Community-based dengue control intervention in Ouagadougou:intervention theory and implementation fidelity

Background:While malaria control is the primary health focus in Burkina Faso,the recent dengue epidemic calls for new interventions.This paper examines the implementation fidelity of an innovative intervention to control dengue in the capital Ouagadougou.Methods:First we describe the content of the intervention and its theory.We then assess the fidelity of the implementation.This step is essential as preparation for subsequent evaluation of the intervention’s effectiveness.Observations(n=62),analysis of documents related to the intervention(n=8),and semi-structured interviews with stakeholders(n=18)were conducted.The collected data were organized and analyzed using QDA Miner.The theory of the intervention,grounded in reported good practices of community-based interventions,was developed and discussed with key stakeholders.Results:The theory of the intervention included four components:mobilization and organization,operational planning,community action,and monitoring/evaluation.The interactions among these components were intended to improve people’s knowledge about dengue and enhance the community’s capacity for vector control,which in turn would reduce the burden of the disease.The majority of the planned activities were conducted according to the intervention’s original theory.Adaptations pertained to implementation and monitoring of activities.Conclusions:Despite certain difficulties,some of which were foreseeable and others not,this experience showed the feasibility of developing community-based interventions for vector-borne diseases in Africa.

Does the gap between health workers’expectations and the realities of implementing a performance-based financing project in Mali create frustration?

Background:Performance-Based Financing(PBF),an innovative health financing initiative,was recently implemented in Mali.PBF aims to improve quality of care by motivating health workers.The purpose of this research was to identify and understand how health workers’expectations related to their experiences of the first cycle of payment of PBF subsidies,and how this experience affected their motivation and sentiments towards the intervention.We pose the research question,“how does the process of PBF subsidies impact the motivation of health workers in Mali?”Methods:We adopted a qualitative approach using multiple case studies.We chose three district hospitals(DH 1,2 and 3)in three health districts(district 1,2 and 3)among the ten in the Koulikoro region.Our cases correspond to the three DHs.We followed the principle of data source triangulation;we used 53 semi-directive interviews conducted with health workers(to follow the principle of saturuation),field notes,and documents relating to the distribution grids of subsidies for each DH.We analyzed data in a mixed deductive and inductive manner.Results:The results show that the PBF subsidies led to health workers feeling more motivated to perform their tasks overall.Beyond financial motivation,this was primarily due to PBF allowing them to work more efficiently.However,respondents perceived a discrepancy between the efforts made and the subsidies received.The fact that their expectations were not met led to a sense of frustration and disappointment.Similarly,the way in which the subsidies were distributed and the lack of transparency in the distribution process led to feelings of unfairness among the vast majority of respondents.The results show that frustrations can build up in the early days of the intervention.Conclusion:The PBF implementation in Mali left health workers frustrated.The short overall implementation period did not allow actors to adjust their initial expectations and motivational responses,neither positive nor negative.This underlines how short-term interventions might not just lack impact,but instil negative sentiments likely to carry on into the future.

Health financing policies in Sub-Saharan Africa:government ownership or donors’influence?A scoping review of policymaking processes

Background:The rise on the international scene of advocacy for universal health coverage(UHC)was accompanied by the promotion of a variety of health financing policies.Major donors presented health insurance,user fee exemption,and results-based financing policies as relevant instruments for achieving UHC in Sub-Saharan Africa.The“donor-driven”push for policies aiming at UHC raises concerns about governments’effective buy-in of such policies.Because the latter has implications on the success of such policies,we searched for evidence of government ownership of the policymaking process.Methods:We conducted a scoping review of the English and French literature from January 2001 to December 2015 on government ownership of decision-making on policies aiming at UHC in Sub-Saharan Africa.Thirty-five(35)results were retrieved.We extracted,synthesized and analyzed data in order to provide insights on ownership at five stages of the policymaking process:emergence,formulation,funding,implementation,and evaluation.Results:The majority of articles(24/35)showed mixed results(i.e.ownership was identified at one or more levels of policymaking process but not all)in terms of government ownership.Authors of only five papers provided evidence of ownership at all reviewed policymaking stages.When results demonstrated some lack of government ownership at any of the five stages,we noticed that donors did not necessarily play a role:other actors’involvement was contributing to undermining government-owned decision-making,such as the private sector.We also found evidence that both government ownership and donors’influence can successfully coexist.Discussion:Future research should look beyond indicators of government ownership,by analyzing historical factors behind the imbalance of power between the different actors during policy negotiations.There is a need to investigate how some national actors become policy champions and thereby influence policy formulation.In order to effectively achieve government ownership of financing policies aiming at UHC,we recommend strengthening the State’s coordination and domestic funding mobilization roles,together with securing a higher involvement of governmental(both political and technical)actors by donors.

Presence of three dengue serotypes in Ouagadougou(Burkina Faso):research and public health implications

Background:The significant malaria burden in Africa has often eclipsed other febrile illnesses.Burkina Faso’s first dengue epidemic occurred in 1925 and the most recent in 2013.Yet there is still very little known about dengue prevalence,its vector proliferation,and its poverty and equity impacts.Methods:An exploratory cross-sectional survey was performed from December 2013 to January 2014.Six primary healthcare centers in Ouagadougou were selected based on previously reported presence of Flavivirus.All patients consulting with fever or having had fever within the previous week and with a negative rapid diagnostic test(RDT)for malaria were invited to participate.Sociodemographic data,healthcare use and expenses,mobility,health-related status,and vector control practices were captured using a questionnaire.Blood samples of every eligible subject were obtained through finger pricks during the survey for dengue RDT using SD BIOLINE Dengue Duo(NS1Ag and IgG/IgM)®and to obtain blood spots for reverse transcription polymerase chain reaction(RT-PCR)analysis.In a sample of randomly selected yards and those of patients,potential Aedes breeding sites were found and described.Larvae were collected and brought to the laboratory to monitor the emergence of adults and identify the species.Results:Of the 379 subjects,8.7%(33/379)had positive RDTs for dengue.Following the 2009 WHO classification,38.3%(145/379)had presumptive,probable,or confirmed dengue,based on either clinical symptoms or laboratory testing.Of 60 samples tested by RT-PCR(33 from the positive tests and 27 from the subsample of negatives),15 were positive.The serotypes observed were DENV2,DENV3,and DENV4.Odds of dengue infection in 15-to-20-year-olds and persons over 50 years were 4.0(CI 95%:1.0–15.6)and 7.7(CI 95%:1.6–37.1)times higher,respectively,than in children under five.Average total spending for a dengue episode was 13771 FCFA[1300–67300 FCFA](1$US=478 FCFA).On average,2.6 breeding sites were found per yard.Potential Aedes breeding sites were found near 71.4%(21/28)of patients,but no adult Aedes were found.The most frequently identified potential breeding sites were water storage containers(45.2%).Most specimens collected in yards were Culex(97.9%).Conclusions:The scientific community,public health authorities,and health workers should consider dengue as a possible cause of febrile illness in Burkina Faso.

Priorities and needs for research on urban interventions targeting vector-borne diseases: rapid review of scoping and systematic reviews

This paper highlights the critical importance of evidence on vector-borne diseases(VBD)prevention and control interventions in urban settings when assessing current and future needs,with a view to setting policy priorities that promote inclusive and equitable urban health services.Research should produce knowledge about policies and interventions that are intended to control and prevent VBDs at the population level and to reduce inequities.Such interventions include policy,program,and resource distribution approaches that address the social determinants of health and exert influence at organizational and system levels.

Impact of a community-based intervention on Aedes aegypti and its spatial distribution in Ouagadougou,Burkina Faso

Background:Several studies highlighted the impact of community-based interventions whose purpose was to reduce the vectors’breeding sites.These strategies are particularly interesting in low-and-middle-income countries which may find it difficult to sustainably assume the cost of insecticide-based interventions.In this case study we determine the spatial distribution of a community-based intervention for dengue vector control using different entomological indices.The objective was to evaluate locally where the intervention was most effective,using spatial analysis methods that are too often neglected in impact assessments.Methods:Two neighbourhoods,Tampouy and Juvenat in Ouagadougou,Burkina Faso,were chosen among five after a survey was conducted,as part of an assessment related to the burden of dengue.As part of the communitybased intervention conducted in Tampouy between August and early October 2016,an entomological survey was implemented in two phases.The first phase consisted of a baseline entomological characterization of potential breeding sites in the neighbourhood of Tampouy as well as in Juvenat,the control area.This phase was conducted in October 2015 at the end of the rainy season.The mosquito breeding sites were screened in randomly selected houses:206 in Tampouy and 203 in Juvenat.A second phase took place after the intervention,in October 2016.The mosquito breeding sites were investigated in the same yards as during the baseline phase.We performed several entomological analyses to measure site productivity as well as before and after analysis using multilevel linear regression.We used Local Indicators of Spatial Association(LISAs)to analyse spatial concentrations of larvae.Results:After the intervention,it is noted that LISAs at Tampouy reveal few aggregates of all types and the suppression of those existing before the intervention.The analysis therefore reveals that the intervention made it possible to reduce the number of concentration areas of high and low values of pupae.Conclusions:The contribution of spatial methods for assessing community-based intervention are relevant for monitoring at local levels as a complement to epidemiological analyses conducted within neighbourhoods.They are useful,therefore,not only for assessment but also for establishing interventions.This study shows that spatial analyses also have their place in population health intervention research.