Objective  To describe the implementation of facility‐based case reviews (medical audits) in a maternity unit and their effect on the staff involved. Design  Cross‐sectional descriptive study. Setting  A 26‐bed obstetric unit in a district hospital in Ouagadougou, Burkina Faso. Sample  Sixteen audit sessions conducted between February 2004 and June 2005. Thirty‐five staff members were interviewed. Methods  An analysis of all the tools used in the management of the audit was performed: attendance lists, case summary cards and register of recommendations. The perceptions of the staff about the audits were collected through a questionnaire administrated by an external investigator from 10 June 2005 to 16 June 2005. Main outcome measures  Session participation, types of problems identified, recommendations proposed and implemented and staff reaction to the audits. Results  Only 7 midwives from a total of 15 regularly attended the sessions. Eighty‐two percent of the recommendations made during the audits have been implemented, but sometimes after a delay of several months. Interviewed personnel had a good understanding of the audit goals and viewed audit as a factor in changing their practice. However, midwives highlighted problems of bad interpersonal communication and lack of anonymity during the audit sessions, and pointed out the difficulty of practising self‐criticism. Conclusions  A lack of staff commitment and the resistance of maternity personnel to being evaluated by their peers or service users are reducing acceptance of routine audits. The World Health Organization must take all these factors into account when promoting the institutionalisation of medical audits in obstetrics.

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Background Cervical cancer is among the leading causes of cancer deaths for women in low-income African countries, such as Burkina Faso. Given that cervical cancer is a preventable disease through early detection and vaccination, this study aimed at understanding the barriers to cervical cancer early detection in Ouagadougou, the capital city of Burkina Faso. Women seeking screening and treatment for cervical cancer (n=351) during the period of May-August 2014, at the Yalgado Ouedraogo University Hospital were interviewed about their knowledge, attitudes, and practices toward cervical cancer. Interview questions elicited information about socio-demographic of participants, history of screening, knowledge of cervical cancer, and attitudes toward cervical screening. Scores were assigned to responses of questions and knowledge and tertites of distributions were used for comparison. A multivariate logistic regression was performed to predict cervical screening. Results Study participants were relatively young (37.5 ± 10.7 years), predominately resident of urban areas (83.8%), and over half had no or less than high school education. Over 90% of participants had heard about cervical cancer and about 55% of them had intermediate level knowledge of the disease, its screening, and/or risk factors. Knowledge level was lower among rural than urban residents. Predictors of screening included higher level of education (OR=2.2; 95% CI: 1.48–3.23), older age (OR=1.1; 95% CI: 1.06–1.12), higher socioeconomic standard (SES) (OR=1.5; 95% CI: 1–2.37), urban residence (OR= 2.0; 95% CI: 1.19–3.25), encouragement for screening by a healthcare worker (1.98; 95% CI: 1.06–3.69) and employment (OR=1.9; 95% CI: 1.13–3.11). Conclusion Low awareness and socioeconomic barriers lead to underutilization of screening services of women. Motivation and education by healthcare workers are important factors for increasing screening rates. Organized patient and professional education programs in gynecologic services are warranted for improving screening in Burkina Faso and other low-resources countries in Africa.

BackgroundImplementation of quality maternal death audits requires good programming, good communication and compliance with core principles. Studies on compliance with core principles in the conduct of maternal death audits (MDAs) exist but were conducted in urban areas, at the 2nd or 3rd level of the healthcare system, in experimental situations, or in a context of skills-building projects or technical platforms with an emphasis on the review of “near miss”. This study aims to fill the gap of evidence on the implementation of MDAs in rural settings, at the first level of care and in the routine care situation in Burkina Faso.MethodsWe conducted a multiple-case study, with seven cases (health districts) chosen by contrasted purposive sampling using four criteria: (i) the intra-hospital maternal mortality rates for 2013, (ii) rural versus urban location, (iii) proofs of regular conduct of maternal death audits (MDAs) as per routine health information system, and (iv) the use of district hospital versus regional hospital for reference when the first mentioned does not exist. A review of audit records and structured and semi-structured interviews with staff involved in MDAs were conducted. The survey was conducted from 27 April to 30 May of 2015.ResultsThe results showed that maternal death audits (MDAs) were irregularly scheduled, mostly driven by critical events. Overall, preparing sessions, communication and the conduct of MDAs were most of the time inadequate. Confidentiality was globally respected during the clinical audit sessions. The principle of “no name, no shame, and no blame” was differently applied and anonymity was rarely preserved.ConclusionProgramming, communication, and compliance with the basic principles in the conduct of maternal death audits were inadequate as compared to the national standards. Identifying determinants of such shortcomings may help guide interventions to improve the quality of clinical audits.ResumeLa mise en œuvre d’audits de décès maternels de qualité nécessite une bonne programmation, une bonne communication et le respect des principes fondamentaux. Des études sur le respect des principes fondamentaux existent mais ont été menées dans les zones urbaines, le 2ème ou 3ème niveau du système de santé, dans des situations expérimentales, un contexte de projets de renforcement des compétences ou de plates-formes techniques, en mettant l’accent sur la revue des «near miss». Cette étude vise à combler le manque d’information sur la programmation et le respect des principes fondamentaux concernant le milieu rural, le niveau du système de santé qui est. le district sanitaire et la situation de routine au Burkina Faso.MéthodologieNous avons mené une étude de cas multiple dans 7 établissements de santé sélectionnés par échantillonnage raisonné contrasté selon 4 critères: milieu urbain ou rural, taux de mortalité maternelle dans les établissements de santé en 2013 (les données de l’année 2014 n’étant pas complètes à la rédaction du protocole), la déclaration des audits de décès maternels...

ObjectiveThis study was conducted to determine the prevalence and distribution of high-risk human papillomavirus (HR-HPV) genotypes among sexually active women in Tenkodogo, Burkina Faso.MethodsAmong 131 sexually active women attending the Tenkodogo Urban Medical Center, endocervical samples were collected prior to screening for precancerous lesions. After viral DNA extraction, fourteen HR-HPV genotypes were characterized by real-time multiplex PCR in these cervical samples.ResultsThe mean age was 35.5 ± 9.5 years. Of the 131 women, 45 were infected with at least one HR-HPV genotype. The prevalence of HR-HPV infection among these women was 34.4%. Among the 45 oncogenic HPV-infected women, single HR-HPV genotype was found in 55.6% while 44.4% were infected with more than one HR-HPV genotype. The most frequent genotypes were HPV56 (36.5%), HPV66 (36.5%).ConclusionTenkodogo women included in this study had a higher prevalence of HPV 56, HPV 66. A larger study with a more representative sample would therefore be needed to determine predominant oncogenic genotypes in the subregion and especially in cancer cases.

Confidential enquiries into maternal deaths in West Africa are not just a concern of the others. They are urgently requested to promote the improvement of health services.

The present research was aimed to prevent mother-to-child transmission of HIV; to use RT-PCR in order to detect, 6 months after birth, infected children; and to test the antiretroviral resistance of both children and mothers in order to offer them a suitable therapy. At the Saint Camille Medical Centre, 3,127 pregnant women (aged 15-44 years) accepted to be enrolled in the mother-to-child transmission prevention protocol that envisages: (i) Voluntary Counselling and Testing for all the pregnant women; (ii) Antiretroviral therapy for HIV positive pregnant women and for their newborns; (iii) either powdered milk feeding or short breast-feeding and RT-PCR test for their children; (iv) finally, pol gene sequencing and antiretroviral resistance identifications among HIV positive mothers and children. Among the patients, 227/3,127 HIV seropositive women were found: 221/227 HIV-1, 4/227 HIV-2, and 2/227 mixed HIV infections. The RT-PCR test allowed the detection of 3/213 (1.4%) HIV infected children: 0/109 (0%) from mothers under ARV therapy and 3/104 (2.8%) from mothers treated with Nevirapine. All children had recombinant HIV-1 strain (CRF06_CPX) with: minor PR mutations (M36I, K20I) and RT mutations (R211K). Among them, two twins had Non-Nucleoside Reverse Transcriptase Inhibitor mutation (Y18CY). Both mothers acquired a major PR mutation (V8IV), investigated 6 months after a single-dose of Nevirapine. Prevention by single-dose of Nevirapine reduced significantly mother-to-child transmission of HIV, but caused many mutations and resistance to antiretroviral drugs. Based on present study the antiretroviral therapy protocol, together with the artificial-feeding, might represent the ideal strategy to avoid transmission of HIV from mother-to-child.

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