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The aim of this paper is to determine and compare the risk factors of maternal mortality before and after childbirth in Burkina Faso. Analyses are performed at both bivariate and multivariate level using conditional logistic regression. An Emergency Obstetric Care (EMOC) survey of Burkina Faso for 2010 provided the data utilized for the analyses. The diagnosis of health professionals indicated that abortion with 36.3% is the main direct cause of prenatal maternal deaths while haemorrhage with 41.6% is the main direct cause of maternal mortality after delivery. In addition, 29.4% of post-natal maternal deaths were due to infection while only 23.5% of prenatal maternal deaths were due to the same cause.

Comment le suivi-évaluation participatif apporte une valeur ajoutée à l'effectivité des interventions du programme Paysages et Moyens d'Existence en Afrique Centrale et Occidentale? / par Dominique Endamana, Ricardo Furman, Jacques Somda -- Pour une meilleure implication des communautés dans le suivi et l'évaluation des actions de développement : l'expérience d'un projet pilote "Suivi-Evaluation Participatif" au Burkina Faso / par Jean-François Kobiané, Alexis Loye -- La participation des acteurs locaux à l'évaluation des projets de développement : cas des évaluations de la Banque mondiale au Burkina Faso / par Nouhoun Diallo -- Enjeux éthiques et défis méthodologiques de l'évaluation en santé en Afrique / par Seni Kouanda -- L'évaluation experte des projets de développement : entre instrumentalisation et production d'une analyse partagée / par Philippe Lavigne Delville -- L'évaluation en binôme / par Tinsakré Konkobo -- La problématique de l'expression des besoins en évaluation / par Issa Sombie, Abel Bicaba -- "Bonnes", "vraies" et "quelques meilleurs" pratiques d'évaluation de programme de développement en Afrique / par Valéry Ridde -- Pluralisme méthodologique et évaluation en santé publique en Afrique : une étude de cas au Burkina Faso / par Valéry Ridde -- Le recours aux approches qualitatives dans le cadre des évaluations de programme de santé en Afrique / par Honré Mimche -- L'utilité des données qualitatives dans les évaluations en santé publique / par Valéry Ridde -- Évaluation de la qualité des soins dans la perspective du consommateur : autopsie d'une pratique peu courante en Afrique / par Gervais Beninguisse -- Expériences et défis du suivi des interventions en santé maternelle et néonatale en Afrique / par S. Kouanda [and four others]

SYNOPSIS: Generally, there are disparities in the availability and utilization of postabortion care services within the different regions at the national level in Burkina Faso, Cote d'Ivoire, and Guinea and between the 3 countries. Access to postabortion care at the primary level must be improved and the adoption of family planning when providing postabortion care. Unsafe abortion remains one of the leading causes of maternal mortality in sub-Sahara Africa, with relatively poor access to quality postabortion care (PAC) services. This study evaluated the quantity and distribution as well as the utilization of PAC services in Burkina Faso, Cote d'Ivoire, and Guinea. We conducted a secondary data analysis using the most recent EmONC surveys in the 3 countries between 2016 and 2017. We used PAC signal functions approach to assess facilities' capacity to provide basic PAC at both primary and referral level of care and comprehensive PAC at the referral level. We illustrated population coverage of PAC services based on the WHO benchmark, and then assessed the utilization of PAC services. Basic PAC capacity at primary level was low (36.6%), ranging from 16.2% in Burkina Faso to 36% in Cote d'Ivoire. About 82.0% of hospitals could provide comprehensive PAC. There were disparities in the geographical distribution of PAC services at both national and subnational levels. Abortion complications represented 16.2% of all obstetric emergencies, and uptake of PAC modern contraceptive was low (37.1%) in all countries. There is a need to focus on access to PAC at the primary level of care in the 3 countries.

Nguyen Toan Tran,1–3,* Wambi Maurice E Yameogo,4,5,* Mary Eluned Gaffield,1 Félicité Langwana,6 James Kiarie,1 Désiré Mashinda Kulimba,6 Seni Kouanda4,5 1Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland; 2Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, NSW, Australia; 3Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland; 4Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso; 5Institut Africain de la Santé Publique, Ouagadougou, Burkina Faso; 6School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo *These authors contributed equally to this work Purpose: To address the high unmet need for postpartum family planning (PPFP) in resource-limited settings, particularly in sub-Saharan Africa, this study aimed to identify PPFP-related barriers and catalysts to inform policies and programs to increase access to postpartum contraception.Methods: Using qualitative methodology, we explored the perspectives of women, adolescent girls, men, religious and community leaders, service providers, and decision makers from three rural communities in Burkina Faso and three rural–urban communities in the Democratic Republic of Congo. Both countries have high unmet need for PPFP and are priority countries of the French Muskoka Fund for Maternal and Child Health.Results: Perceived catalysts included negative traditional views on the consequences borne by closely spaced children and their mothers; a 6-week postpartum visit dedicated to PPFP (albeit poorly attended); political will and enabling policies for FP; and support from certain religious leaders and men. Main reported barriers were the lack of male engagement; out-of-pocket copayment for contraceptives; reliance on amenorrhea for pregnancy prevention without knowing its limits; misconceptions about modern contraceptives, including prerequisites for the lactational amenorrhea method; sexual abstinence supported by religious and traditional norms for up to 3–6 months, although women reported earlier resumption of sexual activity; low prioritization of scheduled postpartum visits by women; and limited availability of readily accessible methods, PPFP counseling materials, and clinic days and scheduled visits dedicated to contraceptive services.Conclusion: Based on results found to be most actionable, the following interventions have the potential to optimize access to PPFP services: counseling women on postpartum-pregnancy risks and options at different points in time before and after childbirth through the use of appropriate information, education, and counseling materials; integrating PPFP services into existing maternal and child health visits; making contraceptives readily available and affordable; and meaningfully engaging male partners. Keywords: postpartum contraception, barriers, enablers, sub-Saharan Africa, Burkina Faso, Democratic Republic of Congo

Background: Health systems have experienced unprecedented stress in recent years, and as yet no consensus has emerged as to how to deal with the multiple burden of disease in the context of HIV and AIDS and other competing health priorities. Priority setting is essential, yet this is a complex, multifaceted process. Drawing on a study conducted in five African countries, this paper explores different stakeholders′ perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and Health and how different stakeholders perceive this. Methods: A sub-analysis was conducted of selected data from a wider qualitative study that explored the interactions between health systems and HIV and AIDS responses in five sub-Saharan countries (Burkina Faso, the Democratic Republic of Congo, Ghana, Madagascar and Malawi). Key background documents were analysed and semi-structured interviews (n = 258) and focus group discussions (n = 45) were held with representatives of communities, health personnel, decision makers, civil society representatives and development partners at both national and district level. Results: Health priorities were expressed either in terms of specific health problems and diseases or gaps in service delivery requiring a strengthening of the overall health system. In all five countries study respondents (with the exception of community members in Ghana) identified malaria and HIV as the two top health priorities. Community representatives were more likely to report concerns about accessibility of services and quality of care. National level respondents often referred to wider systemic challenges in relation to achieving the Millennium Development Goals (MDGs). Indeed, actual priority setting was heavily influenced by international agendas (e.g. MDGs) and by the ways in which development partners were supporting national strategic planning processes. At the same time, multi-stakeholder processes were increasingly used to identify priorities and inform ...

Sub-Saharan African countries health systems are generally faced with shortages and inequitable distribution of qualified health workers. The application of provider-population ratio or fixed staff establishments, not considering variation in workload, given contextual variations in service utilization rates, cannot adequately match the human resource needs of different health facilities. The Workload Indicators of Staffing Need (WISN) method uses workload to determine staffing needs in a given facility. The aim of this study was to assess the current workload and staffing needs of maternal and child health services in 12 primary healthcare facilities from Burkina Faso, Niger, and Cote d'Ivoire. We employed the WISN methodology, using document reviews, in-depth interviews with health providers, and observations, to obtain the data needed for estimating the required number of staff in a given facility. Then, we calculated both the WISN difference (current−required staff), and the WISN ratio (current staff/required staff). Using the WISN ratio, we assessed the work pressure that health workers experience. The results showed a shortage of health workers in most services in Cote d'Ivoire and Niger (WISN ratio <1), in contrast to Burkina Faso where services were either adequately staffed or overstaffed (WISN ratio ⩾1). The workload pressure was generally high or very high in Cote d'Ivoire, while in Niger, it was very high in maternity services but rather low in dispensary ones. There was also a geographic discrepancy in health workers staffing, rural areas services being more understaffed, with a higher workload pressure as compared to urban areas ones. This study results strengthens the body of knowledge on the shortage of health workforce in sub-Saharan Africa French speaking countries. Policies and strategies to increase students training capacities and the application of regular WISN studies for a better staff distribution are necessary to address the human resource needs of health facilities in these countries.

Postpartum family planning (PPFP) information and services can prevent maternal and child morbidity and mortality in low-resource countries, where high unmet need for PPFP remains despite opportunities offered by routine postnatal care visits. This study aims to identify a package of PPFP interventions and determine its effectiveness on the uptake of contraceptive methods during the first year postpartum. We hypothesize that implementing a PPFP intervention package that is designed to strengthen existing antenatal and postnatal care services will result in an increase in contraceptive use.

Background: Suicidal ideation is understudied among men who have sex with men (MSM) across Sub-Saharan Africa. Aims: This study aimed to explore social capital and sexual behavior stigma associated with suicidal ideation among MSM in the West African nations of The Gambia, Burkina Faso and Togo. Methods: Participants were recruited using respondent-driven sampling and snowball sampling across multiple cities ( n = 1555) from July 2011 to August 2013. During a single study visit, participants completed a survey. Logistic regression models were used to assess bivariate and multivariable associations with suicidal ideation. Results: The prevalence of lifetime suicidal ideation was 13% overall and ranged 6%–17% across study sites. After adjusting for potential confounders, MSM who reported stigma as a result of having sex with men were more likely to report suicidal ideation. Physical and sexual violence was strongly associated with suicidal ideation, including being physically harmed (adjusted odds ratio (aOR) = 2.94, 95% confidence interval (CI) = 1.91, 4.52), tortured (aOR = 3.86, 95% CI = 2.17, 6.86) and raped (aOR = 3.07, 95% CI = 2.05, 4.60). In contrast, increasing social participation with the broader community was associated with decreased report of suicidal ideation (aOR = 0.91, 95% CI = 0.85, 0.99). Conclusion: Sexual behavior stigma should be addressed to improve mental health among MSM in Western Sub-Saharan Africa.