Mass measles vaccination in urban Burkina Faso, 1998.
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OBJECTIVE: To assess the impact of the National Immunization Days (NIDs) on measles vaccine coverage in Burkina Faso in 1998. METHODS: During the week after the campaign, in which measles vaccine was offered to children aged 9-59 months in six cities regardless of vaccination history, a cluster survey was conducted in Ouagadougou and Bobo Dioulasso, the country's two largest cities. Interviewers visited the parents of 1267 children aged up to 59 months and examined vaccination cards. We analysed the data using cluster sample methodology for the 1041 children who were aged 9-59 months. FINDINGS: A total of 604 (57%) children had received routine measles vaccination prior to the campaign, and 823 (79%) were vaccinated during the NIDs. Among those who had previously had a routine vaccination, 484 (81%) were revaccinated during the NIDs. Among those not previously vaccinated, 339 (78%) received one dose during the NIDs. After the campaign, 943 (91%) children had received at least one dose of measles vaccine. Better socioeconomic status was associated with a higher chance of having been vaccinated routinely, but it was not associated with NID coverage. CONCLUSION: The mass campaign enabled a substantial increase in measles vaccine coverage to be made because it reached a high proportion of children who were difficult to reach through routine methods. (+info)
Clustering of childhood mortality in rural Burkina Faso.
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BACKGROUND: Childhood mortality is a major public health problem in sub-Saharan Africa. For the implementation of efficient public health systems, knowledge of the spatial distribution of mortality is required. METHODS: Data from a demographic surveillance research project were analysed which comprised information obtained for about 30 000 individuals from 39 villages in northwest Burkina Faso (West Africa) in the period 1993--1998. Total childhood mortality rates were calculated and the geographical distribution of total childhood mortality was investigated. In addition, data from a cohort of 686 children sampled from 16/39 of the villages followed up during a randomized controlled trial in 1999 were also used to validate the results from the surveillance data. A spatial scan statistic was used to test for clusters of total childhood mortality in both space and time. RESULTS: Several statistically significant clusters of higher childhood mortality rates comprising different sets of villages were identified; one specific village was consistently identified in both study populations indicating non-random distribution of childhood mortality. Potential risk factors which were available in the database (ethnicity, religion, distance to nearest health centre) did not explain the spatial pattern. CONCLUSION: The findings indicate non-random clustering of total childhood mortality in the study area. The study may be regarded as a first step in prioritizing areas for follow-up public health efforts. (+info)
Measuring the local burden of disease. A study of years of life lost in sub-Saharan Africa.
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BACKGROUND: An effective health policy necessitates a reliable characterization of the burden of disease (BOD) by cause. The Global Burden of Disease Study (GBDS) aims to deliver this information. For sub-Saharan Africa (SSA) in particular, the GBDS relies on extrapolations and expert guesses. Its results lack validation by locally measured epidemiological data. METHODS: This study presents locally measured BOD data for a health district in Burkina Faso and compares them to the results of the GBDS for SSA. As BOD indicator, standard years of life lost (age-weighted YLL, discounted with a discount rate of 3%) are used as proposed by the GBDS. To investigate the influence of different age and time preference weights on our results, the BOD pattern is again estimated using, first, YLL with no discounting and no age-weighting, and, second, mortality figures. RESULTS: Our data exhibit the same qualitative BOD pattern as the GBDS results regarding age and gender. We estimated that 53.9% of the BOD is carried by men, whereas the GBDS reported this share to be 53.2%. The ranking of diseases by BOD share, though, differs substantially. Malaria, diarrhoeal diseases and lower respiratory infections occupy the first three ranks in our study and in the GBDS, only differing in their respective order. Protein-energy malnutrition, bacterial meningitis and intestinal nematode infections occupy ranks 5, 6 and 7 in Nouna but ranks 15, 27 and 38 in the GBDS. The results are not sensitive to the different age and time preference weights used. Specifically, the choice of parameters matters less than the choice of indicator. CONCLUSIONS: Local health policy should rather be based on local BOD measurement instead of relying on extrapolations that might not represent the true BOD structure by cause. (+info)
Evidence of behaviour change following a hygiene promotion programme in Burkina Faso.
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OBJECTIVES: To determine whether a large, 3-year hygiene promotion programme in Bobo-Dioulasso, Burkina Faso, was effective in changing behaviours associated with the spread of diarrhoeal diseases. The programme was tailored to local customs, targeted specific types of behaviour, built on existing motivation for hygiene, and used locally appropriate channels of communication. METHODS: Two population surveys recorded the coverage of the programme among target audiences (mothers of children aged 0-35 months). Four surveys were carried out: three prior to the programme and one in 1998 (after the programme had been running for 3 years), using structured observation of hygiene behaviours in the participants' homes to document changes in target behaviours. FINDINGS: After the programme had run for 3 years, three-quarters of the mothers targeted had had contact with programme activities. Half could cite the two main messages of the programme correctly. Although the safe disposal of children's stools changed little between 1995 and 1998 (80% pre-intervention, 84% post-intervention), hand-washing with soap after cleaning a child's bottom rose from 13% to 31%. The proportion of mothers who washed their hands with soap after using the latrine increased from 1% to 17%. CONCLUSION: Hygiene promotion programmes can change behaviour and are more likely to be effective if they are built on local research and use locally appropriate channels of communication repeatedly and for an extended time. (+info)
Examining out-of-pocket expenditure on health care in Nouna, Burkina Faso: implications for health policy.
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OBJECTIVE: To examine household out-of-pocket expenditure on health care, particularly malaria treatment, in rural Burkina Faso. METHOD: Comprehensive analysis of out-of-pocket expenditure on health care through a descriptive analysis and a second, multivariate analysis using the Tobit model with emphasis on malaria, based on 800 urban and rural households in Nouna health district. RESULTS: Households will spend less on malaria, either in or outside the health facility, if given the choice to do so, because they feel confident to self-treat malaria. Seeking health care from a qualified health worker incurs more out-of-pocket expenditure than self-treatment and traditional healers, and if necessary, households sell off assets to offset the expenditure. More than 80% of household out-of-pocket expenditure is allocated to drugs. CONCLUSION: This has policy implications for malaria control and the Roll Back Malaria Initiative. Communities need to be educated on the risks of malaria complications and the potential risk of inappropriate diagnosis and treatment. Drug or health services pricing policy needs to create an incentive to use the health services. In the fight against malaria, building alliances between households, traditional healers and health workers is essential. (+info)
Perceived quality of care of primary health care services in Burkina Faso.
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INTRODUCTION: Patients' views are being given more and more importance in policy-making. Understanding populations' perceptions of quality of care is critical to developing measures to increase the utilization of primary health care services. OBJECTIVE: Documentation of user's opinion on the quality of care of primary health care services. METHODS: A 20-item scale, including four sub-scales related to health personnel practices and conduct, adequacy of resources and services, health care delivery, and financial and physical accessibility, was administered to 1081 users of 11 health care centres in the health district of Nouna, in rural Burkina Faso. RESULTS: The respondents were relatively positive on items related to health personnel practices and conduct and to health care delivery, but less so on items related to adequacy of resources and services and to financial and physical accessibility. In particular, the availability of drugs for all diseases on the spot, the adequacy of rooms and equipment in the facilities, the costs of care and the access to credit were valued poorly. Overall, the urban hospital was rated poorer than the average rural health care centre. Analysis of variance showed that, overall, health system characteristics explain 29% of all variation of the responses. CONCLUSION: Improving drug availability and financial accessibility to health services have been identified as the two main priorities for health policy action. Policy-makers should respect these patient preferences to deliver effective improvement of the quality of care as a potential means to increase utilization of health care. (+info)
Community factors associated with malaria prevention by mosquito nets: an exploratory study in rural Burkina Faso.
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Malaria-related knowledge, attitudes and practices (KAP) were examined in a rural and partly urban multiethnic population of Kossi province in north-western Burkina Faso prior to the establishment of a local insecticide-treated bednet (ITN) programme. Various individual and group interviews were conducted, and a structured questionnaire was administered to a random sample of 210 heads of households in selected villages and the provincial capital of Nouna. Soumaya, the local illness concept closest to the biomedical term malaria, covers a broad range of recognized signs and symptoms. Aetiologically, soumaya is associated with mosquito bites but also with a number of other perceived causes. The disease entity is perceived as a major burden to the community and is usually treated by both traditional and western methods. Malaria preventive practices are restricted to limited chloroquine prophylaxis in pregnant women. Protective measures against mosquitoes are, however, widespread through the use of mosquito nets, mosquito coils, insecticide sprays and traditional repellents. Mosquito nets are mainly used during the rainy season and most of the existing nets are used by adults, particularly heads of households. Mosquito nets treated with insecticide (ITN) are known to the population through various information channels. People are willing to treat existing nets and to buy ITNs, but only if such services would be offered at reduced prices and in closer proximity to the households. These findings have practical implications for the design of ITN programmes in rural areas of sub-Saharan Africa (SSA). (+info)
Mortality patterns, 1993-98, in a rural area of Burkina Faso, West Africa, based on the Nouna demographic surveillance system.
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The Nouna demographic surveillance system database was analysed for the period 1993-98. Basic demographic parameters, age-specific and age-standardized mortality rates were calculated and a seasonal variation in mortality was analysed. Poisson regression was used to model the calculated mortality rates and to investigate the seasonal mortality pattern. Both the population distribution by age and the mortality rates reflect a typical pattern of population structures and total mortality in rural Africa as a whole: high childhood mortality and a young population (about 60% are up to age 25; about 10% above age 64). We identified a significant seasonal pattern with highest mortality rates in February. Demographic surveillance systems in Africa provide a viable method for the collection of reliable data on vital events in rural Africa and should therefore be established and supported. (+info)