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B Dujardin

Publications and source records attributed to B Dujardin.

At least 19 recordsLinked to original sources
PubMed2006

[Validity, cost and feasibility of the mAECT and CTC confirmation tests after diagnosis of African of sleeping sickness].

OBJECTIVES: To evaluate the validity, cost and feasibility of two parasitological tests for the confirmation of Human African Trypanosomiasis (HAT): the mini Anion-exchange Centrifugation Technique (mAECT) and Capillary Tube Centrifugation (CTC). METHODS: During a sleeping sickness screening campaign in 2004 we screened 6502 people in Kwamouth, DRC. Those with a positive result in the Card Agglutination Test for Trypanosomiasis (CATT) had a gland puncture, fresh blood examination, stained thick blood film, mAECT, CTC and CATT titration. Sensitivity and specificity of the confirmation tests were calculated using the combination of all parasitological tests as a reference standard. Each method was costed and its feasibility was assessed with structured interviews of the technicians. RESULTS: Sensitivity of classical parasitological methods was 44.8% (36.8-53.0), of CTC 56.5% (48.3-64.5) and of mAECT 75.3% (95% CI: 67.7-81.9). Cost per test was 2.82 Euro for mAECT and 0.76 Euro for CTC. Time per test was 29.78 min for mAECT and 18.25 min for CTC. These two tests were judged feasible in field conditions. CONCLUSION: CTC and mAECT used alone or in combination would bring a considerable improvement to HAT active case finding when used as confirmation tests in CATT-whole blood-positive persons. They proved feasible in operational conditions if a 220 V power supply can be guaranteed. As mAECT is more sensitive but also considerably more expensive, efficiency as well as feasibility considerations will have to guide the choice of the best algorithm.

Adolescent↗
PubMed2006

[Emergency obstetrical care in Benin referral hospitals: 'near miss' patients' views].

OBJECTIVE: To evaluate emergency obstetric care and the perceptions and expectations of women who experienced 'near miss' events to improve maternal health in Benin. METHODS: Qualitative survey in seven hospitals at the three referral levels of the health pyramid from July to October 2003. We used two methods: 557 women with near miss events were interviewed in hospital and a standard questionnaire completed; then semi-structured individual interviews were conducted at home with 42 of these 557 women. RESULTS: Provided care, accommodation, facilities, costs and modalities of recovery, hygiene of the premises, dynamism, expertise, social support, behaviours and attitude of staff were the criteria used to express patients' satisfaction. Most women interviewed in hospital were happy with physical access, organization, functioning and environment. However, excessive costs and coercive recovery of the expenses, failure of the referral system, lack of empathy and discrimination of the nursing staff, lack of resources for emergencies, lack of hygiene and comfort of the premises were criticized by the women interviewed at home. CONCLUSION: The current maternal care system fails to effectively deal with obstetric complications. It needs to be better resourced, more easily available, cheaper and take into account the women's needs.

Abortion, Threatened↗
PubMed2006

Decentralising tuberculosis case management in two districts of Burkina Faso.

SETTING: In West Africa, national tuberculosis programmes (NTPs) face many problems due to the low performance of health care delivery systems and patients' social and cultural environment. OBJECTIVE: To improve the case management of TB in Burkina Faso. DESIGN: Using the operational research process as a tool, TB case management was decentralised from the district hospital to eight primary health care centres in 2003. RESULTS: Twelve months after decentralisation, the quality of case detection remained satisfactory. The delay between the identification of TB suspects with chronic cough and the confirmation of TB was reduced from 13 to 6 days. The detection rate of TB suspects during the study (30%) was twice as high as for 2001 and 2002 (15%). However, the detection rate for smear-positive TB cases decreased from 32.3% in 2001 and 2002 to 6.5% during the year of the study. CONCLUSION: Sufficient time and commitment are essential to obtain a case management system that is decentralised and effective. Efforts therefore need to continue to obtain more information and better results.

Burkina Faso↗
PubMed2006

Are patients who present spontaneously with PTB symptoms to the health services in Burkina Faso well managed?

SETTING: Six health districts selected from a total of 53 in Burkina Faso. OBJECTIVE: To evaluate the performance of the health services in identifying infectious pulmonary tuberculosis (PTB) cases in Burkina Faso. DESIGN: Retrospective review of initial consultation registers in the first level health centres and the laboratory and treatment registers kept at the Centres for TB Diagnosis and Treatment (CDTs) in 2001. RESULTS: The rate of detection of sputum-positive cases of PTB was 11.7 cases per 100000 population. Cough was the reason for consulting for 10.6% of 248,730 adults; 1.1% had chronic cough. Among patients with chronic cough, 66% had been referred for smear microscopy, 69.7% of whom were registered at the CDT to which they were referred. A positive diagnosis was made in 22.5% of the suspects referred and traced to the CDT. Among those with a positive diagnosis, 87.1% were put on treatment in the same CDT. CONCLUSIONS: The PTB case detection rate in Burkina Faso is low, due to the loss of cases at each of the stages leading to the diagnosis of TB. Case detection depends on the operational effectiveness of the staff working in the health services, as well as the referral of suspect patients to the CDT.

Adolescent↗
PubMed2004

[Effect of a participation in a community-based nutrition program on children's outcomes].

BACKGROUND: This study aimed to assess the effectiveness of a protein-energetic malnutrition prevention and treatment community program on the nutritional status of 18 to 36-month-old children in the poor communities of the Mono Region in Benin. METHODS: Two cross sectional anthropometric surveys were conducted. The first survey took place in 1998, before the implementation of the program; the second survey was conducted three years later. At each survey, cluster samples proportional to the population size was done; the sizes of the samples were 617 in 1998 and 648 in 2001. The nutritional status of 18 to 36 month-old-children was assessed by z-score of the indexes height-for-age, weight-for-age and weight-for-height and the cut-off point of -2 standard deviation was used to identify children who had stunting, wasting or underweight; children with serious stunting, wasting or underweight were identified with the cut-off point of -3 standard deviation. RESULTS: From 1998 to 2001, there was a significant reduction in the prevalence of growth retardation (-13.1%) and underweight (-13.0%). The reductions observed for the three types of protein-energetic malnutrition were more pronounced in the 30 to 36 months age group than in the others age groups. CONCLUSION: Substantial improvement was observed during the three years activities. This improvement cannot be attributed to the program unconditionally, because there was no difference between the nutritional status of participant and non participant children.

Benin↗
PubMed2004

The cost of medical care and people's health-seeking behaviour before being suspected of tuberculosis in three local health systems, Nicaragua.

OBJECTIVE: To assess the medical costs incurred by users and delay between first contact with a care provider and sputum test for acid-fast bacilli (AFB) in three areas of Nicaragua. METHODS: Directed interviews of consecutive series of tuberculosis (TB) suspects whose sputum had been examined for AFB. RESULTS: Of 252 TB suspects interviewed, 52% used more than one type of care giver and 35% used private practitioners. As a consequence, 18%, 21% and 29% of the interviewees in Carazo, El Viejo and Matagalpa, respectively, spent more than 1 month of the country's median income per inhabitant on medical care between the first visit to a care provider and the first sputum examination. Furthermore, more than 3 months elapsed on that part of the care pathway for 30%, 17% and 3% of interviewees in Matagalpa, El Viejo and Carazo, respectively. CONCLUSION: This study sheds light on the costs and delays incurred by TB suspects before reaching a laboratory for sputum smear examination. Both costs are lower for those suspects who exclusively use first-line governmental health services (FLGHS). This has been relatively little documented in Latin America to date and could be used as an argument to develop strategies to strengthen the credibility of FLGHS.

Bacteriological Techniques↗
PubMed2003

[Structural adjustment, cultural adjustment?].

Over the last two decades, multiple studies have been conducted and many articles published about Structural Adjustment Programmes (SAPs). These studies mainly describe the characteristics of SAPs and analyse their economic consequences as well as their effects upon a variety of sectors: health, education, agriculture and environment. However, very few focus on the sociological and cultural effects of SAPs. Following a summary of SAP's content and characteristics, the paper briefly discusses the historical course of SAPs and the different critiques which have been made. The cultural consequences of SAPs are introduced and are described on four different levels: political, community, familial, and individual. These levels are analysed through examples from the literature and individual testimonies from people in the Southern Hemisphere. The paper concludes that SAPs, alongside economic globalisation processes, are responsible for an acute breakdown of social and cultural structures in societies in the South. It should be a priority, not only to better understand the situation and its determining factors, but also to intervene and act with strategies that support and reinvest in the social and cultural sectors, which is vital in order to allow for individuals and communities in the South to strengthen their autonomy and identify.

Cultural Characteristics↗
PubMed1999

[Utilization of hospital emergency service for primary care (study at the Children's Hospital of Rabat, Morocco)].

BACKGROUND: Utilisation of emergency department (ED) for non-urgent problems, usually dealt with in first line health services (FLHS), has an impact both in terms of efficiency (ED care is more expensive than primary health care) and in terms of quality of care (due to ED overcrowding). This study describes the utilisation pattern of the ED at the Children's Hospital of Rabat (CHR) and assesses the appropriateness of ED utilisation. METHODS: During a whole week in September 1991, 24 h/24, information about every child admitted in the ED was collected by outside investigators, using a questionnaire. This questionnaire was divided into two sections. One section, filled out at admission of the child, consisted of the following items: time of arrival, health problem, health seeking pattern and identification of child (name, age, gender and address). The second section was filled out at the medical consultation and consisted primarily of a judgement about the relevance of ED utilisation (urgent/non-urgent condition, need for hospital-based equipment, subjective assessment of delay). RESULTS: During the week under study, 1,544 children were admitted at the ED: 904 at the medical ED and 640 at the surgical ED. At the medical ED, the proportion of urgent cases was 38%; among them, 65% needed hospital-based equipment and among the latter 72% arrived on time. It means that only 18% of the children utilised the ED in an appropriate way. At the surgical ED, the proportion of urgent cases was 56%; among them, 41% needed hospital-based equipment and among the latter 86% arrived on time. It means that only 20% of the children appropriately utilised the surgical ED. Appropriate utilisation is not associated with gender. The proportion of cases judged as urgent was associated neither to hour of admission--at least for the medical ED--nor to distance (less than 15 km). However, the proportion of urgent cases varied according to the day of the week. CONCLUSION: Results confirmed the opinion of the CHR staff: most children admitted to the ED had health problems that should have been cared for at FLHS. Rationalisation of ED utilisation will depend on the health system's ability to supply acceptable and accessible care at FLHS.

Adolescent↗
PubMed1999

[Why patients do not comply with reference decision made by general practitioners?].

SUBJECT: A health system's efficacy depends on the efficacy of its different components (first-level health services and hospitals). It also depends on the system's ability to ensure the continuity of care among the various levels of the system. Health care officials in Settat Province, Morocco, found continuity in this province to be unsatisfactory. Depending on the health centre involved, only 31 to 52% of patients referred from the first to the second level of care reached the hospital. METHODS: The study was conducted in two rural and two urban health centres (HCs) covering a total population of around 94,000. The methodology consisted of two steps. First we analysed retrospectively various determinants (age, gender, distance, time until appointment) that might influence the compliance of patients referred by the four health centres in 1994. Then we observed curative medical consultations conducted in each of these health centres over a three-day period; the 38 patients referred to the hospital over this period were interviewed and the organisation of the hospital used on was analysed. RESULTS: The results revealed low compliance: only 43% (782/1807) of the patients referred actually consulted the hospital's departments. The compliance rates varied from one HC to the other and were lower in rural than urban areas taken as a whole (34% (207/607) versus 48% (575/1200), respectively). The interviews revealed that patients did not trust the last-year medical students who staffed the emergency rooms. Another organisational problem in the hospital was identified: patients referred to the hospital to consult a specialist were not seen immediately but given appointments at later dates, and these waiting times influenced the final success of the referral process. Thus, if the patients were seen immediately, compliance increased from 48 to 77% in the case of the urban HCs and from 34 to 67% in the case of the rural HCs. CONCLUSION: The most important determinants of compliance were above all associated with the way health services were organized and the quality of communication between health professionals and patients.

Adolescent↗
PubMed1996

The value of maternal height as a risk factor of dystocia: a meta-analysis.

Ten publications and studies on the relation between maternal height and the risk of dystocia due to cephalopelvic disproportion (CPD) are analysed. The rate of Caesarean sections was chosen as the CPD indicator. When maternal height is presented in percentiles, curves can be superimposed, and sensitivities and specificities of the various studies may be analysed together. One biased study was excluded; the remaining 9 were pooled and regression lines calculated for sensitivity (Se) and specificity (Sp) of the entire set of points. The resulting model, i.e. Se = 10.9 + 1.99 Y and Sp = 99.9 - 0.99 Y, permits easy calculation of the expected sensitivity and specificity for each percentile Y. When the frequency of Caesarean section due to CPD is known, positive and negative predictive values can also be calculated. The proposed formulas can also be used to determine confidence intervals. The findings in terms of the sensitivity and specificity of low maternal height as a risk factor for dystocia indicate that 1 out of 5 pregnant women would have to be referred for further investigation to identify half of the cases of mechanical dystocia necessitating Caesarean section. The predictive value for a Caesarean rate of 2% (a value often seen in developing countries) for this 20th percentile would be only 5%. Practical ways of choosing a reference criterion are suggested. A two-track strategy (antenatal check-ups and community monitoring) is proposed.

Body Height↗
PubMed1995

Oxytocics in developing countries.

OBJECTIVES: A prospective multicenter study of obstetric practices was conducted in three developing countries (Benin, Congo and Senegal) to analyze oxytocic use during labor. One of the objectives was to assess the possible negative effects of the treatment regimens instituted during the labor monitoring phase. METHODS: Four health districts participated in the study. All women who gave birth in one of the participating health facilities over a 6-month period in Benin and Congo, and over a 3-month period in Senegal, were recruited. The number of deliveries studied in each district varied from 457 to 1048. For each case a partogram was used to assess the progress of labor and the onset of dysfunctional labor. Information was collected on the risk factors for dysfunctional labor, stillbirths and resuscitation of the neonate. RESULTS: Each of the four collaborating centers used oxytocics preferentially to treat dysfunctional labor, but even in normal labor (i.e. with a normal partogram) oxytocics were used in 4.4-21.5% of cases. In normal labor the incidence of neonatal resuscitation was higher in cases with than in those without oxytocic use: the relative risks (R.R.) varied from 1.9 to 5.6; the odds ratios varied from 2.4 to 7.0, and both were statistically significant in the four settings. In addition the stillbirth rate was always higher, though not significantly, when oxytocics were used in normal labor (R.R. 1.2-2.2). When the data of the four centers were pooled, the global relative risk for stillbirths was 1.9, and the 95% confidence interval was 1.1-3.4. Logistic regression analysis was carried out for five confounding factors (primiparity, a previous complicated delivery, presence of meconium, ruptured membranes and educational level) to adjust the odds ratio for the risk of neonatal resuscitation when oxytocics were used in normal labor. Except in the case of Abomey in Benin, where the variable 'presence of meconium' decreased the odds ratio from 6.4 to 3.4, the adjusted odds ratios remained similar to their non-adjusted values. In cases of non-dysfunctional labor, nurses and midwives used oxytocics more often than lesser trained health personnel (R.R. 4.0 [3.2-5.1]). CONCLUSION: Our results show that an obstetric treatment which is safe when used in certain well-defined indications, may have significant negative effects when used in situations where the same technical quality of care cannot be guaranteed.

Developing Countries↗
PubMed1995

The strategy of risk approach in antenatal care: evaluation of the referral compliance.

The main goal of antenatal care in developing countries is to identify women whose pregnancy or delivery is likely to raise problems and to refer them at the appropriate time to a hospital facility where the necessary medical equipment and expertise (vacuum extractors, cesarian sections, human skill, etc.) is available. This approach, which is known as the Risk Approach (RA) strategy, is expected to significantly reduce maternal morbidity and mortality. However, the RA will function properly only if the women identified at risk agree to give birth in a hospital on the one hand, and if they can indeed reach this hospital on the other hand. In this article the authors assess to what extent women with a risk of difficult labor (nulliparous or primiparous women under 150 cm, history of previous difficult delivery or stillbirth, women with transverse lie) agreed to give birth in a hospital. This descriptive survey, which covered 5060 pregnancies monitored in the Kasongo District, Maniema, in eastern Zaire, showed that the referral success rate in this socioeconomically very disadvantaged region was only 33%, despite some favorable conditions, such as a strong emphasis on community participation, a complementarity of health centers and hospital, and the absence of financial barriers within the health services system. Of the various hypotheses tested, the geographic accessibility of the hospital and the parturient's perception of the risk status were the two most important factors determining the compliance rate. A stratified analysis shows that the intensity of the parturient's perception has a different impact on compliance whether rural or urban situations are considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Likelihood ratios: a real improvement for clinical decision making?

The concept of likelihood ratio has been advocated for several years as one of the better means to evaluate diagnostic tests and as a practical and valuable tool in clinical decision making. In this paper we review the basic concepts underlying the evaluation of diagnostic tests and we explore the properties and usefulness of both positive and negative likelihood ratios compared with sensitivity and specificity. Particular attention is given to the use of likelihood ratios in the clinical setting. Likelihood ratios have three main advantages: they are intuitive, they simplify the predictive value calculation and the overall evaluation of sequential testing. Disadvantages are the non-linearity and the necessity to recalculate probabilities in odds. Although they summarize the information contained in sensitivity and specificity, these characteristics are still necessary for certain clinical decisions. Since likelihood ratios have been promoted among physicians and medical students, we discuss examples of inappropriate use and misunderstandings in the medical literature: the frequent omission of confidence intervals, the choice of cut-off points based on likelihood ratios for positive test results only and the confusion between likelihood ratios for ranges and those for cut-off points.

Decision Support Techniques↗
PubMed1994

Health and human rights: the challenge for developing countries.

What are the priorities when it comes to health and human rights? This article is subtended by the following principle, i.e. issues of health and human rights must be considered from different angles in industrial countries and developing countries. Indeed, the subjects that preoccupy the countries of 'the North,' such as the ethics of mandatory screening, assisted insemination, and euthanasia, to name a few, are of only marginal importance in the 'South.' The exception is the very specific case of health services' involvement in the organization of torture, which is common to North and South. Geographical, economic and cultural barriers have been lowered or removed in most industrialized countries and using effective, good-quality services has become a right for the overwhelming majority of their citizens. Priority in the developing countries continues to be given above all to improving the quality and effectiveness of health services and making them accessible to the greatest number of people. This article starts with a brief historical overview of the development of the 'health and human rights' concept. The body of the paper will then be devoted to an analysis of constraints and identification of the solutions that will allow health to become a real 'human right' for the people of developing countries. Health as a human right is the challenge for developing countries.

Developing Countries↗