Satisfaction des parents accompagnateurs des enfants de moins de 5 ans pris en charge au centre médical de Kokologho au Burkina Faso

La satisfaction des usagers des centres médicaux (CM) au Burkina Faso n'est pas connue. Notre objectif était d´étudier le niveau de satisfaction et les facteurs associés des parents accompagnateurs des enfants de moins de 5 ans pris en charge au CM de Kokologho en 2018. Il s'est agi d'une étude transversale. Réalisée dans l'aire de santé du CM de Kokologho, les cibles étaient les parents accompagnateurs d'enfants de moins de 5 ans pour l´enquête ménage et pour les entretiens qualitatifs les représentants de la communauté, les agents de santé et les leaders administratifs et coutumiers. Les outils de collecte des données ont été construits à partir des référentiels (SAPHORA-job 2014, conseil Québécois d'Agrément 2005). Des scores de satisfaction, Odds Ratio ajustées et IC95 % ont été calculés. Des analyses thématiques ont été effectuées. Le niveau de satisfaction globale des parents accompagnateurs des enfants pris en charge au CM de Kokologho en 2018 était satisfaisant (70,6 %). Les dimensions étudiées étaient l'accueil (47,2 %), le respect (65,3 %), l'empathie (60,5 %), la confidentialité (73,8 %), la fiabilité (71,9 %), la rapidité (51,4 %), le confort (89,0 %), l'accessibilité géographique (97,5 %) et l'accessibilité financière (28,5 %). Le niveau d'instruction non scolarisé, le sexe féminin et la situation matrimoniale mariée étaient significativement associés à la satisfaction globale des parents. Les usagers sont satisfaits des services du CM de Kokologho. Cependant, des efforts doivent être faits pour améliorer l'accueil, la rapidité de l'offre de service et l'accessibilité financière

Effect of the Health Extension Program and other Accessibility Factors on Care-Seeking Behaviors for Common Childhood Illnesses in Rural Ethiopian

Background:In January 2011; Health Extension Workers (HEWs) of Ethiopia's Health Extension Program (HEP) began providing pneumonia case management for children less than five years of age through the integrated Community Case Management (iCCM) strategy. Objective. To report the effect of HEP; following the introduction of iCCM; and other accessibility factors on care-seeking behaviors for common childhood illnesses (acute respiratory infection [ARI]; diarrhea; and fever). Methods. Three possible care-seeking outcomes for childhood illnesses were considered: not seeking appropriate care; seeking care from HEP sources; or seeking care from other appropriate sources. The baseline care-seeking outcomes from the Ethiopian Demographic and Health Survey; 2011; were compared with the care-seeking out-comes in a follow-up iCCM survey in December 2012. The effects of the HEP intensity and other factors on care-seeking outcomes were estimated using regression analyses. Results. Appropriate careseeking for children with acute respiratory infection; ARI; diarrhea; or fever increased two-fold; from 19 at baseline to 38 at follow-up; mainly due to an increase in seeking care for common child-hood illnesses from HEWs. Higher intensity of the HEP and other accessibility factors were associated with higher care-seeking for childhood illnesses from HEP sources. Conclusion. Incorporating iCCM within the HEP service package significantly improved the appropriate care-seeking behaviors for childhoodillnesses in rural Ethiopia

Quality of Care Offered to Children Attending Primary Health Care Clinics in Johannesburg; South Africa

Objective. To assess the quality of child health services provided at primary health care (PHC) facilities in Johannesburg; South Africa. Design. Observational study conducted at 16 PHC clinics. A researcher-developed structured checklist; based on national guidelines and protocols; was utilised. Results. The majority of facilities were adequately equipped and well stocked with drugs. A total of 141 sick child and 149 well child visits were observed. Caregivers experienced long waiting times (mean 135 (standard deviation 72) minutes). Many routine examination procedures were poorly performed; with an adequate diagnosis established in 108 of 141 consultations (77); even though health professionals were experienced and well trained. Triage and attention to danger signs were poor. An antibiotic was prescribed in almost half (65/141) of the consultations; but antibiotic use was unwarranted in one-third of these cases. Health promotion activities (such as growth monitoring) were consistently ignored during sick child visits. HIV status was seldom asked about or investigated; for the mother or for the child. Growth monitoring and nutritional counselling at well child visits was generally inadequate; with not one of 11 children who qualified for food supplementation receiving it. Conclusion. The poor quality of PHC offered to children in the richest city in Africa is a sad indictment of the inability of health service providers to address children's health needs meaningfully. A deliberate and radical restructuring of PHC for children; with clearly defined and monitored standard clinical practice routines and norms; is required to change the status quo

Prevention of Mother-to-Child Transmission of the Human Immunodeficiency Virus: Investigating the Uptake and Utilization of Maternal and Child Health Services in Tiko Health District; Cameroon

Introduction: despite evi dence that interventions to prevent mother-to-chil d transmission (PMTCT) of HIV are effective in ensuring a healthy child and keeping mothers alive; there are many challenges to achieving successful interventions in Cameroon. The stu dy was con ducted to investigate factors that affect access to and utilization of maternal and chil d health (MCH) and PMTCT services among women in Tiko health district in Cameroon. Methods: we conducted a cross-sectional; descriptive study on women of reproductive age who had experienced a pregnancy using a self-a dministered; structured questionnaire; in health facilities offering PMTCT services and in communities within the district. Results: four hun dred and thirteen women were interviewed. The majority; 98.4%; of them atten ded antenatal care (ANC) during their most recent pregnancy. Of these women; 87.4% of them made at least four ANC visits. HIV testing during the first visit among the ANC atten dees was 85.5%. Approximately; 92.1% of women who tested for HIV received their results on the same day. All participants reported to have given birth in a health facility during their most recent pregnancy. No education (Odds Ratio [OR] 0.11; 95% CI 0.01-0.83) and acquisition of primary education (OR 0.25; 95% CI 0.06-0.88) was associated with better male partner involvement in PMTCT. Conclusion: the uptake of MCH1PMTCT services was high in this study. Further exploration of these levels is warranted so that this model of care and engagement can be replicated in other parts of the country where uptake is low

The Profile of Non-Communicable Disease in Patients Admitted into the Children's Medical Ward of the University of Port Harcourt Teaching Hospital

Background: The prevalence of non-communicable diseases (NCD) is increasing in recent years in low income countries in sub-Saharan Africa because of changing disease patterns following socioeconomic development. Nevertheless; communicable diseases (CD) still remain the predominant health problem. At present; non-communicable diseases are not a high priority in sub-Saharan Africa but the probability of death from a NCD is higher in sub-Saharan Africa than in the developed world. It is therefore important to know the existing disease burden due to NCD with a view to alerting policy makers and health workers of the trend of disease in our environment. Objectives: To determine the pattern of admission of paediatric patients seen at the children's ward of the University of Port Harcourt Teaching Hospital (UPTH) and ascertain the pattern of non communi- cable diseases. Methods: The study was retrospective and involved analysis of data from the admission records of the children's wards of the UPTH from February 2004-November 2005. Patients with non-communicable diseases were analysed for this study. Results: A total of two thousand four hundred and fourteen (2414) children were admitted during the period of study. Out of these; 479 (19.8) had non-communicable diseases consisting of 279 (58.2) males and 200 (41.8) females with a male: female ratio of 1.4:1. The top five non-communicable diseases were sickle cell disease (SCD) (17.1); malignancies (14.8); renal diseases (12.9); tetanus (10.2) and malnutrition (10.0). Conclusion: This study suggests a concomitant rise in NCD with four of them being among the top 10 disease burden when combined with communicable diseases. This poses a risk of a 'double burden' of disease which we cannot afford in our country which is fraught with poor government policies; poverty and poor funding of the health sector. Effective strategies are needed to control the risk factors for NCD

The Use of the Road to Health Card in Monitoring Child Health

Objectives: The Road to Health Chart (RTHC) provides a simple; cheap; practical and convenient method of monitoring child health. The RTHC could assist with vaccine compliance and early identification of growth faltering; to improve general health. The purpose of the study was to assess whether the RTHCs were adequately completed and interpreted at primary; secondary and tertiary care levels in South Africa.Methods: The study was carried out at a primary; secondary and tertiary care centre. A questionnaire was administered to 100 subjects from each; seeking demographic information; whether the RTHC was brought along; and if not why it was not brought.Results: Most children were brought by their mothers. The RTHC was not brought to 48 of the consultations; of those; about 72 thought that bringing the RTHC along was not necessary. Health workers seldom asked to see the RTHC at the primary and secondary care settings; but 50 of them did so at Ga-Rankuwa Hospital (p = 0;002). In only 8 cases overall were the children below the 3rd percentile of weight-for-age. Approximately 20 had incomplete immunisations.Conclusions: Many parents believe that the RTHC is only required for Well-baby-clinic visits; not for consultations. The RTHC is not often asked for at consultations; the fact that this is more often done at the tertiary care centre may be that much of the service is supplied by paediatricians-in-training. Health workers should ask to see the RTHC; in order for mothers to understand the importance of the information. The study showed that the RTHC is not used to its full potential

Assessing the Impact of Educational Intervention for Improving Management of Malaria and Other Childhood Illness in Kabaha District Tanzania

Objective: The study was carried out to evaluate short term effects of one to one educational intervention approach; conducted with 40 drug sellers in order to improve the private sector's practices; compliance and performance in using the national treatment guidelines for malaria and other common childhood (diarrhoea; acute respiratory tract infection-ARI) illnesses in Kibaha district-Tanzania. Methods: The training took place one month after baseline data collection. Data collection was undertaken eight months after training and the effects of training was evaluated. The 40 drug stores were divided into 20 intervention and 20 control facilities. Trained nurses were used as clients who posed as caretakers of sick under-five children needing medication. The drug dispensers/sellers knowledge of anti-malarials and other drugs and their dispensing practices was assessed. Results: The intervention seemed to have had a significant impact on knowledge pattern for prescribing and dispensing practices of drug stores for some common childhood illnesses but not in other control drug stores/shops. About 90 (n = 18) of shops prescribed to clients; the approved first-line anti-malarial drug for uncomplicated malaria (sulfadoxine-pyrimethamine); as compared to only 55 (n = 11) of the control shops. Conclusion: Changing the private sectors' knowledge; behaviour and practices/performance may be a slow and difficult process. The intervention approach applied in this study seems to be feasible at district-level. This strategy can be applied in all districts of Tanzania with the aim of achieving significant improvements in knowledge; behaviour; compliance; improving performance and practices of drug sellers in drug stores/shops. However; other alternative strategies are needed to influence drug sellers'/dispensers' compliance and performance. Thus; the overall impact on performance and practices in these facilities will remain at moderate level for quite sometime unless national policies; other programs and stakeholders are involved actively

The management of traumatic stress disorder in infants

The number of very young children exposed to trauma is under-represented. Trauma interferes with the organisation and development of brain structures and thus may have lasting effects on the individual's life. Traumatic stress disorder (TSD); which is the Axis I diagnosis used in the under-three patient population; encompasses four symptom clusters. Of note is the integral part of the Relationship Disorder Classification (Axis II) during this phase of life. The capacities needed to experience and recall early trauma are largely present from the beginning of life and rapidly develop during the first six months. The treatment of traumatic stress disorder rests on establishing a sense of safety; reducing the overwhelming affects evoked; helping the child to form a coherent narrative and thereby aiding the integration and psychological mastery of the traumatic event. The support of the attachment relationship with an adequate caregiver is pivotal

Progress in Implementing the Child Survival Strategy in the African Region

Under-five mortality rate in the African Region was estimated at 145/1;000 live births in 2007. These deaths were the result mainly of preventable or treatable conditions. A child survival strategy for the African Region was developed by WHO; UNICEF and World Bank and adopted by the fifty-sixth WHO Regional Committee in 2006 to address this high mortality rate.1 This report; which is a review made using reports and the results of a questionnaire sent to countries; summarizes progress in implementing the strategy as at December 2009 and proposes next steps for action. Significant achievement has been made in the areas of policy; strategy and plandevelopment; capacity building; partnerships and communication strategies; operations research; documentation and monitoring and evaluation. Also in scalingup of child survival interventions such as measles vaccination coverage; insecticidetreated nets use in children and provision of antiretroviral drugs to prevent motherto-child transmission of HIV. Currently; 21 countries are implementing the Integrated Management of Childhood Illness strategy in more than 75of the districts. Despite the achievements in some areas; coverage of some eff ective interventions remains low. Various health system challenges hamper the progress of child survival. These include inadequate country-level funding for scaling-up effective interventions; inadequate monitoring of coverage of interventions and human resource limitations. In order to increase coverage of eff ective child survival interventions and accelerate progress in implementation of the regional child survival strategy; the paper recommends several actions including the improvement of coverage of key child survival interventions and mobilization and allocation of resources to implement national child survival scale-up strategies and plans

Evolution des prestations du service de pédiatrie de Morondava (Madagascar): morbidité et mortalité des enfants de 0 à 15 ans hospitalisé de 1986 a 1989

"La faiblesse des ressources familiales; la cherte et la penurie de medicaments entraine a Madagascar; un recours souvent tardif a l'hospitalisation des enfants. Afin de faciliter l'acces des enfants aux services de sante; le service de pediatrie de Moronava a progressivement adapte ses prestations et ses techniques de soins avec la mise en place d'hospitalisation de jour et la formation de femmes relais dans tous les quartiers de la ville qui assurent depuis un suivi hebdomadaire de tous les enfants de 0 a 5 ans. Cette evolution s'est traduite dans les statistiques hospitalieres. De 1986 a 1989; 2011 enfants ont ete hospitalises dans le service avec une mortalite de 15;7 per cent. La mortalite des enfants hospitalises originaires de la ville (10;8 per cent) est comparable a celle des malades venant de peripherie (12;1 per cent) dont 48 per cent habitent a plus de 30 km de la ville. La malnutrition represente la premiere cause de deces et d'hospitalisation des enfants de 0 a 5 ans. La letalitte des enfants malnutris est passee de 16;1 per cent a 43;4 per cent lors du cyclone ""Cynthia"" de janvier 1989. Les principales pathologies etaient par ordre chronologique: le paludisme realisant seulement la 5 eme cause de deces avec une lethalite de 4;6 per cent; les diarrhees (lethalite 8;7 per cent); les infections respiratoires 8letalite 12;5 per cent). La pathologie neonatale presente la letalite la plus forte (31 per cent) apres les intoxications (41 per cent). L'hospitalisation de jour s'est traduite par une baisse de la proportion d'hospitalisation chez les consultants ce qui accrut la disponibilite du personnel pour la surveillance des cas graves et diminue la charge que represente l'hospitalisation pour les familles. L'ouverture d'un service de tri des consultants par un infirmier a permis de poursuivre la prise en charge des pathologies simples et de repondre a la demande des familles. Plusieurs techniques originales de traitement ont ete etudiees et vulgarisees: bouillie de riz aux crevetttes sechees (koba pasta) pour les enfants malnutris; eau de riz salee sucree (Fanafody fivalana) pour la diarrhee; quinine injectable diluee en intra rectale en alternative des intra musculaires de quinine."

Etude analytique des facteurs de risque au cours de la grossesse dans cinq centres urbains de Conakry

Dans une enquete clinique; les auteurs etudient les facteurs de risque les plus frequemment rencontres au cours de la grossesse dans cinq centres de sante urbains de Conakry. La conclusion est que la strategie de l'approche en fonction du risque devrait etre la methode de travail dans les centres de sante maternelle et infantile. Cela permettrait des references a temps et dans les bonnes conditions

The WHO/UNICEF approach to integrated management of the sick child

This document notes that there are 12 million children who die every year before their fifth birth day and that many die before their first year of life (in Uganda underfive and infant mortality rates are 203 and 122 respectively). Seventy percent of these children die from diarrhoea; pneumonia; measles; malaria or malnutrition and sometimes a combination of these conditions. The WHO/UNICEF Documenta argues that there considerable overlap of signs and symptoms of the childhood disease making it often inappropriate to diagnose a single condition

A vaccination survey using the EPI methodology to evaluate the impact of a child health outreach programme in an urban area of South Africa

A community-based survey of the vaccination status of children aged 12-23 months was conducted to evaluate the impact of a child health outreach programme on vaccination coverage in Alexandra township, South Africa. The EPI cluster sampling technique was adapted for this purpose. The sample size, including the number of clusters and the number of units per cluster, was increased to permit stratification of the data and comparison of the results with those obtained in a study conducted prior to the introduction of the outreach services in 1988. At the time of the survey interview, 67% of the children were fully vaccinated (78% against measles) and by 1 year of age, 58% were fully vaccinated (69% against measles). The increase in coverage since the introduction of the programme was statistically significant only for measles (Student's t-test, P < 0.01). A total of 75% of children living in formal dwellings, compared with 51% living in informal dwellings, were fully vaccinated by interview (Fisher's exact test, two tailed, P < 0.0001). Mothers from informal dwellings had a 1.88 times greater chance of not knowing about the outreach services (P < 0.001). Children whose mothers knew where vaccinations were given, attended postnatal clinics, used the outreach services, possessed a road-to-health card from the Alexandra Health Centre, and who resided in a formal dwelling all had a higher chance of being vaccinated

Etude anatomique du canal arteriel chez l'enfant africain: a propos de 50 cas

Cinquante enfants (32 sexe feminin; 18 sexe masculin) nes a terme; morts a la naissance ont ete disseques en vue de determiner chez l'enfant africain les normes et les caracteristiques anatomiques du canal arteriel. Cette etude a permis de noter une particularite tenant a la naissance du canal arteriel a partir de l'artere pulmonaire gauche. Les autres parametres sont identiques a la litterature

Valeurs reticulocytaires dans une population pediatrique a Abidjan

Cette etude rapporte les valeurs reticulocytaires (0;1 - 1 pour cent; soit 4220 - 49.900/mm3) chez 54 enfants de 3 a 14 ans dont 34 garcons et 20 filles; tous scolaries; en bonne sante apparente et vivant a Abidjan. Ces valeurs refletent une hypo-activite medullaire qui pourrait etre rattachee au status alimentaire precaire des enfants des pays en voie de developpement

The role of HIV infection in pregnancy wastage in Dar es Salaam; Tanzania

Since AIDS and HIV infections were recognised in Tanzania; The prevalence of HIV infections among pregnant women in this country has been increasing. If studies from the Western World show no adverse effects; studies and observation in East and Central Africa indicate adverse pregnancy outcome. There is probably yet undetermined factors operating

Mother's knowledge and attitude about immunization in Vurra and Madi Counties; Arua District; Uganda

200 mothers with children between 0 and 5 years were interviewed about the knowledge; attitude and practice of immunization in Vurra and Madi Counties; Arua District; West Nile. The majority of them were uneducated or stopped in primary school. It was generally noticed that those mothers did not attend immunization. The main reasons of this fact included too much work and mothers feared the adverse effects of the vaccines