Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.
BMC Public Health. 2021 Jan 5;21(1):20. doi: 10.1186/s12889-020-09994-7.
The Service Availability and Readiness Assessment surveys generate data on the readiness of health facility services. We constructed a readiness index related to malaria services and determined the association between health facility malaria readiness and malaria mortality in children under the age of 5 years in Burkina Faso.
Data on inpatients visits and malaria-related deaths in under 5-year-old children were extracted from the national Health Management Information System in Burkina Faso. Bayesian geostatistical models with variable selection were fitted to malaria mortality data. The most important facility readiness indicators related to general and malaria-specific services were determined. Multiple correspondence analysis (MCA) was employed to construct a composite facility readiness score based on multiple factorial axes. The analysis was carried out separately for 112 medical centres and 546 peripheral health centres.
Malaria mortality rate in medical centres was 4.8 times higher than that of peripheral health centres (3.5% vs. 0.7%, p < 0.0001). Essential medicines was the domain with the lowest readiness (only 0.1% of medical centres and 0% of peripheral health centres had the whole set of tracer items of essential medicines). Basic equipment readiness was the highest. The composite readiness score explained 30 and 53% of the original set of items for medical centres and peripheral health centres, respectively. Mortality rate ratio (MRR) was by 59% (MRR = 0.41, 95% Bayesian credible interval: 0.19-0.91) lower in the high readiness group of peripheral health centres, compared to the low readiness group. Medical centres readiness was not related to malaria mortality. The geographical distribution of malaria mortality rate indicate that regions with health facilities with high readiness show lower mortality rates.
Performant health services in Burkina Faso are associated with lower malaria mortality rates. Health system readiness should be strengthened in the regions of Sahel, Sud-Ouest and Boucle du Mouhoun. Emphasis should be placed on improving the management of essential medicines and to reducing delays of emergency transportation between the different levels of the health system.
服务可用性和准备情况评估调查生成有关卫生机构服务准备情况的数据。我们构建了一个与疟疾服务相关的准备指数，并确定了布基纳法索五岁以下儿童疟疾死亡率与医疗机构疟疾准备情况之间的关系。
从布基纳法索国家卫生管理信息系统中提取五岁以下儿童住院就诊和与疟疾相关死亡的数据。采用具有变量选择的贝叶斯地质统计学模型拟合疟疾死亡率数据。确定与一般和疟疾特定服务相关的最重要的设施准备指标。采用多元对应分析（MCA）基于多个因子轴构建综合设施准备得分。对 112 个医疗中心和 546 个基层卫生中心分别进行分析。
医疗中心的疟疾死亡率是基层卫生中心的 4.8 倍（3.5%对 0.7%，p<0.0001）。基本药物是准备情况最低的领域（只有 0.1%的医疗中心和 0%的基层卫生中心拥有整套基本药物追踪项目）。基本设备准备情况最高。综合准备得分分别解释了医疗中心和基层卫生中心原始项目的 30%和 53%。基层卫生中心高准备组的死亡率比值（MRR）比低准备组低 59%（MRR=0.41，95%贝叶斯可信区间：0.19-0.91）。医疗中心的准备情况与疟疾死亡率无关。疟疾死亡率的地理分布表明，准备情况良好的卫生设施地区死亡率较低。
布基纳法索表现良好的卫生服务与较低的疟疾死亡率相关。萨赫勒、西南和布克莱迪穆洪地区的卫生系统准备情况应得到加强。应重点改善基本药物的管理，并减少卫生系统各级之间的紧急运输延误。
