The two surveys did not show a significant improvement in the availability, utilization, and quality of maternal and neonatal healthcare services between 2010 and 2014.

Background The effective use of contraception among adolescents and young women can reduce the risk of unintended pregnancies. However, the prevalence of contraceptive use remains low in this age group. The objective of this study was to estimate the rate of contraceptive method discontinuation among adolescents and young women and to identify its associated factors in Burkina Faso, Mali, and Niger. Method This was a secondary analysis of data from Demographic and Health Surveys of Burkina Faso (2010), Mali (2012–2013), and Niger (2012). The dependent variable was the time to discontinuation of contraceptive methods. Independent variables were represented by sociodemographic, socioeconomic, and cultural characteristics. Mixed-effects survival analysis with proportional hazards was used to identify the predictors. Results A total of 2,264 adolescents and young women aged 15 to 24 years were included in this analysis, comprising 1,100 in Burkina Faso, 491 in Mali, and 673 in Niger. Over the last five years, the overall contraceptive discontinuation rate was 68.7% (50.1% in Burkina Faso, 59.6% in Mali, and 96.8% in Niger). At the individual level, in Burkina Faso, occupation (aHR = 0.33), number of living children (aHR = 2.17), marital status (aHR = 2.93), and region (aHR = 0.54) were associated with contraceptive discontinuation. Except for education and marital status, we found the same factors in Mali. In Niger, a women's education level (aHR = 1.47) and her partner (aHR = 0.52) were associated with discontinuation. At the community level, the region of origin was associated with discontinuation of contraceptive methods. Conclusion Most adolescents and young women experienced at least one episode of discontinuation. Discontinuation of contraceptive methods is associated with the level of education, occupation, number of children, marital status, and desire for children with the spouse. Promotion of contraceptive interventions should target adolescents, young women, and their partners, as well as those with a low education level or in a union.

Needs assessment for EmONC showed low availability of EmONC services and underutilization of the available services.

Objective To evaluate the implementation of the maternal and neonatal death surveillance and response (MNDSR) system at county level in Liberia. Methods Secondary analysis of data from a cross‐sectional study carried out in March 2016, using both quantitative and qualitative methods to collect data in five counties based on set criteria. Three health facilities were selected in each county through the Health Management Information System (HMIS) by random sampling. The evaluation was also carried out in one catchment community per health facility and at the county referral hospital. Primary data were collected through individual interviews and a review of MNDSR tools and structure. Data were analyzed using thematic analysis. Results Implementation of the MNDSR system was very low in the five counties. Only two out of the five counties were currently conducting MNDSR. MNDSR guidelines and standard operating procedures were not available at the county level. Only 12 (23.5%) health facilities had a maternal and neonatal death review committee. Less than a quarter of the assessed community members could correctly give the definition of a maternal or neonatal death. Conclusion The MNDSR system is weak in Liberia, at county, health facility, and community levels. Strong national commitment is needed in collaboration with diverse partners for successful implementation of the system.

a b s t r a c t a r t i c l e i n f oObjective: To analyze the factors associated with maternal mortality in hospitals in Burkina Faso in the context of emergency obstetric neonatal care. Methods: A case-control study was conducted in 812 health facilities in the public and private sectors, involving all categories of health facility in the 13 regions of Burkina Faso. The study population included all women with obstetric complications from May 2013 to April 2014. For any identified case of maternal death, a control counterpart (living woman) was matched according to the obstetric complication. Conditional logistic regression was used to assess factors associated with maternal mortality. Results: The analysis focused on a total of 1128 women (564 cases and 564 controls). Place of residence (P=0.011), the referral for care (Pb0.001), maternal age (Pb0.001), state of consciousness of the mother (Pb0.001), and the presence of a fever (Pb0.001) were significantly associated with the occurrence of maternal death. In multivariate analysis, maternal age (OR 1.45; 95% CI, 0.95-2.20; Pb0.001), coma (OR 1.44; 95% CI, 0.16-0.2; P=0.010), and presence of fever (OR 1.67; 95% CI, 1.21-2.28; Pb0.001) were risk factors related to maternal death. Conclusion: The determined factors demonstrate that the survival of women is closely linked to their health.