The effect of community-based health insurance on the utilization of modern health care services: evidence from Burkina Faso.

Objective: To quantify the impact of community-based health insurance (CBI) on utilization of health care services in rural Burkina Faso.

Methods: Propensity score matching was used to minimise the observed baseline differences in the characteristics of insured and uninsured groups such that the observed difference in healthcare utilisation could generally be attributed to the CBI.

Results: Compared with those who were not enrolled in the CBI, the overall increase in outpatient visits given illness in the insured group was about 40% higher, while the differential effect on utilization of inpatient care between insured and non-insured groups was insignificant.

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.

Breast milk as the "water that supports and preserves life"--socio-cultural constructions of breastfeeding and their implications for the prevention of mother to child transmission of HIV in sub-Saharan Africa.

Objectives: Complementary breastfeeding represents an important source of risk of HIV infection for infants born to HIV positive mothers. The World Health Organisation recommends that infants born to HIV positive mothers receive either replacement feeding or exclusive breastfeeding (EBF) followed by early weaning. Beyond the clinical and epidemiological debate, it remains unclear how acceptable and feasible the two options are for rural populations in sub-Saharan Africa.

Assessment of indirect cost-of-illness in a subsistence farming society by using different valuation methods.

Indirect costs or productive labour time lost are the largest share of household economic burden of illness. However, the estimate of household indirect cost can vary depending on the valuation methods used. We therefore estimated household indirect cost in a subsistence farming society in Burkina Faso based on daily production value.

A qualitative investigation into knowledge, beliefs, and practices surrounding mastitis in sub-Saharan Africa: what implications for vertical transmission of HIV?

Background: Mastitis constitutes an important risk factor in HIV vertical transmission. Very little, however, is known on how women in sub-Saharan Africa conceptualise health problems related to breastfeeding, such as mastitis, and how they act when sick. We aimed at filling this gap in knowledge, by documenting the indigenous nosography of mastitis, health seeking behaviour, and remedies for prophylaxis and treatment in rural sub-Saharan Africa.

Comparison of individual and group valuation of health state scenarios across communities in West Africa.

Background: The correct valuation of health state scenarios is important for economic analyses, disease burden assessment and setting clinical guidelines. However, it is unclear whether we should use individual or group valuations. We aimed to compare individual and group valuations of a range of clinically and culturally relevant health state scenarios in a West African population.

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.

Biomass solid fuel and acute respiratory infections: the ventilation factor.

Biomass solid fuel smoke is linked to acute respiratory infections (ARI). In future, its use will likely increase among poor households, and better ventilation is one important measure that can reduce this health impact. The authors aimed to study the extent to which improvement in ventilation-related factors reduces the fraction of ARI attributable to exposure to biomass smoke in children under 5 years old.

Safety of the methylene blue plus chloroquine combination in the treatment of uncomplicated falciparum malaria in young children of Burkina Faso [ISRCTN27290841].

Background: Safe, effective and affordable drug combinations against falciparum malaria are urgently needed for the poor populations in malaria endemic countries. Methylene blue (MB) combined with chloroquine (CQ) has been considered as one promising new regimen.

Objectives: The primary objective of this study was to evaluate the safety of CQ-MB in African children with uncomplicated falciparum malaria.

"To enrol or not to enrol?": A qualitative investigation of demand for health insurance in rural West Africa.

In spite of the fact that feeble levels of participation have long been identified as a major constraint to the successful long-term implementation of community-based health insurance (CBI) in low-income countries, evidence on determinants of enrolment in CBI is still lacking. The application of econometric modelling has provided a partial answer to the question, but on its own it has proved to be insufficient to guide policy making. This paper aims to fill this gap in knowledge using qualitative research methods.

Understanding consumers' preferences and decision to enrol in community-based health insurance in rural West Africa.

This paper presents a qualitative investigation of consumers' preferences regarding the single elements of a community-based health insurance (CBI) scheme recently implemented in a rural region in west Africa. The aim is to provide adequate policy-guidance to decision makers in low and middle income countries by producing an in-depth understanding of how consumers' preferences may affect decision to participate in such schemes. Although it has long been suggested that feeble levels of participation may very well be an expression of consumers' dissatisfaction with scheme design, little systematic efforts have so far been channelled towards supporting such argument with empirical evidence.

Safety of the combination of chloroquine and methylene blue in healthy adult men with G6PD deficiency from rural Burkina Faso.

New drug combinations against falciparum malaria which are both effective and affordable for Sub-Saharan African populations are urgently needed. The combination of the well-known drugs chloroquine (CQ) and methylene blue (MB) is such a promising new regimen. However, there is some concern that MB could cause development of haemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, a condition which is prevalent in malaria-endemic regions.

Informal risk-sharing arrangements (IRSAs) in rural Burkina Faso: lessons for the development of community-based insurance (CBI).

In resource-poor environments, community-based insurance (CBI) is increasingly being propagated as a strategy to improve access of poor rural populations to modern health care. It has been repeatedly hypothesized that CBI schemes need to be grounded in national as well as local traditions of solidarity. This paper presents a typology of informal risk sharing arrangements (IRSAs) in a rural area of North-Western Burkina Faso and discusses their modus operandi as well as the underlying concepts of solidarity and reciprocity.