Research Article
Economic Evaluation of Mobile Payments for Health Workers in Vaccination Programs: A Case Study from Cote d’Ivoire
Issue:
Volume 11, Issue 6, December 2025
Pages:
335-342
Received:
20 September 2025
Accepted:
10 October 2025
Published:
30 October 2025
DOI:
10.11648/j.cajph.20251106.11
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Abstract: Background: Timely and reliable remuneration of frontline health workers is critical for vaccination campaign performance, yet in many low- and middle-income countries cash-based disbursement remains vulnerable to delays, leakage, and inefficiencies. These weaknesses undermine accountability and create recurrent financial burdens, particularly in large-scale operations such as polio immunization campaigns. Objective: This study aimed to evaluate the cost implications of shifting from traditional cash payments to digital disbursement through mobile money during Cote d’Ivoire’s October 2023 national polio immunization campaign. Method: A partial economic evaluation was conducted using a top-down costing approach from the payer’s perspective. Data from all 113 districts and 33 regions were analyzed to compare cash-based and mobile money systems. The analysis focused on direct financial costs, including transaction fees (digital) and transport allowances or ghost worker disbursements (cash). A cost-minimization framework was applied under the assumption of equivalent immunization outputs, and deterministic sensitivity analysis was performed to test robustness. Result: Both systems disbursed the same total amount to vaccinators (397,582,460 FCFA). However, cash payments incurred additional costs of 7,820,967 FCFA in transport and 3,938,930 FCFA in ghost payments, while digital payments generated a 1% transaction fee (3,975,825 FCFA). The digital modality produced a net saving of 7,784,073 FCFA (12,435 USD), or 257 FCFA (0.41 USD) per vaccinator. Sensitivity analysis confirmed the stability of these savings across plausible parameter variations. Conclusion: Digital disbursement via mobile money offers a cost-saving and governance-enhancing alternative to cash payments in vaccination campaigns. Although the absolute savings represent less than 2% of total outlays, the benefits in efficiency, fraud reduction, and transparency are significant for health systems facing budget constraints. Cote d’Ivoire’s experience provides evidence for policymakers to consider institutionalizing digital payments to strengthen financial sustainability and support universal health coverage.
Abstract: Background: Timely and reliable remuneration of frontline health workers is critical for vaccination campaign performance, yet in many low- and middle-income countries cash-based disbursement remains vulnerable to delays, leakage, and inefficiencies. These weaknesses undermine accountability and create recurrent financial burdens, particularly in l...
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Research Article
High Mortality Rate Among Children and Adolescents with Cancer Treated in Burkina Faso
Issue:
Volume 11, Issue 6, December 2025
Pages:
343-351
Received:
1 September 2025
Accepted:
1 November 2025
Published:
3 November 2025
DOI:
10.11648/j.cajph.20251106.12
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Abstract: Data on childhood cancer mortality are scarce in Burkina Faso. We estimated pediatric cancer mortality and identified its associated factors at the Yalgado Ouédraogo University Hospital Center (CHUYO) in Ouagadougou (Burkina Faso). We conducted a retrospective cohort study of children under the age of 15 admitted for cancer and treated at CHUYO between March 1, 2014, and December 31, 2017. The cumulative incidence of mortality and its associated factors were estimated with the risk of abandonment of treatment or follow-up as a competing risk. A total of 168 children/adolescents were included at a median age of 7 years (interquartile range [IQR]: 4–10 years); 71% were boys. The median follow-up duration was 4.51 person-months (IQR: 1.85-10.5). Burkitt lymphoma (77%) and retinoblastoma (21%) were the most common cancer. The majority of Burkitt lymphoma (90%) were diagnosed at stage 3/4; the abdominal (58%) and maxillofacial (23%) locations were the most common. All children/adolescents received chemotherapy and 10% received chemotherapy and surgery. No patients received radiotherapy. During follow-up, overall mortality was 46%, and the risk of abandonment was 39%. The cumulative incidence of mortality was 30, 43, and 45 per 100 person-months at 6, 12, and 24 months, respectively. In multivariate analysis, male gender (adjusted sub hazard ratio [aSHR]: 2.20; 95%CI: 1.13-4.27), abdominal localization (aSHR: 2.68; 95%CI: 1.24-5.78), maxillofacial and abdominal localization (aSHR: 3.39; 95%CI: 1.42-8.09) increased significantly the risk of death among children and adolescent treated for Burkitt lymphoma. Early diagnosis and improved access to treatment are essential for better survival rates among children and adolescents with cancer in Burkina Faso.
Abstract: Data on childhood cancer mortality are scarce in Burkina Faso. We estimated pediatric cancer mortality and identified its associated factors at the Yalgado Ouédraogo University Hospital Center (CHUYO) in Ouagadougou (Burkina Faso). We conducted a retrospective cohort study of children under the age of 15 admitted for cancer and treated at CHUYO bet...
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Research Article
Access to Tuberculosis Prevention and Treatment for Persons Deprived of Liberty in Southern Benin in 2023
Issue:
Volume 11, Issue 6, December 2025
Pages:
352-363
Received:
14 September 2025
Accepted:
4 October 2025
Published:
7 November 2025
DOI:
10.11648/j.cajph.20251106.13
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Abstract: Background: Access to tuberculosis (TB) preventive services in prisons is a performance indicator for disease reduction strategies in the general population. People deprived of liberty often face constraints in utilizing these services. This survey aimed to study prisoners' access to TB prevention in 2023. Methods: This was a cross-sectional analytical study, including a retrospective analysis, on a non-probabilistic sample. It was conducted at the Abomey-Calavi remand center and involved 60 people deprived of liberty. Interviews were conducted with the head nurse and their deputy, followed by a review of the curative care registers from the prison infirmary. Coverage rates for screening, awareness, and isolation during and after treatment were determined, and associations with factors were assessed at a significance threshold of p=5%. Results: Less than half (43.75%) of prisoners with a cough lasting two weeks or more were screened. Among the 60 surveyed prisoners, 38.33%, 46.67%, and 10% had access respectively to screening, awareness and isolation for TB prevention. The care pathway for prisoners includes several key steps from screening to isolation, but it faces discontinuities that compromise effective TB treatment. Factors associated with TB screening were the effectiveness of awareness-raising activities (OR= 6.21; 95% CI= [1.67; 23.05]) and perception regarding seeking TB screening and treatment (OR= 9.36; 95% CI= [1.44; 60.79]). Conclusion: The decrescendo decrease in coverage indicates the presence of several bottlenecks limiting prisoners' access to TB prevention. Their consideration by health interventions will be necessary to ensure the protection of prisoners against TB.
Abstract: Background: Access to tuberculosis (TB) preventive services in prisons is a performance indicator for disease reduction strategies in the general population. People deprived of liberty often face constraints in utilizing these services. This survey aimed to study prisoners' access to TB prevention in 2023. Methods: This was a cross-sectional analyt...
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Research Article
Prevalence and Associated Factors of Exclusive Breastfeeding in Rural Areas of Burkina Faso
Issue:
Volume 11, Issue 6, December 2025
Pages:
364-371
Received:
15 September 2025
Accepted:
20 October 2025
Published:
12 November 2025
DOI:
10.11648/j.cajph.20251106.14
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Abstract: Introduction: Child malnutrition remains a major public health threat in sub-Saharan Africa and is reported to be associated with half of child deaths in Burkina Faso. The World Health Organization recommends exclusive breastfeeding (EBF) as a major intervention to improve overall child nutritional status and survival for the first 6 months of life. The study objectives were to assess the prevalence rates of EBF and to identify factors associated with improved EBF rates. Methods: As part of the evaluation of the Alive and Thrive interventional project in a Western area of Burkina Faso, we conducted a prospective cross-sectional survey in twelve villages randomly selected in the “Boucle du Mouhoun” region. The EBF-prevalence was calculated as the proportion of children who were exclusively breastfed. The factors associated with increased EBF-prevalence were identified using multivariable logistic regression models. The results were expressed as odds ratios (OR) and the corresponding 95% confidence intervals (95% CI) were constructed. Results: Overall, 157 mother-infant pairs were enrolled in the study. with an average of 13 pairs per village. The average age (±SD) of the babies at inclusion was 2.6 months (± 1.2), and 51.6% were girls. The average age (±SD) of the mothers was 27.7 years (± 7). Overall, 96.2% of mothers were married and 61% had no formal education. The EBF-prevalence rate was 66.2% (95% CI: 46.8-81.4) using the 24-hours recall period. The factors associated with improved EBF-rates were the intervention study arm (adjusted OR: 3.38, P =0.003) and the early initiation of EBF within 72 hours of delivery (adjusted OR: 10.95, P <0.001). Conclusion: This study clearly highlights the relevance of EBF promotion around the time of birth and the importance of early initiation of EBF within 72 hours of birth. A policy focused on these two practices should be implemented in rural areas of Burkina Faso.
Abstract: Introduction: Child malnutrition remains a major public health threat in sub-Saharan Africa and is reported to be associated with half of child deaths in Burkina Faso. The World Health Organization recommends exclusive breastfeeding (EBF) as a major intervention to improve overall child nutritional status and survival for the first 6 months of life...
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Ama Kounangui Marie Noelle Ano
