Institute Of Recherche En Science Of La Sante

porte, Burkina Faso

Institute Of Recherche En Science Of La Sante

porte, Burkina Faso

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Ridde V.,Institute Of Recherche En Science Of La Sante
Health Policy and Planning | Year: 2013

To improve access to health care services, an intervention was implemented in Burkina Faso granting full exemption from user fees. Two further components, staff training and supervision, were added to support the intervention. Our aim in this study was to examine how this tripartite intervention affected the quality of drug prescriptions. Using a mixed methodology, we first conducted an interrupted time series over 24 months. Nine health centres were studied that had previously undergone a process analysis. A total of 14 956 prescriptions for children 0-4 years old were selected by interval sampling from the visit registries from 1 year before to 1 year after the intervention's launch. We then interviewed 14 prescribers. We used three World Health Organization (WHO) indicators to assess drug prescription quality. Analysis was carried out using linear regression and logistic regression. The prescribers' statements underwent content analysis, to understand their perceptions and changes in their practice since the subsidy's introduction. One effect of the intervention was a reduced use of injections (odd ratio (OR) = 0.28 [0.17; 0.46]) in cases of acute lower respiratory tract infections (ALRTI) without comorbidity. Another was a reduction in the inappropriate use of antibiotics in malaria without comorbidity (OR = 0.48 [0.33; 0.70]). The average number of drugs prescribed also decreased (coefficient = -0.14 [-0.20; -0.08]) in cases of ALRTI without comorbidity. The prescribers reported that their practices were either maintained or improved. The user fees exemption programme, combined with health staff training and supervision, did not lead to any deterioration in the quality of drug prescriptions. © 2012 Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2012; all rights reserved.


Objective: To estimate the impact on maternal and child mortality after eliminating user fees for pregnant women and for children less than five years of age in Burkina Faso.Methods: Two health districts in the Sahel region eliminated user fees for facility deliveries and curative consultations for children in September 2008. To compare health-care coverage before and after this change, we used interrupted time series, propensity scores and three independent data sources. Coverage changes were assessed for four variables: women giving birth at a health facility, and children aged 1 to 59 months receiving oral rehydration salts for diarrhoea, antibiotics for pneumonia and artemesinin for malaria. We modelled the mortality impact of coverage changes in the Lives Saved Tool using several scenarios.Findings: Coverage increased for all variables, however, the increase was not statistically significant for antibiotics for pneumonia. For estimated mortality impact, the intervention saved approximately 593 (estimate range 168–1060) children’s lives in both districts during the first year. This lowered the estimated under-five mortality rate from 235 deaths per 1000 live births in 2008 to 210 (estimate range 189–228) in 2009. If a similar intervention were to be introduced nationwide, 14 000 to 19 000 (estimate range 4000–28 000) children’s lives could be saved annually. Maternal mortality showed a modest decrease in all scenarios.Conclusion: In this setting, eliminating user fees increased use of health services and may have contributed to reduced child mortality. © 2014, World Health Organization. All rights reserved.


Pennetier C.,University of Sussex | Pennetier C.,University of Greenwich | Warren B.,University of Sussex | Dabire K.R.,Institute Of Recherche En Science Of La Sante | And 3 more authors.
Current Biology | Year: 2010

Anopheles gambiae, responsible for the majority of malaria deaths annually, is a complex of seven species and several chromosomal/molecular forms. The complexity of malaria epidemiology and control is due in part to An. gambiae's remarkable genetic plasticity, enabling its adaptation to a range of human-influenced habitats. This leads to rapid ecological speciation when reproductive isolation mechanisms develop [1-6]. Although reproductive isolation is essential for speciation, little is known about how it occurs in sympatric populations of incipient species [2]. We show that in such a population of "M" and "S" molecular forms, a novel mechanism of sexual recognition (male-female flight-tone matching [7-9]) also confers the capability of mate recognition, an essential precursor to assortative mating; frequency matching occurs more consistently in same-form pairs than in mixed-form pairs (p = 0.001). Furthermore, the key to frequency matching is "difference tones" produced in the nonlinear vibrations of the antenna by the combined flight tones of a pair of mosquitoes and detected by the Johnston's organ. By altering their wing-beat frequencies to minimize these difference tones, mosquitoes can match flight-tone harmonic frequencies above their auditory range. This is the first description of close-range mating interactions in incipient An. gambiae species. © 2010 Elsevier Ltd. All rights reserved.


Lefevre T.,IRD Montpellier | Vantaux A.,IRD Montpellier | Dabire K.R.,Institute Of Recherche En Science Of La Sante | Dabire K.R.,Center Muraz | And 4 more authors.
PLoS Pathogens | Year: 2013

Understanding how mosquito vectors and malaria parasites interact is of fundamental interest, and it also offers novel perspectives for disease control. Both the genetic and environmental contexts are known to affect the ability of mosquitoes to support malaria development and transmission, i.e., vector competence. Although the role of environment has long been recognized, much work has focused on host and parasite genetic effects. However, the last few years have seen a surge of studies revealing a great diversity of ways in which non-genetic factors can interfere with mosquito-Plasmodium interactions. Here, we review the current evidence for such environmentally mediated effects, including ambient temperature, mosquito diet, microbial gut flora, and infection history, and we identify additional factors previously overlooked in mosquito-Plasmodium interactions. We also discuss epidemiological implications, and the evolutionary consequences for vector immunity and parasite transmission strategies. Finally, we propose directions for further research and argue that an improved knowledge of non-genetic influences on mosquito-Plasmodium interactions could aid in implementing conventional malaria control measures and contribute to the design of novel strategies. © 2013 Lefèvre et al.


Churcher T.S.,Imperial College London | Trape J.-F.,IRD Montpellier | Cohuet A.,Institute Of Recherche En Science Of La Sante | Cohuet A.,IRD Montpellier
Nature Communications | Year: 2015

The efficiency of malaria transmission between human and mosquito has been shown to be influenced by many factors in the laboratory, although their impact in the field and how this changes with disease endemicity are unknown. Here we estimate how human-mosquito transmission changed as malaria was controlled in Dielmo, Senegal. Mathematical models were fit to data collected between 1990 and the start of vector control in 2008. Results show that asexual parasite slide prevalence in humans has reduced from 70 to 20%, but that the proportion of infectious mosquitoes has remained roughly constant. Evidence suggests that this is due to an increase in transmission efficiency caused by a rise in gametocyte densities, although the uneven distribution of mosquito bites between hosts could also contribute. The resilience of mosquito infection to changes in endemicity will have important implications for planning disease control, and the development and deployment of transmission-reducing interventions. © 2015 Macmillan Publishers Limited. All rights reserved.


Diabate A.,Institute Of Recherche En Science Of La Sante | Bilgo E.,Institute Of Recherche En Science Of La Sante | Dabire R.K.,Institute Of Recherche En Science Of La Sante | Tripet F.,Keele University
Malaria Journal | Year: 2013

Background: Current malaria control strategies have cut down the malaria burden in many endemic areas, however the emergence and rapid spread of insecticide and drug resistance undermine the success of these efforts. There is growing concern that malaria eradication will not be achieved without the introduction of novel control tools. One approach that has been developed in the last few years is based on house screening to reduce indoor mosquito vector densities and consequently decrease malaria transmission. Here screening and trapping were combined in one tool to control mosquito populations. The trap does not require an insecticide or even an attractant, yet it effectively collects incoming resistant and susceptible mosquitoes and kills them. Results: Performance of the funnel entry trap was tested in low and high malaria vector density areas. An overall reduction of 70 to 80% of mosquito density was seen in both. Species and molecular forms of Anopheles gambiae identification indicated no variation in the number of Anopheles arabiensis and the molecular forms of An. gambiae between houses and traps. Mosquitoes collected in the traps and in houses were highly resistant to pyrethroids (0.9 kdr-based mechanism). Conclusion: There is a global consensus that new intervention tools are needed to cross the last miles in malaria elimination/eradication. The funnel entry trap showed excellent promise in suppressing mosquito densities even in area of high insecticide resistance. It requires no chemicals and is self-operated. © 2013 Diabaté et al.; licensee BioMed Central Ltd.


Desclaux A.,University Paul Cezanne dAix Marseille | Kouanda S.,Institute Of Recherche En Science Of La Sante | Obermeyer C.M.,WHO
AIDS | Year: 2010

Operational research (OR) has been identified as a key component of the scaling-up of antiretroviral therapy provision in resource-limited settings. OR is usually defined through its concern for applied issues and the participation of local stakeholders. Who the stakeholders should be or what their participation entails has seldom been precisely defined, and there are variations among guidelines about the conditions of their participation in the research process. The scope, achievements and limits of stakeholders'participation is analyzed here, with reference to an OR project on care practices for AIDS patients at various levels and in various sectors of the health system in Burkina Faso. The overall objectives of the project were to ameliorate care practices and to reinforce the collaboration between caregivers in non-governmental organizations, public, private, faith and community-based facilities. A large number of stakeholders was involved in the advisory committee and the research team and participated in the research from formulation to dissemination. This helped define research questions that were relevant for each sector and facilitate the acceptance of the study in the field. Some disadvantages also appeared, such as an overly broad scope of the project, delays in implementation, difficulties in coordination and unequal involvement of team members. The experience analysed here shows that effective participation of stakeholders at all stages can make a difference to the relevance, quality and implementation of OR. There may, in addition, be an optimal level of stakeholders'participation, both in terms of the numbers and composition of the group, beyond which disadvantages become apparent. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Ridded V.,University of Montréal | Meessen B.,Institute Of Medecine Tropicale | Kouanda S.,Institute Of Recherche En Science Of La Sante
Sante Publique | Year: 2011

As the idealistic deadline of the Millennium Development Goals (MDGs), 2015, looms ever closer, some are calling for user fees abolition. In many African countries, this involves targeting groups considered vulnerable. However, operational problems have surfaced in the experiences of some of the pioneering West African countries. We identified various health system bottlenecks. These challenges are also starting points and opportunities to strengthen health care systems in Africa through making changes such as significantly increasing health care funding, improving the reliability of funding, making equity a health policy priority, adopting "New Public Management" types of reforms, ensuring the supply and quality of inputs, making efforts to reinforce the systemic components of the health sector, and improving the quality and quantity of evaluations undertaken in the health sector.


Druetz T.,University of Montréal | Kadio K.,Institute Of Recherche En Science Of La Sante | Kadio K.,University of Montréal | Haddad S.,University of Montréal | And 2 more authors.
Social Science and Medicine | Year: 2015

The use of community health workers to administer prompt treatments is gaining popularity in most sub-Saharan African countries. Their performance is a key challenge because it varies considerably, depending on the context, while being closely associated with the effectiveness of case management strategies. What determines community health workers' performance is still under debate. Based on a realist perspective, a systematic review recently hypothesized that several mechanisms are associated with good performance and successful community interventions. In order to empirically investigate this hypothesis and confront it with the reality, we conducted a study in Burkina Faso, where in 2010 health authorities have implemented a national program introducing community case management of malaria. The objective was to assess the presence of the mechanisms in community health workers, and explore the influence of contextual factors. In 2012, we conducted semi-structured interviews with 35 community health workers from a study area established in two similar health districts (Kaya and Zorgho). Results suggest that they perceive most of the mechanisms, except the sense of being valued by the health system and accountability to village members. Analysis shows that drug stock-outs and past experiences of community health workers simultaneously influence the presence of several mechanisms. The lack of integration between governmental and non-governmental interventions and the overall socio-economic deprivation, were also identified as influencing the mechanisms' presence. By focusing on community health workers' agency, this study puts the influence of the context back at the core of the performance debate and raises the question of their ability to perform well in scaled-up anti-malaria programs. © 2014 The Authors.


Ridde V.,University of Montréal | Druetz T.,University of Montréal | Poppy S.,Institute Of Recherche En Science Of La Sante | Kouanda S.,Institute Of Recherche En Science Of La Sante | Haddad S.,University of Montréal
PLoS ONE | Year: 2013

Background:Every year 40,000 people die of malaria in Burkina Faso. In 2010, the Burkinabè authorities implemented a national malaria control program that provides for the distribution of mosquito nets and the home-based treatment of children with fever by community health workers. The objective of this study was to measure the implementation fidelity of this program.Methods:We conducted a case study in two comparable districts (Kaya and Zorgho). Data were collected one year after the program's implementation through field observations (10 weeks), documentary analysis, and individual interviews with stakeholders (n = 48) working at different levels of the program. The analysis framework looked at the fidelity of (i) the intervention's content, (ii) its coverage, and (iii) its schedule.Results:The program's implementation was relatively faithful to what was originally planned and was comparable in the two districts. It encountered certain obstacles in terms of the provision of supplies. Coverage fidelity was better in Kaya than in Zorgho, where many community health workers (CHW) experienced problems with the restocking of artemisinin-based combination therapy and with remuneration for periods of training. In both districts, the community was rarely involved in the process of selecting CHWs. The components affected by scheduling all experienced successive implementation delays that pushed nets distribution and the initial provision of artemisinin-based combination therapies to the CHWs past the 2010 malaria season.Conclusions:The activities intended by the program were mostly implemented with good fidelity. However, the implementation was plagued by delays that probably postponed the expected beneficial effects. © 2013 Ridde et al.

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