The Health and Demographic Surveillance System (HDSS) in Nouna, Burkina Faso, 1993-2007.

The Nouna Health and Demographic Surveillance System (HDSS) is located in rural Burkina Faso and has existed since 1992. Currently, it has about 78,000 inhabitants. It is a member of the International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), a global network of members who conducts longitudinal health and demographic evaluation of populations in low- and middle-income countries.

Illness reporting and demand for medical care in rural Burkina Faso.

The issue of illness reporting in modelling demand for health care in low- and middle-income countries can be handled according to either of two conceptually-different constructs: (a) considering illness reporting behaviour as endogenous to demand; or (b) considering demand itself as the outcome of a sample selection phenomenon. In this paper, we take the second viewpoint and estimate the demand for medical care with an estimator that uses Heckman-type. Empirical estimates based on household survey data from rural Burkina Faso suggest that there are some implications of illness reporting behaviour for modelling the demand for medical care.

Willingness to pay for maternal health outcomes: are women willing to pay more than men?

Background: Only a limited number of studies have specifically sought to analyse and try to understand sex differences in willingness to pay (WTP).

Objective: To identify the role of sex in determining monetary values placed upon improvements in maternal health in Burkina Faso, West Africa.

Methods: A contingent valuation survey using the bidding game method was conducted in the district of Nouna in 2005; a sample of 409 male heads of households and their spouses were asked their WTP for a reduction in the number of maternal deaths in the Nouna area.

A game of two halves? Incentive incompatibility, starting point bias and the bidding game contingent valuation method.

The bidding game (BG) method of contingent valuation is one way to increase the precision of willingness to pay (WTP) estimates relative to the single dichotomous choice approach. However, there is evidence that the method may lead to incentive incompatible responses and be associated with starting point bias. While previous studies in health using BGs test for starting point bias, none have also investigated incentive incompatibility.

Step-wedge cluster-randomised community-based trials: an application to the study of the impact of community health insurance.

Background: We describe a step-wedge cluster-randomised community-based trial which has been conducted since 2003 to accompany the implementation of a community health insurance (CHI) scheme in West Africa. The trial aims at overcoming the paucity of evidence-based information on the impact of CHI. Impact is defined in terms of changes in health service utilisation and household protection against the cost of illness.

Revealing the burden of maternal mortality: a probabilistic model for determining pregnancy-related causes of death from verbal autopsies.

Background: Substantial reductions in maternal mortality are called for in Millennium Development Goal 5 (MDG-5), thus assuming that maternal mortality is measurable. A key difficulty is attributing causes of death for the many women who die unaided in developing countries. Verbal autopsy (VA) can elicit circumstances of death, but data need to be interpreted reliably and consistently to serve as global indicators.

The differences in characteristics between health-care users and non-users: implication for introducing community-based health insurance in Burkina Faso.

The purposes of this study are to describe the characteristics of different health-care users, to explain such characteristics using a health demand model and to estimate the price-related probability change for different types of health care in order to provide policy guidance for the introduction of community-based health insurance (CBI) in Burkina Faso. Data were collected from a household survey using a two stage cluster sampling approach. Household interviews were carried out during April and May 2003.

Understanding enrolment in community health insurance in sub-Saharan Africa: a population-based case-control study in rural Burkina Faso.

Objective: To identify factors associated with decision to enrol in a community health insurance (CHI) scheme.

Methods: We conducted a population-based case-control study among 15 communities offered insurance in 2004 in rural Burkina Faso. For inclusion in the study, we selected all 154 enrolled (cases) and a random sample of 393 non-enrolled (controls) households.

A simple method to estimate tobacco-related lung cancer deaths based on smoking prevalence data.

Objective: Tobacco is the major cause of cancer and a relevant risk factor for several other chronic diseases. Due to the epidemiological transition in developing countries with overall increasing life expectancy there is an increasing relevance of chronic diseases to the total burden of diseases. Furthermore, there are indications for a rise in the consumption of tobacco products in developing countries.

Determinants of household health expenditure on western institutional health care.

We try to identify determinants of illness reporting, provider choice and resulting expenditure with different econometric models using data from a representative household panel survey of 800 households in Nouna health district, Burkina Faso, during 2000-2001. The factors "being an adult", "married", "illness occurred in rainy season" and "severe illness" significantly increased the magnitude of health expenditure. Compared to malaria, individuals spent more on other infectious diseases, injury and the other disease category.

Cause-specific mortality rates in sub-Saharan Africa and Bangladesh.

Objective: To provide internationally comparable data on the frequencies of different causes of death.

Methods: We analysed verbal autopsies obtained during 1999 -2002 from 12 demographic surveillance sites in sub-Saharan Africa and Bangladesh to find cause-specific and age-specific mortality rates. The cause-of-death codes used by the sites were harmonized to conform to the ICD-10 system, and summarized with the classification system of the Global Burden of Disease 2000 (Version 2).

Willingness to pay for hypothetical malaria vaccines in rural Burkina Faso.

Aims: This study aims to set priorities for anti-disease malaria vaccines by determining community preference in a hyperendemic area.

Methods: A bidding game technique was used to elucidate willingness to pay in rural Burkina Faso and 2,326 adults were interviewed.

Results: It is shown that there are significant differences between community preference for an anti-disease vaccine aimed at reducing pathology in pregnant women, and for a vaccine directed against childhood malaria.

The feasibility of community-based health insurance in Burkina Faso.

To ensure the acceptability of community-based insurance (CBI) by the community and its sustainability, a feasibility study of CBI was conducted in Burkina Faso, including preference for benefit package of CBI, costing of health services, costing of the benefit package and willingness-to-pay (WTP) for the package. Qualitative methods were used to collect information about preferences for the benefit package. Cost per unit health services, health demand obtained from household survey and physician-judged health needs were used to estimate the cost of the benefit package.

Risk factors of infant and child mortality in rural Burkina Faso.

Objective: The aim of the study was to quantify the effect of risk factors for childhood mortality in a typical rural setting in sub-Saharan Africa.

Methods: We performed a survival analysis of births within a population under demographic surveillance from 1992 to 1999 based on data from a demographic surveillance system in 39 villages around Nouna, western Burkina Faso, with a total population of about 30000. All children born alive in the period 1 January 1993 to 31 December 1999 in the study area (n = 10 122) followed-up until 31 December 1999 were included.

Mortality patterns, 1993-98, in a rural area of Burkina Faso, West Africa, based on the Nouna demographic surveillance system.

The Nouna demographic surveillance system database was analysed for the period 1993-98. Basic demographic parameters, age-specific and age-standardized mortality rates were calculated and a seasonal variation in mortality was analysed. Poisson regression was used to model the calculated mortality rates and to investigate the seasonal mortality pattern.

Examining out-of-pocket expenditure on health care in Nouna, Burkina Faso: implications for health policy.

Objective: To examine household out-of-pocket expenditure on health care, particularly malaria treatment, in rural Burkina Faso.

Method: Comprehensive analysis of out-of-pocket expenditure on health care through a descriptive analysis and a second, multivariate analysis using the Tobit model with emphasis on malaria, based on 800 urban and rural households in Nouna health district.

Results: Households will spend less on malaria, either in or outside the health facility, if given the choice to do so, because they feel confident to self-treat malaria.

Effect of zinc supplementation on malaria and other causes of morbidity in west African children: randomised double blind placebo controlled trial.

Objective: To study the effects of zinc supplementation on malaria and other causes of morbidity in young children living in an area holoendemic for malaria in west Africa.

Design: Randomised, double blind, placebo controlled efficacy trial.

Setting: 18 villages in rural northwestern Burkina Faso.

Measuring the local burden of disease. A study of years of life lost in sub-Saharan Africa.

Background: An effective health policy necessitates a reliable characterization of the burden of disease (BOD) by cause. The Global Burden of Disease Study (GBDS) aims to deliver this information. For sub-Saharan Africa (SSA) in particular, the GBDS relies on extrapolations and expert guesses.