KABORE Charles Wendyam Paulin

Discipline de la thèse  : Epidémiologie

Il a soutenu sa thèse « Déterminants de la césarienne de qualité en Afrique de l’ouest » sous la direction de DUMONT Alexandre au Ceped le 28 novembre 2017.

Publications en relation avec la thèse

  • Dumont Alexandre, Betrán Ana Pilar, Kaboré Charles, de Loenzien Myriam, Lumbiganon Pisake, Bohren Meghan A., Mac Quoc Nhu Hung, Opiyo Newton, Carroli Guillermo, Annerstedt Kristi Sidney, Ridde Valery, Escuriet Ramón, Robson Michael, Hanson Claudia et The QUALI-DEC research group (2020) « Implementation and evaluation of nonclinical interventions for appropriate use of cesarean section in low- and middle-income countries: protocol for a multisite hybrid effectiveness-implementation type III trial », Implementation Science, 15 (1) (décembre). DOI : 10.1186/s13012-020-01029-4. https://implementationscience.biomedcentral.com/articles/10.1186/s13012-020-01029-4.
    Résumé : Background While cesarean sections (CSs) are a life-saving intervention, an increasing number are performed without medical reasons in low- and middle-income countries (LMICs). Unnecessary CS diverts scarce resources and thereby reduces access to healthcare for women in need. Argentina, Burkina Faso, Thailand, and Vietnam are committed to reducing unnecessary CS, but many individual and organizational factors in healthcare facilities obstruct this aim. Nonclinical interventions can overcome these barriers by helping providers improve their practices and supporting women’s decision-making regarding childbirth. Existing evidence has shown only a modest effect of single interventions on reducing CS rates, arguably because of the failure to design multifaceted interventions effectively tailored to the context. The aim of this study is to design, adapt, and test a multifaceted intervention for the appropriate use of CS in Argentina, Burkina Faso, Thailand, and Vietnam. Methods We designed an intervention (QUALIty DECision-making—QUALI-DEC) with four components: (1) opinion leaders at heathcare facilities to improve adherence to best practices among clinicians, (2) CS audits and feedback to help providers identify potentially avoidable CS, (3) a decision analysis tool to help women make an informed decision on the mode of birth, and (4) companionship to support women during labor. QUALI-DEC will be implemented and evaluated in 32 hospitals (8 sites per country) using a pragmatic hybrid effectiveness-implementation design to test our implementation strategy, and information regarding its impact on relevant maternal and perinatal outcomes will be gathered. The implementation strategy will involve the participation of women, healthcare professionals, and organizations and account for the local environment, needs, resources, and social factors in each country. Discussion There is urgent need for interventions and implementation strategies to optimize the use of CS while improving health outcomes and satisfaction in LMICs. This can only be achieved by engaging all stakeholders involved in the decision-making process surrounding birth and addressing their needs and concerns. The study will generate robust evidence about the effectiveness and the impact of this multifaceted intervention. It will also assess the acceptability and scalability of the intervention and the capacity for empowerment among women and providers alike.

  • Dumont Alexandre, de Loenzien Myriam, Nhu Hung Mac Quo, Dugas Marylène, Kabore Charles, Lumbiganon Pisake, Torloni Maria Regina, Gialdini Celina, Carroli Guillermo, Hanson Claudia, Betrán Ana Pilar et On behalf of the QUALI-DEC consortium (2022) « Caesarean section or vaginal delivery for low-risk pregnancy? Helping women make an informed choice in low- and middle-income countries », éd. par Melissa Morgan Medvedev, PLOS Global Public Health, 2 (11) (novembre 14), p. e0001264. DOI : 10.1371/journal.pgph.0001264. https://dx.plos.org/10.1371/journal.pgph.0001264.
    Résumé : Women’s fear and uncertainty about vaginal delivery and lack of empowerment in decision-making generate decision conflict and is one of the main determinants of high caesarean section rates in low- and middle-income countries (LMICs). This study aims to develop a decision analysis tool (DAT) to help pregnant women make an informed choice about the planned mode of delivery and to evaluate its acceptability in Vietnam, Thailand, Argentina, and Burkina Faso. The DAT targets low-risk pregnant women with a healthy, singleton foetus, without any medical or obstetric disorder, no previous caesarean scarring, and eligibility for labour trials. We conducted a systematic review to determine the short- and long-term maternal and offspring risks and benefits of planned caesarean section compared to planned vaginal delivery. We carried out individual interviews and focus group discussions with key informants to capture informational needs for decision-making, and to assess the acceptability of the DAT in participating hospitals. The DAT meets 20 of the 22 Patient Decision Aid Standards for decision support. It includes low- to moderate-certainty evidence-based information on the risks and benefits of both modes of birth, and helps pregnant women clarify their personal values. It has been well accepted by women and health care providers. Adaptations have been made in each country to fit the context and to facilitate its implementation in current practice, including the development of an App. DAT is a simple method to improve communication and facilitate shared decision-making for planned modes of birth. It is expected to build trust and foster more effective, satisfactory dialogue between pregnant women and providers. It can be easily adapted and updated as new evidence emerges. We encourage further studies in LMICs to assess the impact of DAT on quality decision-making for the appropriate use of caesarean section in these settings.

  • Kaboré Charles, Chaillet N., Kouanda Séni, Bujold E., Traoré Mamadou et Dumont Alexandre (2016) « Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries », BJOG: An International Journal of Obstetrics & Gynaecology, 123 (13) (décembre), p. 2147-2155. DOI : 10.1111/1471-0528.13615. http://doi.wiley.com/10.1111/1471-0528.13615.

  • Kaboré Charles, Ridde Valéry, Chaillet Nils, Yaya Bocoum Fadima, Betrán Ana Pilar et Dumont Alexandre (2019) « DECIDE: a cluster-randomized controlled trial to reduce unnecessary caesarean deliveries in Burkina Faso », BMC Medicine, 17 (1) (décembre), p. 87. DOI : 10.1186/s12916-019-1320-y. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1320-y.
    Résumé : Background In Burkina Faso, facility-based caesarean delivery rates have markedly increased since the national subsidy policy for deliveries and emergency obstetric care was implemented in 2006. Effective and safe strategies are needed to prevent unnecessary caesarean deliveries. Methods We conducted a cluster-randomized controlled trial of a multifaceted intervention at 22 referral hospitals in Burkina Faso. The evidence-based intervention was designed to promote the use of clinical algorithms for caesarean decision-making using in-site training, audits and feedback of caesarean indications and SMS reminders. The primary outcome was the change in the percentage of unnecessary caesarean deliveries. Unnecessary caesareans were defined on the basis of the literature review and expert consensus. Data were collected daily using a standardized questionnaire, in the same way at both the intervention and control hospitals. Caesareans were classified as necessary or unnecessary in the same way, in both arms of the trial using a standardized computer algorithm.ResultsA total of 2138 and 2036 women who delivered by caesarean section were analysed in the pre and post-intervention periods, respectively. A significant reduction in the percentage of unnecessary caesarean deliveries was evident from the pre- to post-intervention period in the intervention group compared with the control group (18.96 to 6.56% and 18.27 to 23.30% in the intervention and control groups, respectively; odds ratio [OR] for incremental change over time, adjusted for hospital and patient characteristics, 0.22; 95% confidence interval [CI], 0.14 to 0.34; P<0.001; adjusted risk difference, -17.02%; 95% CI, -19.20 to -13.20%).The intervention did not significantly affect the rate of maternal death (0.75 to 0.19% and 0.92 to 0.40% in the intervention and control groups, respectively; adjusted OR 0.32; 95% CI 0.04 to 2.23; P=0.253) or intrapartum-related neonatal death (4.95 to 6.32% and 5.80 to 4.29% in the intervention and control groups, respectively, adjusted OR 1.73; 95% CI 0.82 to 3.66; P=0.149). The overall perinatal mortality data were not available.Conclusion Promotion and training on clinical algorithms for decision-making, audit and feedback and SMS reminders reduced unnecessary caesarean deliveries, compared with usual care in a low-resource setting.
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  • Kaboré Charles, Ridde Valéry, Kouanda Seni, Agier Isabelle, Queuille Ludovic et Dumont Alexandre (2016) « Determinants of non-medically indicated cesarean deliveries in Burkina Faso », International Journal of Gynecology & Obstetrics, 135 (S1) (novembre), p. S58-S63. DOI : 10.1016/j.ijgo.2016.08.019. http://doi.wiley.com/10.1016/j.ijgo.2016.08.019.

  • Kaboré Charles, Ridde Valéry, Kouanda Séni et Dumont Alexandre (2018) « Assessment of clinical decision-making among healthcare professionals performing caesarean deliveries in Burkina Faso », Sexual & Reproductive Healthcare, 16 (juin), p. 213-217. DOI : 10.1016/j.srhc.2018.04.008. http://linkinghub.elsevier.com/retrieve/pii/S1877575618300284.

  • Kaboré Charles, Ridde Valéry, Kouanda Séni, Queuille Ludovic, Somé Paul-André, Agier Isabelle et Dumont Alexandre (2016) « DECIDE: a cluster randomized controlled trial to reduce non-medically indicated caesareans in Burkina Faso », BMC Pregnancy and Childbirth, 16 (1). DOI : 10.1186/s12884-016-1112-8. http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1112-8.

  • Mensah Keitly, Kaboré Charles, Zeba Salifou, Bouchon Magali, Duchesne Véronique, Pourette Dolorès, DeBeaudrap Pierre et Dumont Alexandre (2021) « Implementation of HPV-based screening in Burkina Faso: lessons learned from the PARACAO hybrid-effectiveness study », BMC Women's Health, 21 (1) (décembre), p. 251. DOI : 10.1186/s12905-021-01392-4. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-021-01392-4.
    Résumé : Abstract Background Cervical cancer screening in sub-Saharan countries relies on primary visual inspection with acetic acid (VIA). Primary human papillomavirus (HPV)-based screening is considered a promising alternative. However, the implementation and real-life effectiveness of this strategy at the primary-care level in limited-resource contexts remain under explored. In Ouagadougou, Burkina Faso, free HPV-based screening was implemented in 2019 in two primary healthcare centers. We carried out a process and effectiveness evaluation of this intervention. Methods Effectiveness outcomes and implementation indicators were assessed through a cohort study of screened women, observations in participating centers, individual interviews with women and healthcare providers and monitoring reports. Effectiveness outcomes were screening completeness and women’s satisfaction. Logistic regression models and concurrent qualitative analysis explored how implementation variability, acceptability by women and the context affected effectiveness outcomes. Results After a 3-month implementation period, of the 350 women included in the cohort, 94% completed the screening, although only 26% had their screening completed in a single visit as planned in the protocol. The proportion of highly satisfied women was higher after result disclosure (95%) than after sampling (65%). A good understanding of the screening results and recommendations increased screening completeness and women’s satisfaction, while time to result disclosure decreased satisfaction. Adaptations were made to fit healthcare workers’ workload. Conclusion Free HPV-based screening was successfully integrated within primary care in Ouagadougou, Burkina Faso, leading to a high level of screening completeness despite the frequent use of multiple visits. Future implementation in primary healthcare centers needs to improve counseling and reduce wait times at the various steps of the screening sequence.

  • Ravit Marion, Lohmann Julia, Dumont Alexandre, Kabore Charles, Koulidiati Jean‐Louis et De Allegri Manuela (2023) « How a supply‐side intervention can help to increase caesarean section rates in Burkina Faso facilities—Evidence from an interrupted time‐series analysis using routine health data », Tropical Medicine & International Health, 28 (2), p. 136-143. DOI : 10.1111/tmi.13840. https://onlinelibrary.wiley.com/doi/10.1111/tmi.13840.
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