Slim Haddad

Université Laval | ULAVAL

This study aims to monitor the spread of SARS-CoV-2 in the wastewater of institutions accommodating vulnerable people in Quebec City, including long-term care facilities and community shelters, using a low-cost and continuous sampling methodology, and have access to quick-release detection results to assist decision-making. Business Solution covid-...

Seasonal malaria chemoprevention (SMC) for children < 5 is a strategy that is gaining popularity in West African countries. Although its efficacy to reduce malaria incidence has been demonstrated in trials, the effects of SMC implemented in routine program conditions, outside of experimental contexts, are unknown. In 2014 and 2015, a survey was con...

With solid evidence that free healthcare increases the utilization of health services, Burkina Faso recently exempted all children under five and pregnant women from direct payment at health facilities. However, there is little insight into the capacity to maintain the gains attributable to free healthcare under routine conditions of implementation...

Background Stunting affects 165 million children worldwide, with repercussions on their survival and development. A contaminated environment is likely to contribute to stunting: frequent faecal-oral transmission possibly causes environmental enteropathy, a chronic inflammatory disorder that may contribute to faltering growth in children. This study...

Objective: To identify the factors associated with home births in the Kaya health district in Burkina Faso, where child delivery was free of charge between 2007 and 2011. Methods: Both qualitative and quantitative data were collected from the Kaya Health and Demographic Surveillance System (Kaya HDSS) among women who delivered at home or in a he...

This paper explores the factors associated with the place of death in Burkina Faso, based on mortality data from the Kaya Health and Demographic Surveillance System (Kaya HDSS). A multilevel logistic regression model with random intercept is used to determine the factors associated with the place of death. More than half of the deaths (55%) occur a...

Malaria is holo-endemic in Burkina Faso and causes approximately 40,000 deaths every year. In 2010, health authorities scaled up community case management of malaria with artemisinin-based combination therapy. Previous trials and pilot project evaluations have shown that this strategy may be feasible, acceptable, and effective under controlled impl...

Introduction: Larval source management has contributed to malaria decline over the past years. However, little is known about the impact of larval control practices undertaken at the household level on malaria transmission. Methods: The study was conducted in Kaya health district after the 2010 mass distribution of insecticide treated-nets and t...

Introduction: Burkina Faso started nationwide community case management of malaria (CCMm) in 2010. In 2011, health center user fees for children under five were abolished in some districts. Objective: To assess the effects of concurrent implementation of CCMm and user fees abolition on treatment-seeking practices for febrile children. Methods:...

Since September 2008, an intervention has made it possible to provide free care to children under five in public health facilities in two districts of Burkina Faso. This study evaluated the intervention's impact on household expenses incurred for services (consultations and medications) to the children targeted. The study is based on a survey of a...

Thirty years after Alma-Ata, there has been an upsurge of interest in community health workers (CHWs) in low- and middle-income countries. This echoes several strategic policies recently endorsed by the World Health Organization and its global call to re-establish the primary healthcare (PHC) policy. However, we are witnessing a reframing of this a...

The use of community health workers to administer prompt treatments is gaining popularity in most sub-Saharan African countries. Their performance is a key challenge because it varies considerably, depending on the context, while being closely associated with the effectiveness of case management strategies. What determines community health workers’...

Objective To estimate the impact on maternal and child mortality after eliminating user fees for pregnant women and for children less than five years of age in Burkina Faso. Methods Two health districts in the Sahel region eliminated user fees for facility deliveries and curative consultations for children in September 2008. To compare health-care...

Background Periodic mass distributions contribute significantly to universal access to insecticide-treated nets (ITNs). However, due to the limited number of nets distributed, needs remain unsatisfied, particularly in large households. Methods This study was conducted in Kaya health district following the 2010 mass distribution of ITNs in Burkina...

Background: Malaria is holo-endemic in Burkina Faso and causes the death of approximately 40,000 individuals every year. Local health authorities have been implementing population interventions such as universal bednet distribution and community case management of malaria in every village. However, recent studies conducted in other countries have r...

Addressing the complex, multi-factorial causes of childhood anaemia is best done through integrated packages of interventions. We hypothesized that due to reduced child vulnerability, a "buffering" of risk associated with known causes of anaemia would be observed among children living in areas benefiting from a community-based health and nutrition...

Using a world-wide, population-based dataset, we sought to examine the relationship between visual difficulty and employment status. The World Health Survey was conducted in 70 countries throughout the world in 2003 using a random, multi-stage, stratified, cluster sampling design. Far vision was assessed by asking about the level of difficulty in s...

Pneumonia causes around 750 000 child deaths per year in sub-Saharan African (SSA) countries. The lack of accessibility to prompt and effective treatment is an important contributor to this burden. Community case management of pneumonia (CCMp) uses trained community health workers (CHWs) to administer antibiotics to suspected child pneumonia cases...

Every year 40,000 people die of malaria in Burkina Faso. In 2010, the Burkinabè authorities implemented a national malaria control program that provides for the distribution of mosquito nets and the home-based treatment of children with fever by community health workers. The objective of this study was to measure the implementation fidelity of this...

Content fidelity of activities in Kaya District. Source: survey data. (PDF)

Coverage fidelity of activities in Kaya District. Source: survey data. (PDF)

Coverage fidelity of activities in Zorgho District. Source: survey data. (PDF)

Content fidelity of activities in Zorgho District. Source: survey data. (PDF)

Cette note présente les résultats d'une recherche effectuée auprès de toutes les femmes ayant accouchées dans le district de Ouargaye afin d'évaluer l'efficacité de la subvention nationale des accouchements (SONU) organisée en 2007. L'étude montre une réduction de la moyenne des dépenses médicales entre 2006 et 2010 de 65%. Cette réduction des dépe...

Background: Maternal mortality is higher in west Africa than in most industrialised countries, so the development and validation of effective interventions is essential. We did a trial to assess the effect of a multifaceted intervention to promote maternity death reviews and onsite training in emergency obstetric care in referral hospitals with hi...

Background This study evaluated the effects on healthcare access inequities of an intervention exempting children under 5 years from user fees in Burkina Faso. Methods The design consisted of two complementary studies. The first was an interrupted time series (56 months before and 12 months after) study of daily curative consultations according to...

The Kaya Health and Demographic Surveillance System (Kaya HDSS) is located in the North Central region of Burkina Faso in the Kaya health district. The main purposes of the Kaya HDSS are to study demographic, infectious and chronic disease indicators in the district, to observe changes in health over time, evaluate health programmes and to provide...

Forty years ago, Schwartz and Lellouch invented pragmatic clinical trials. Their proposal has not yet been fully espoused. This appears to be the case today also in the domain of public health interventions evaluation, where some still insist on the superiority of experimental methods. Yet evaluations of complex public health interventions are frau...

Using a world-wide, population-based dataset of adults, we sought to determine the frequency of far visual difficulty and its associated risk factors. The World Health Survey (WHS) was conducted in 70 countries throughout the world in 2003 using a random, multi-stage, stratified, cluster sampling design of adults ages 18 years and older. Far vision...

Introduction Mutual health organizations (MHO) have been implemented across Africa to increase access to healthcare and improve financial protection. Despite efforts to develop MHOs, low levels of both initial enrolment and membership renewals continue to threaten their financial viability. The purpose of this study was to map initiatives implement...

The provision of free healthcare is increasingly advocated as a way to improve access to health services for vulnerable population groups. However, decision makers are still short of factual data about the effects of payment exemptions (free provision) where they have already been introduced, and on the impact of different forms of implementation i...

Background The health and well-being of widows in India is an important but neglected issue of public health and women’s rights. We investigate the lives of Indian women as they become widows, focussing on the causes of their husband’s mortality and the ensuing consequences of these causes on their own lives and identify the opportunities and chall...

To improve access to health care services, an intervention was implemented in Burkina Faso granting full exemption from user fees. Two further components, staff training and supervision, were added to support the intervention. Our aim in this study was to examine how this tripartite intervention affected the quality of drug prescriptions. Using a m...

Mutual health organizations (MHO) have been seen as a promising alternative to the fee-based funding model but scientific foundations to support their generalization are still limited. Very little is known about the extent of the impact of MHOs on health-seeking behaviours, quality and costs. We present the results of an evaluation of the effects a...

Introduction. The African Union and United Nations agencies requested that children under five years and pregnant women be exempt from healthcare payment at the point of service. Indeed, this payment method is a financial barrier to healthcare access that the most vulnerable populations cannot overcome. Since Burkina Faso had not yet implemented su...

Abstract Background Several studies have demonstrated that women have greater mobility disability than men. The goals of this research were: 1) to assess the gender gap in mobility difficulty in 70 countries; 2) to determine whether the gender gap is explained by sociodemographic and health factors; 3) to determine whether the gender gap differs ac...

The objective of this study is to investigate the magnitude and nature of health inequalities between indigenous (Scheduled Tribes) and non-indigenous populations, as well as between different indigenous groups, in a rural district of Kerala State, India. A health survey was carried out in a rural community (N = 1660 men and women, 18-96 years). Ag...

Tables presenting non-standardized morbidity prevalence across groups. Table A: Morbidity across tribal and non-tribal groups (non-standardized). Table B: Morbidity across social groups (non-standardized). This additional file provides two supplementary tables presenting the non-standardized prevalence of morbidity for tribal and non-tribal groups...

Oaxaca-Blinder Decomposition Detailed Regression Results. This additional file provides the detailed results for each Oaxaca-Blinder decomposition regression model, from which the results in Table 3 were summarized.

The risk of visual impairment increases dramatically with age and therefore older adults should have their eyes examined at least every 1 to 2 years. Using a world-wide, population-based dataset, we sought to determine the frequency that older people had their eyes examined. We also examined factors associated with having a recent eye exam. The Wor...

Since 2007, Burkina Faso has subsidized 80% of the costs of child birth. Women are required to pay 20% (900 F CFA = 1.4 Euros), except for the indigent, who are supposed to be exempted. The objective of the policy is to increase service utilization and reduce costs for households. We analyze the efficacy of the policy and the distribution of its be...

In sub-Saharan Africa, women must overcome numerous barriers when they need modern healthcare. Respect of gender norms within the household and the community may still influence women's ability to obtain care. A lack of gender-sensitive instruments for measuring women's ability to overcome barriers compromises attempts to adequately quantify the bu...

WHO estimates suggest that age-specific death rates from non-communicable diseases are higher in sub-Saharan Africa than in high-income countries. The objectives of this study were to examine, in Burkina Faso, the prevalence of non-communicable disease symptoms by age, gender, socioeconomic group and setting (rural/urban), and to assess gender and...

The objective of this study was to assess the prevalence and the contribution of socio-demographic factors and chronic diseases to mobility disability in West African countries. Data were obtained from the World Health Survey (2002-2003) in which adults≥18 years participated, from Burkina Faso (n=4822), Mali (n=4230) and Senegal (n=3197). Participa...

Systems to exempt the indigent from user fees have been put in place to prevent the worst-off from being excluded from health care services for lack of funds. Yet the implementation of these mechanisms is as rare as the operational research on this topic. This article analyzes an action research project aimed at finding an appropriate solution to m...

Background: Inadequate public action in vulnerable communities is a major constraint for the health of poor and marginalized groups in low and middle-income countries (LMICs). The south Indian state of Kerala, known for relatively equitable provision of public resources, is no exception to the marginalization of vulnerable communities. In Kerala,...

Participatory research is increasingly being used with poor and marginalised populations in developing countries. However, there has been relatively little attention paid to ethical considerations in participatory research. We argue that there is a need for additional strategies to promote ethically sound participatory research, especially when wor...

Effective mechanisms to exempt the indigent from user fees at health care facilities are rare in Africa. A State-led intervention (2004-2005) and two action research projects (2007-2010) were implemented in a health district in Burkina Faso to exempt the indigent from user fees. This article presents the results of the process evaluation of these t...

The West African country of Mali implemented referral systems to increase spatial access to emergency obstetrical care and lower maternal mortality. We test the hypothesis that spatial access- proxied by travel time during the rainy and dry seasons- is associated with in-hospital maternal mortality. Effect modification by caesarean section is explo...

Alcohol consumption in India is disproportionately higher among poorer and socially marginalised groups, notably Scheduled Tribes (STs). We lack an understanding of STs own views with regard to alcohol, which is important for implementing appropriate interventions. This study was undertaken with the Paniyas (a previously enslaved ST) in a rural com...

In May 2010, Grand Challenges Canada (GCC) was launched with the mandate to identify global challenges in health that could be supported through the Government of Canada's Development Innovations Fund (DIF: $225 million over five years). The GCC offers a potentially excellent mechanism for taking Canada's participation in global health challenges "...

In the Indian context, a household's caste characteristics are most relevant for identifying its poverty and vulnerability status. Inadequate provision of public health care, the near-absence of health insurance and increasing dependence on the private health sector have impoverished the poor and the marginalised, especially the scheduled tribe pop...

To determine the prevalence and risk factors for near and far visual difficulty in Burkina Faso. Population-based data were used from the World Health Survey done in Burkina Faso in 2002-2003;2003 (n=4,822 adults). Near and far visual difficulty were assessed by questions about difficulty seeing and recognizing an object at arm's length and about d...

User fees were generalized in Burkina Faso in the 1990s. At the time of their implementation, it was envisioned that measures would be instituted to exempt the poor from paying these fees. However, in practice, the identification of indigents is ineffective, and so they do not have access to care. Thus, a community-based process for selecting indig...

The primary aim of Mutual Health Organizations (MHOs) is the financial protection of their members. However, given their community-based, participative and voluntary nature, it is conceivable that MHOs, as social organizations, would affect social dynamics. In an exploratory study in Benin, we studied social dynamics related to mutual aid, relation...

In India, indigenous populations, known as Adivasi or Scheduled Tribes (STs), are among the poorest and most marginalized groups. 'Deprived' ST groups tend to display high levels of resignation and to lack the capacity to aspire; consequently their health perceptions often do not adequately correspond to their real health needs. Moreover, similar t...

Data aggregation in national information systems begins at the district level. Decentralization has given districts a lead role in health planning and management, therefore validity of administrative-based estimates at that level is important to improve the performance of immunization information systems. To assess the validity of administrative-ba...

Background Indigenous populations tend to have the poorest health outcomes worldwide and they have limited opportunities to present their own perspectives of their situation and shape priorities in research and policy. This study aims to explain low healthcare utilisation rates and opportunities to cope with illness among a deprived indigenous grou...

Objective: We examine patterns of expenditures on health services in Kerala, India, evaluate the extent of health expenditure disparities and identify factors associated with these disparities. Methods: Longitudinal data of annual health care consumption for 531 households (2926 individuals) is used. Expenses are categorized according to type of...

Introduction: Apart from the mainstream Allopathic system, there are six other officially recognised systems of medicine in India. The common perception among many people is alternative and complementary medicines (CAM) are less expensive and more effective in the long-term with less or no side effects compared to Allopathic. This paper (i) intends...

Despite rapid and tangible progress in vaccine coverage and in premature mortality rates registered in sub-Saharan Africa, inequities to access remain firmly entrenched, large pockets of low vaccination coverage persist, and coverage often varies considerably across regions, districts, and health facilities' areas of responsibility. This paper focu...