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Effect of Free Healthcare Policy for Children under Five Years Old on the Incidence of Reported Malaria Cases in Burkina Faso by Bayesian Modelling: “Not only the Ears but also the Head of the Hippopotamus”

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  • Mady Ouédraogo

    (Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, 1070 Brussels, Belgium
    Institut de Recherche Santé et Sociétés, Faculté de Santé Publique, Université catholique de Louvain, 1200 Brussels, Belgium
    Institut National de la Statistique et de la Démographie (INSD), Ouagadougou 01 BP 374, Burkina Faso)

  • Toussaint Rouamba

    (Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, 1070 Brussels, Belgium
    Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou 11 BP 218, Burkina Faso)

  • Sékou Samadoulougou

    (Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute, Quebec, QC G1V 4G5, Canada
    Centre for Research on Planning and Development (CRAD), Université Laval, Quebec, QC G1V 0A6, Canada)

  • Fati Kirakoya-Samadoulougou

    (Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, 1070 Brussels, Belgium)

Abstract

Burkina Faso has recently implemented an additional strategy, the free healthcare policy, to further improve maternal and child health. This policy targets children under five who bear the brunt of the malaria scourge. The effects of the free-of-charge healthcare were previously assessed in women but not in children. The present study aims at filling this gap by assessing the effect of this policy in children under five with a focus on the induced spatial and temporal changes in malaria morbidity. We used a Bayesian spatiotemporal negative binomial model to investigate the space–time variation in malaria incidence in relation to the implementation of the policy. The analysis relied on malaria routine surveillance data extracted from the national health data repository and spanning the period from January 2013 to December 2018. The model was adjusted for meteorological and contextual confounders. We found that the number of presumed and confirmed malaria cases per 1000 children per month increased between 2013 and 2018. We further found that the implementation of the free healthcare policy was significantly associated with a two-fold increase in the number of tested and confirmed malaria cases compared with the period before the policy rollout. This effect was, however, heterogeneous across the health districts. We attributed the rise in malaria incidence following the policy rollout to an increased use of health services combined with an increased availability of rapid tests and a higher compliance to the “test and treat” policy. The observed heterogeneity in the policy effect was attributed to parallel control interventions, some of which were rolled out at different paces and scales. Our findings call for a sustained and reinforced effort to test all suspected cases so that, alongside an improved case treatment, the true picture of the malaria scourge in children under five emerges clearly (see the hippopotamus almost entirely).

Suggested Citation

  • Mady Ouédraogo & Toussaint Rouamba & Sékou Samadoulougou & Fati Kirakoya-Samadoulougou, 2020. "Effect of Free Healthcare Policy for Children under Five Years Old on the Incidence of Reported Malaria Cases in Burkina Faso by Bayesian Modelling: “Not only the Ears but also the Head of the Hippopo," IJERPH, MDPI, vol. 17(2), pages 1-23, January.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:2:p:417-:d:306428
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    1. Julian Besag & Jeremy York & Annie Mollié, 1991. "Bayesian image restoration, with two applications in spatial statistics," Annals of the Institute of Statistical Mathematics, Springer;The Institute of Statistical Mathematics, vol. 43(1), pages 1-20, March.
    2. Muhammad Farooq Umer & Shumaila Zofeen & Abdul Majeed & Wenbiao Hu & Xin Qi & Guihua Zhuang, 2018. "Spatiotemporal Clustering Analysis of Malaria Infection in Pakistan," IJERPH, MDPI, vol. 15(6), pages 1-15, June.
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    1. Mady Ouédraogo & David Tiga Kangoye & Sékou Samadoulougou & Toussaint Rouamba & Philippe Donnen & Fati Kirakoya-Samadoulougou, 2020. "Malaria Case Fatality Rate among Children under Five in Burkina Faso: An Assessment of the Spatiotemporal Trends Following the Implementation of Control Programs," IJERPH, MDPI, vol. 17(6), pages 1-22, March.

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