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Background Measuring progress towards financial risk protection for the poorest is essential within the framework of Universal Health Coverage. The study assessed the level of out-of-pocket expenditure and factors associated with excessive out-of-pocket expenditure among the ultra-poor who had been targeted and exempted within the context of the performance-based financing intervention in Burkina Faso. Ultra-poor were selected based on a community-based approach and provided with an exemption card allowing them to access healthcare services free of charge. Methods We performed a descriptive analysis of the level of out-of-pocket expenditure on formal healthcare services using data from a cross-sectional study conducted in Diébougou district. Multivariate logistic regression was performed to investigate the factors related to excessive out-of-pocket expenditure among the ultra-poor. The analysis was restricted to individuals who reported formal health service utilisation for an illness-episode within the last six months. Excessive spending was defined as having expenditure greater than or equal to two times the median out-of-pocket expenditure. Results Exemption card ownership was reported by 83.64% of the respondents. With an average of FCFA 23051.62 (USD 39.18), the ultra-poor had to supplement a significant amount of out-of-pocket expenditure to receive formal healthcare services at public health facilities which were supposed to be free. The probability of incurring excessive out-of-pocket expenditure was negatively associated with being female (β = − 2.072, p = 0.00, ME = − 0.324; p = 0.000) and having an exemption card (β = − 1.787, p = 0.025; ME = − 0.279, p = 0.014). Conclusions User fee exemptions are associated with reduced out-of-pocket expenditure for the ultra-poor. Our results demonstrate the importance of free care and better implementation of existing exemption policies. The ultra-poor’s elevated risk due to multi-morbidities and severity of illness need to be considered when allocating resources to better address existing inequalities and improve financial risk protection.

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Posterior urethral valves (UPVs) are congenital obstructive membranous folds that represent the main cause of bilateral renal obstruction and dysuria in children and infants. The seriousness of this malformative uropathy lies in the importance of its impact on the upper urinary tract with a significant risk of end-stage renal failure. The objective of this work is to report our experience on the management of this pathology, for this we carried out a retrospective and descriptive study over a period of 5 years, from January 2018 to December 2022, including all hospitalized patients or seen in consultation at the pediatric surgery unit of Hôpital du Mal. The parameters studied were demographic, clinical, radiological and therapeutic variables. We collected 10 patients, an average of 2 patients per year and a frequency of 0.38%. The infant age group was the most represented, i.e. 80% of cases. The average age of our patients was 9.1 months with extremes of 2 days and 48 months. The most common reason for consultation was dysuria with 60% of cases. Overflow urination was the most frequent functional sign. Fever was present in 90% of cases. Abdominal distension was present in nearly half of our patients and acute urinary retention in 30% of cases. All our patients underwent cytobacteriological examination of urine. It was positive in 4 patients, i.e. 40% of cases. THE. Coli was the majority germ. All our patients performed retrograde urethrocystography (UCR) and objectified a dilation of the posterior urethra in all patients. Surgical treatment concerned all our patients. The FOGARTHY technique was used in 9 patients and a vesicostomy was performed in one patient. In the immediate therapeutic follow-up, 1 patient died in intensive care, 3 patients presented with sepsis, one of whom subsequently died. After an 8-month follow-up, the consequences are simple in all our patients.