with age-appropriate complete vaccination was 69.76% in 2010, 55.38% in 2015, 50.47% in 2019-2020, and 64.75% in 2021. Analyses assessing changes in age-appropriate full-vaccination coverage before and during the pandemic show a significant increase (OR: 1.8, 95% CI: 1.14-2.85). Our models also confirmed the presence of heterogeneity in full vaccination between health administrative districts. The pandemic could have increased inequities in infant vaccination completion between these districts. The analyses suggest no disruption in age-appropriate full vaccination due to COVID-19. Our findings from our sensitivity analyses to examine trends since 2010 did not show any steady trends. CONCLUSION Our findings in Burkina Faso do not support the predicted detrimental effects of COVID-19 on the immunization schedule for infants in low- and middle-income countries. Analyses comparing 2019 and 2021 show an improvement in age-appropriate full vaccination. Regardless of achieving and sustaining vaccination coverage levels in Burkina Faso, this should remain a priority for health systems and political agendas.
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Affiliation(s)
- Sarah Cooper
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique, Montreal, QC, Canada
| | - Frank Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
- Sciences de la Vie et de la Santé, University Aix-Marseille, Marseille, France
| | - Cheick Oumar Tiendrebeogo
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique, Montreal, QC, Canada
| | - Alice Bila
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Thomas Druetz
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
- Centre de recherche en santé publique, Montreal, QC, Canada.
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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Fassinou LC, Hien H, Yombi JC, Nagot N, Kirakoya-Samadoulougou F. Availability and readiness of the health facilities to provide HIV counseling and testing and prevention of mother-to-child transmission services in Burkina Faso: a trend analysis from 2012 to 2018. BMC Health Serv Res 2023; 23:757. [PMID: 37452422 PMCID: PMC10347843 DOI: 10.1186/s12913-023-09757-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Provider-Initiated HIV Testing and Counseling (PITC) and Prevention of Mother-To-Child Transmission (PMTCT) are key services for achieving the goal of complete elimination of HIV. However, there is limited evidence on the ability of health facilities to provide these services in Burkina Faso. Therefore, we aimed to assess the trends and disparities in the availability and readiness of health facilities to provide PITC and PMTCT services in Burkina Faso between 2012 and 2018. METHODS We performed a secondary analysis of facility-level data from the World Health Organization's Service Availability and Readiness Assessment (SARA) surveys conducted in 2012, 2014, 2016, and 2018 in Burkina Faso. The availability and readiness of health facilities were assessed using SARA's manual, and linear regressions were used to examine trends. RESULTS Between 2012 and 2018, the mean proportion of health facilities providing PITC services increased, but not significantly, from 82.9% to 83.4% (p = 0.11), with the mean readiness index significantly decreasing from 71.5% to 65.4% (p < 0.001). This decrease concerned the staff and guidelines (73.8% to 50.5%; p < 0.001), equipment (79.0% to 77.4%; p < 0.001), and medicines and commodities (54.2% to 45.2%; p < 0.001) domains. Regarding the PMTCT services, the mean proportion of health facilities globally providing the service significantly decreased from 83.7% in 2012 to 67.7% (p = 0.030) in 2018, and the mean readiness significantly decreased from 53.2% in 2012 to 50.9% in 2018 (p = 0.004). This decreasing trend was related to the staff and training (80.3% to 57.6%; p < 0.001) and medicines and commodities (9.2% to 6.5%; p < 0.001) domains. The global significant negative trend of readiness was mainly observed at the primary level of healthcare (52.7% to 49.4%; p = 0.030). Four regions experienced a significant decrease in the readiness index of health facilities to provide PMTCT services: Cascades, Centre, Centre-Sud, and Sud-Ouest, while Haut-Bassins and Nord regions showed increasing trends. CONCLUSION Availability and readiness of health facilities to provide PITC and PMTCT remain suboptimal in Burkina Faso. Actions to strengthen the skills of professionals and enhance the availability of medicines and commodities while focusing more on health regions with significant decreasing trends are urgently needed to improve the quality of services for HIV.
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Affiliation(s)
- Lucresse Corine Fassinou
- Centre de Recherche en Epidémiologie, Biostatistiques Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Hervé Hien
- Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Jean Cyr Yombi
- Department of Internal Medicine, Infectious and Tropical Diseases, AIDS Reference Centre, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Nagot
- Pathogenesis & Control of Chronic and Emerging Infections, University of Montpellier, INSERM, University of Antilles, Etablissement Français du Sang, Montpellier, France
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
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Offosse MJ, Avoka C, Yameogo P, Manli AR, Goumbri A, Eboreime E, Boxshall M, Banke-Thomas A. Effectiveness of the Gratuité user fee exemption policy on utilization and outcomes of maternal, newborn and child health services in conflict-affected districts of Burkina Faso from 2013 to 2018: a pre-post analysis. Confl Health 2023; 17:33. [PMID: 37415179 DOI: 10.1186/s13031-023-00530-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Evidence on effectiveness of user fee exemption policies targeting maternal, newborn, and child health (MNCH) services is limited for conflict-affected settings. In Burkina Faso, a country that has had its fair share of conflicts, user fee exemption policies have been piloted since 2008 and implemented along with a national government-led user fee reduction policy ('SONU': Soins Obstétricaux et Néonataux d'Urgence). In 2016, the government transitioned the entire country to a user fee exemption policy known as Gratuité. Our study objective was to assess the effect of the policy on the utilization and outcomes of MNCH services in conflict-affected districts of Burkina Faso. METHODS We conducted a quasi-experimental study comparing four conflict-affected districts which had the user fee exemption pilot along with SONU before transitioning to Gratuité (comparator) with four other districts with similar characteristics, which had only SONU before transitioning (intervention). A difference-in-difference approach was initiated using data from 42 months before and 30 months after implementation. Specifically, we compared utilization rates for MNCH services, including antenatal care (ANC), facility delivery, postnatal care (PNC) and consultation for malaria. We reported the coefficient, including a 95% confidence interval (CI), p value, and the parallel trends test. RESULTS Gratuité led to significant increases in rates of 6th day PNC visits for women (Coeff 0.15; 95% CI 0.01-0.29), new consultations in children < 1 year (Coeff 1.80; 95% CI 1.13-2.47, p < 0.001), new consultations in children 1-4 years (Coeff 0.81; 95% CI 0.50-1.13, p = 0.001), and uncomplicated malaria cases treated in children < 5 years (Coeff 0.59; 95% CI 0.44-0.73, p < 0.001). Other service utilization indicators investigated, including ANC1 and ANC5+ rates, did not show any statistically significant positive upward trend. Also, the rates of facility delivery, 6th hour and 6th week postnatal visits were found to have increased more in intervention areas compared to control areas, but these were not statistically significant. CONCLUSIONS Our study shows that, even in conflict-affected areas, the Gratuité policy significantly influences MNCH service utilization. There is a strong case for continued funding of the user fee exemption policy to ensure that gains are not reversed, especially if the conflict ceases to abate.
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Affiliation(s)
- Marie-Jeanne Offosse
- ThinkWell, 11 B.P. 1255 CMS 11 Ouagadougou - Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso
| | - Cephas Avoka
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Astrid Raissa Manli
- ThinkWell, 11 B.P. 1255 CMS 11 Ouagadougou - Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso
| | - Aude Goumbri
- ThinkWell, 11 B.P. 1255 CMS 11 Ouagadougou - Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Matt Boxshall
- ThinkWell, 11 B.P. 1255 CMS 11 Ouagadougou - Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso
| | - Aduragbemi Banke-Thomas
- ThinkWell, 11 B.P. 1255 CMS 11 Ouagadougou - Quartier Ouaga 2000, près de la fondation Kimi, à 500 du boulevard Muammar Kadaffi, Ouagadougou, Burkina Faso.
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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10
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Cissé K, Samadoulougou S, Kaboré J, Somda P, Zongo A, Traoré S, Zabsonre P, Yombi JC, Kouanda S, Kirakoya-Samadoulougou F. Healthcare system's preparedness to provide cardiovascular and diabetes-specific care in the context of geopolitical crises in Burkina Faso: a trend analysis from 2012 to 2018. BMJ Open 2023; 13:e065912. [PMID: 37221029 DOI: 10.1136/bmjopen-2022-065912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the trends of the availability and readiness of the healthcare system to provide cardiometabolic (cardiovascular diseases (CVD) and diabetes) services in Burkina Faso in multiple political and insecurity crises context. DESIGN We performed a secondary analysis of repeated nationwide cross-sectional studies in Burkina Faso. DATA SOURCE Four national health facility survey data (using WHO Service Availability and Readiness Assessment (SARA) tool) conducted between 2012 and 2018 were used. PARTICIPANTS In 2012, 686 health facilities were surveyed, 766 in 2014, 677 in 2016 and 794 in 2018. PRIMARY AND SECONDARY OUTCOME MEASURES The main outcomes were the availability and readiness services indicators defined according to the SARA manual. RESULTS Between 2012 and 2018, the availability of CVD and diabetes services significantly increased (67.3% to 92.7% for CVD and 42.5% to 54.0% for diabetes). However, the mean readiness index of the healthcare system to manage CVD decreased from 26.8% to 24.1% (p for trend <0.001). This trend was observed mainly at the primary healthcare level (from 26.0% to 21.6%, p<0.001). For diabetes, the readiness index increased (from 35.4% to 41.1%, p for trend=0.07) during 2012-2018. However, during the crisis period (2014-2018), both CVD (27.9% to 24.1%, p<0.001) and diabetes (45.8% to 41.1%, p<0.001) service readiness decreased. At the subnational level, the readiness index for CVD significantly decreased in all regions but predominantly in the Sahel region, which is the main insecure region (from 32.2% to 22.6%, p<0.001). CONCLUSION In this first monitoring study, we found a low level and decreased trend of readiness of the healthcare system for delivering cardiometabolic care, particularly during the crisis period and in conflicted regions. Policymakers should pay more attention to the impact of crises on the healthcare system to mitigate the rising burden of cardiometabolic diseases.
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Affiliation(s)
- Kadari Cissé
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
- Institut de Recherche en Sciences de la santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Sékou Samadoulougou
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute Research Center, Quebec City, Quebec, Canada
- Centre for Research On Planning and Development (CRAD), Laval University, Quebec City, Quebec, Canada
| | - Jean Kaboré
- Institut de Recherche en Sciences de la santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Paulin Somda
- Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | | | | | - Patrice Zabsonre
- Unité de formation et de recherche en sciences de la santé, Université Joseph Ki-Zerbo Ouagadougou, Ouagadougou, Burkina Faso
| | - Jean Cyr Yombi
- Service de médecine interne et maladies infectieuses, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Seni Kouanda
- Institut de Recherche en Sciences de la santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
- Institut Africain de Sante Publique, Ouagadougou, Burkina Faso
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
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11
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Hata R, Hart A, Hertelendy A, Tin D, Taubman C, Cheng L, Ciottone GR. Terrorist Attacks in Sub-Saharan Africa from 1970 through 2020: Analysis and Impact from a Counter-Terrorism Medicine Perspective. Prehosp Disaster Med 2023; 38:216-222. [PMID: 36710636 DOI: 10.1017/s1049023x23000080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has become a hotspot for global terrorism, with nearly 50% of global terror-related deaths occurring in SSA in 2021. With a large population and complex geopolitical and social climate, terrorist activity further burdens an already strained medical system. This study provides a retrospective descriptive analysis of terrorist-related activity in SSA from 1970-2020. METHODS A retrospective analysis of the Global Terrorism Database (GTD) was performed for the region of SSA from 1970-2020. Data were filtered using the internal database search function for all events in the following countries: Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, the Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Niger, Nigeria, People's Republic of the Congo, Republic of the Congo, Rhodesia, Rwanda, Senegal, Seychelles, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Swaziland, Tanzania, Togo, Uganda, Zaire, Zambia, and Zimbabwe. Number of attacks, deaths, and injuries, as well as primary weapons types, country where attacks occurred, and primary target types, were collated and analyzed. RESULTS A total 19,320 attacks were recorded, resulting in 77,565 deaths and 52,986 injuries. Firearms were the most frequent weapons used (8,745), followed by explosives (6,031), unknown (2,615), and incendiary (1,246), with all others making up the remainder (683.) Private citizens and property were the most frequently targeted entities (8,031), followed by general government facilities (2,582), police (1,854), business (1,446), military (805), diplomatic government facilities (741), and religious figures/institution (678), with all other targets making up the remainder (3,183). CONCLUSION The majority of deaths from terrorism in SSA are the result of firearm attacks and explosions. Nigeria, Somalia, South Africa, The Democratic Republic of the Congo, and Sudan have had the largest number of attacks since 1970, and Nigeria has the largest number of people killed and injured. The health implications of terrorist attacks are often compounded by violence and pose unique challenges to governments, populations, and aid organizations. By understanding the impact and scope of terrorist activity in SSA, Counter-Terrorism Medicine (CTM) initiatives can be employed to improve health care outcomes.
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Affiliation(s)
- Ryan Hata
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
- Harvard Medical School, Boston, MassachusettsUSA
| | - Alexander Hart
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
- Department of Emergency Medicine, Hartford Hospital, Hartford, ConnecticutUSA
- University of Connecticut School of Medicine, Farmington, ConnecticutUSA
| | - Attila Hertelendy
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
- Florida International University, Miami, FloridaUSA
| | - Derrick Tin
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
- Harvard Medical School, Boston, MassachusettsUSA
| | - Cara Taubman
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
| | - Lenard Cheng
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
- Harvard Medical School, Boston, MassachusettsUSA
| | - Gregory R Ciottone
- BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Boston, MassachusettsUSA
- Harvard Medical School, Boston, MassachusettsUSA
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12
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Fassinou LC, Ouoba J, Ngwasiri C, Romba I, Zoungrana-Yameogo WN, Bakiono F, Traoré IT, Hien H, Nagot N, Kirakoya-Samadoulougou F. Uptake of prevention of mother-to-child transmission cascade services in Burkina Faso between 2013 and 2020: are we on the right track? BMC Womens Health 2023; 23:126. [PMID: 36959578 PMCID: PMC10036241 DOI: 10.1186/s12905-023-02227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/13/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND The use of services to prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) remains a serious challenge in sub-Saharan Africa. In the last decade, Burkina Faso has implemented numerous policies to increase the use of PMTCT services by pregnant women and their partners, as well as children. This study assesses trends in the uptake of PMTCT services in Burkina Faso from 2013 to 2020 in order to study the progress and gaps in achieving the national and international targets set for 2020. METHODS A repeated cross-sectional analysis was performed using data extracted from district health information software version 2. Percentages were computed for each PMTCT indicator and comparisons between the years were made using a chi-square test for trends with a significance threshold of 5%. Regions were not compared with each other. RESULTS The proportion of pregnant women who were tested and received their results significantly increased from 47.9% in 2013 to 84.6% in 2020 (p value < 0.001). Of the 13 regions in the country, only 1 region met the 95% national targets whereas, 6 regions met the 90% international targets for this indicator. The proportions of HIV-positive women receiving antiretroviral therapy (ART) increased from 90.8% in 2013 to 100% in 2020. In the same period, the proportion of exposed infants who received antiretroviral prophylaxis increased from 64.3% in 2013 to 86.8% in 2020. Only 3 regions reached the national and international targets for this indicator. A positive trend was also observed for the indicator related to screening at 2 months or later of exposed infants using Polymerase Chain Reaction (PCR) technic; with the rate rising from 7.4% in 2013 to 75.7% in 2020. However, for this indicator, the national and international targets were not achieved considering the national and regional settings. Concerning the women's partners, the proportion of those who tested for HIV increased from 0.9% in 2013 to 4.5% in 2020, with only 1 region that fully met the national target of 10% in 2020. The prevalence of HIV in this particular group was 0.5% in 2020. CONCLUSIONS PMTCT indicators show an increase from 2013 to 2020 but with a strong disparity between regions. National and international targets have not been achieved for any indicator; except for those related to women receiving ART. Strengthening strategies to effectively engage women and their partners on the use of PMTCT cascade services could help reduce mother-to-child transmission in Burkina Faso.
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Affiliation(s)
- Lucresse Corine Fassinou
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso.
| | - Joël Ouoba
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso.
| | - Calypse Ngwasiri
- Centre for Research in Epidemiology, Biostatistics and Clinical Research of the School of Public Health, Université Libre de Bruxelles, Brussels, Belgique
| | - Issa Romba
- Secrétariat Permanent du Conseil National de lutte contre le Sida et les Infections Sexuellement Transmissibles, Ministère de la Santé, Burkina Faso
| | | | - Fidèle Bakiono
- Secrétariat Permanent du Conseil National de lutte contre le Sida et les Infections Sexuellement Transmissibles, Ministère de la Santé, Burkina Faso
| | - Isidore Tiandiogo Traoré
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
- Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | - Hervé Hien
- Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, University of Montpellier, INSERM, University Antilles, Etablissement Français du Sang, Montpellier, France
| | - Fati Kirakoya-Samadoulougou
- Centre for Research in Epidemiology, Biostatistics and Clinical Research of the School of Public Health, Université Libre de Bruxelles, Brussels, Belgique
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13
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Bonnet E, Lerosier T, Touré L, Diarra Y, Diabaté S, Diarra D, Ridde V. Evolution of assisted deliveries at primary healthcare centres in an unstable security context in Mali. BMJ Glob Health 2023; 7:bmjgh-2022-010811. [PMID: 36863725 PMCID: PMC10175949 DOI: 10.1136/bmjgh-2022-010811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/28/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION In Mali, healthcare systems are severely affected by conflict. However, several studies suggest a lack of knowledge about its impact on maternal healthcare. Frequent and repeated attacks increase insecurity, limit access to maternal care, and thus represent a barrier to accessing care. The objective of this study is to understand how assisted deliveries are being reorganised at the health centre level, and how they are adapting to the security crisis. METHOD This is a mixed sequential and explanatory study. The quantitative approaches combine a spatial scan analysis of assisted deliveries by health centres, an analysis of health centre performance using an ascending hierarchical classification, and a spatial analysis of violent events in two health districts in central Mali: Mopti and Bandiagara. The qualitative phase analyses semidirective and targeted interviews with managers (n=22) of primary healthcare centres (CsCOM) and two agents of international institutions. RESULTS The study reveals an important territorial heterogeneity of assisted deliveries. The primary health centres with high rates of assisted deliveries have mainly high-performance levels. This high level of use can be explained by the movement of the population to areas less exposed to attacks. The centres with low rates of assisted deliveries are those where qualified health workers refused to practice, where populations had few financial resources, and where they limited their travel to reduce their exposure to insecurity. CONCLUSION This study confirms that combining methodological approaches is essential to explain significant use in the local context. The analysis of the number of assisted deliveries in conflict zones must consider the number of procedures, the nearby security context, the number of internally displaced persons and the presence of camps in which humanitarian organisations offer programmes.
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Affiliation(s)
- Emmanuel Bonnet
- UMR 215 Prodig, Institut de recherche pour le developpement, Aubervilliers, France
| | | | | | | | | | - Dansiné Diarra
- Geography, Université des Sciences Sociales et de Gestion de Bamako, Bamako, Mali
| | - Valery Ridde
- CEPED, IRD, Paris, France.,ISED, UCAD, Dakar, Senegal
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Hameed MA, Rahman MM, Khanam R. The health consequences of civil wars: evidence from Afghanistan. BMC Public Health 2023; 23:154. [PMID: 36690962 PMCID: PMC9872361 DOI: 10.1186/s12889-022-14720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/24/2022] [Indexed: 01/24/2023] Open
Abstract
This study examines the effects of long-run civil wars on healthcare, which is an important component of human capital development and their causality nexus in Afghanistan using the MVAR (modified vector autoregressive) approach and the Granger non-causality model covering data period 2002Q3-2020Q4. The primary results support a significant long-run relationship between variables, while the results of the MVAR model indicate the per capita cost of war, per capita GDP, and age dependency ratio have significantly positive impacts on per capita health expenditures, whereas child mortality rate and crude death rate have negative impacts. The results of the Granger non-causality approach demonstrate that there is a statistically significant bidirectional causality nexus between per capita health expenditure, per capita cost of war, per capita GDP, child mortality rate, crude death rate, and age dependency ratio, while it also supports the existence of strong and significant interconnectivity and multidimensionality between per capita cost of war and per capita health expenditure, with a significantly strong feedback response from the control variables. Important policy implications sourced from the key findings are also discussed.
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Affiliation(s)
- Mohammad Ajmal Hameed
- School of Business; Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia.
| | - Mohammad Mafizur Rahman
- School of Business; Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
| | - Rasheda Khanam
- School of Business; Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
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15
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Druetz T, Cooper S, Bicaba F, Bila A, Shareck M, Milot DM, Tiendrebeogo C, Bicaba A. Change in childbearing intention, use of contraception, unwanted pregnancies, and related adverse events during the COVID-19 pandemic: Results from a panel study in rural Burkina Faso. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000174. [PMID: 36962234 PMCID: PMC10021617 DOI: 10.1371/journal.pgph.0000174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
Evidence on how the COVID-19 pandemic has affected women's reproductive health remains scarce, particularly for low- and middle-income countries. Deleterious indirect effects seem likely, particularly on access to contraception and risk of unwanted pregnancies, but rigorous evaluations using quasi-experimental designs are lacking. Taking a diachronic perspective, we aimed to investigate the effects of the pandemic on four indicators of women's reproductive health: history of recent adverse events during pregnancy (past), use of contraception and unwanted pregnancies (present), and childbearing intentions (future). This study was conducted in four rural health districts of Burkina Faso: Banfora, Leo, Sindou and Tenado. Two rounds of household surveys (before and during the pandemic) were conducted in a panel of 696 households using standardized questionnaires. The households were selected using a stratified two-stage random sampling method. All women aged 15-49 years living in the household were eligible for the study. The same households were visited twice, in February 2020 and February 2021. The effects were estimated by fitting hierarchical regression models with fixed effects or random intercepts at the individual level. A total of 814 and 597 women reported being sexually active before and during the COVID-19 pandemic, respectively. The odds of not wanting (any more) children were two times higher during the pandemic than before (2.0, 95% CI [1.32-3.04]). Among those with childbearing intention, the average desired delay until the next pregnancy increased from 28.7 to 32.8 months. When comparing 2021 versus 2020, there was an increase in the adjusted odds ratio of contraception use (1.23, 95% CI [1.08-1.40]), unwanted pregnancies (2.07, 95% CI [1.01-4.25]), and self-reported history of miscarriages, abortions, or stillbirths in the previous 12 months (2.4, 95% CI [1.04-5.43]). Our findings in rural Burkina Faso do not support the predicted detrimental effects of COVID-19 on the use of family planning services in LMICs, but confirm that it negatively affects pregnancy intentions. Use of contraception increased significantly among women in the panel, but arguably not enough to avoid an increase in unwanted pregnancies.
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Affiliation(s)
- Thomas Druetz
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, Canada
- Centre de recherche en santé publique, Montréal, Canada
- Center for Applied Malaria Research and Evaluation, Tulane University, New Orleans, Louisiana, United States of America
| | - Sarah Cooper
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, Canada
| | - Frank Bicaba
- Société d’Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Alice Bila
- Société d’Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Martine Shareck
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Canada
| | - David-Martin Milot
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Canada
| | - Cheick Tiendrebeogo
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, Canada
| | - Abel Bicaba
- Société d’Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
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16
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Browne L, Cooper S, Tiendrebeogo C, Bicaba F, Bila A, Bicaba A, Druetz T. Using experience to create evidence: a mixed methods process evaluation of the new free family planning policy in Burkina Faso. Reprod Health 2022; 19:67. [PMID: 35303898 PMCID: PMC8932047 DOI: 10.1186/s12978-022-01375-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2019, Burkina Faso was one of the first countries in Sub-Saharan Africa to introduce a free family planning (FP) policy. This process evaluation aims to identify obstacles and facilitators to its implementation, examine its coverage in the targeted population after six months, and investigate its influence on the perceived quality of FP services. METHODS This process evaluation was conducted from November 2019 through March 2020 in the two regions of Burkina Faso where the new policy was introduced as a pilot. Mixed methods were used with a convergent design. Semi-directed interviews were conducted with the Ministry of Health (n = 3), healthcare workers (n = 10), and women aged 15-49 years (n = 10). Surveys were also administered to the female members of 696 households randomly selected from four health districts (n = 901). RESULTS Implementation obstacles include insufficient communication, shortages of consumables and contraceptives, and delays in reimbursement from the government. The main facilitators were previous experience with free healthcare policies, good acceptability in the population, and support from local associations. Six months after its introduction, only 50% of the surveyed participants knew about the free FP policy. Higher education level, being sexually active or in a relationship, having recently seen a healthcare professional, and possession of a radio significantly increased the odds of knowing. Of the participants, 39% continued paying for FP services despite the new policy, mainly because of stock shortages forcing them to buy their contraceptive products elsewhere. Increased waiting time and shorter consultations were also reported. CONCLUSION Six months after its introduction, the free FP policy still has gaps in its implementation, as women continue to spend money for FP services and have little knowledge of the policy, particularly in the Cascades region. While its use is reportedly increasing, addressing implementation issues could further improve women's access to contraception.
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Affiliation(s)
- Lalique Browne
- School of Public Health, University of Montreal, C.P 6128, Succursale Centre-Ville, Montreal, QC, H3C 3J7, Canada
| | - Sarah Cooper
- School of Public Health, University of Montreal, C.P 6128, Succursale Centre-Ville, Montreal, QC, H3C 3J7, Canada
| | - Cheick Tiendrebeogo
- School of Public Health, University of Montreal, C.P 6128, Succursale Centre-Ville, Montreal, QC, H3C 3J7, Canada
| | - Frank Bicaba
- Société d'Études et de Recherche en Santé Publique (SERSAP), Ouagadougou, Burkina Faso.,Sciences de la vie et de la Santé, Université Aix-Marseille, Marseille, France
| | - Alice Bila
- Société d'Études et de Recherche en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherche en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
| | - Thomas Druetz
- School of Public Health, University of Montreal, C.P 6128, Succursale Centre-Ville, Montreal, QC, H3C 3J7, Canada. .,Centre de Recherche en Santé Publique (CReSP), Montreal, QC, Canada. .,Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University, New Orleans, LA, USA.
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