Perceptions des acteurs sur les stratégies de suivi-évaluation des indicateurs de performance de la santé de reproduction de la DGSHP / NA

La performance des projets ou programmes se mesure le plus souvent, par rapport aux dimensions de l'efficacité, de l'efficience, de l'équité, de la recevabilité et de la transparence. Le but de cette étude était de mieux comprendre le processus du S&E de la Direction Générale de la Santé et de l'Hygiène Publique du Mali (DGSHP) et documenter les dysfonctionnements en vue de permettre aux décideurs d'apporter des solutions. Nos résultatsontmontré l'exactitude et la fiabilité des données du S&E de cette structure à travers la disponibilité de mécanismes de contrôle et de traitement des données. Cependant, dans le cadre de la cohérence organisationnelle des différents acteurs, il a été constaté un manque réel de cadre formel de concertation entre les acteurs pour mieux coordonner et harmoniser les activités. Concernant l'efficacité des activités, la majorité des acteurs interrogées pense que le niveau technique du personnel de suivi est faible surtout, au niveau des Directions régionales. En termes de l'adéquation entre les résultats obtenus et les moyens mis à disposition, 57% des répondants ne sont pas satisfaits de l'efficience des activités de S&E de la DGSHP. En conséquence, les autorités doivent envisager des solutions appropriées permettant de comblerces lacunes et d'améliorer la performance du processus de S&Ede la DGSHP.Mots clés: Stratégies, cohérence, performance, suivi et évaluation, santé

The performance of projects or programs is often measured through the dimensions of effectiveness, efficiency, equity, admissibility,and transparency. The purpose of this study was to better understand the monitoring and evaluation (M&E) process and to document dysfunctions toenable decision-makers of the General Direction of Health and Public Hygiene of Mali (DGSHP) to provide solutions. Our results of these surveys have shown the accuracy and reliability of the M&E data of this structure through the availability of control mechanisms and data processing. On the other hand, within the framework of the organizational coherence of the various actors, it was noted a real lack of formal framework of dialogue between the actors to better coordinate and harmonize the activities. Page 41of50RASPVolume 5, Issue1Concerning the effectiveness of the activities, the majority of the interviewed actors think that the technical level of the monitoring staff is low, especially at the level of the regional directions. In terms of the adequacy between the results obtained and the available means, 57% of respondents are not satisfied with the efficiency of the M&E activities of the DGSHP. Consequently, the authorities should consider appropriate solutions to fill the gaps and improve the performance of the M&E process of the DGSHP

Prevalence of COVID-19 at the Wahgnion-Gold mining site in Burkina Faso and use of RT-PCR initial cycle threshold to monitor the dynamics of SARS-CoV-2 load

Background: To control the spread of coronavirus disease-19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), it is necessary to adequately identify and isolate infectious patients particularly at the work place. Real time polymerase chain reaction (RT-PCR) assay is the recommended confirmatory method for the diagnosis of SARS-CoV-2 infection. The aim of this study was to determine the prevalence of SARSCoV-2 infection in Burkina Faso and to use the initial cycle threshold (Ct) values of RT-PCR as a tool to monitor the dynamics of the viral load. Methodology: Between September 2021 and February 2022, oropharyngeal and/or nasopharyngeal swab samples of consecutively selected COVID-19 symptomatic and apparently healthy workers from the Wahgnion mining site in the South-western Burkina Faso who consented to the study were collected according to the two weeks shift program and tested for SARS-CoV-2 using RT-PCR assay. Patients positive for the virus were followed-up weekly until tests were negative. Association of the initial RT-PCR Ct values with disease duration was assessed by adjusted linear regression approach. Two-sided p value < 0.05 was considered statistically significant. Results: A total of 1506 (92.9% males) participants were recruited into the study, with mean age and age range of 37.18.7 and 18-68 years respectively. The overall prevalence of SARS-CoV-2 infection was 14.3% (216/1506). Of the 82 patients included in the follow-up study, the longest duration of positive RT-PCR test, from the first positive to the first of the two negative RT-PCR tests, was 33 days (mean 11.6 days, median 10 days, interquartile range 8- 14 days). The initial Ct values significantly correlated with the duration of RT-PCR positivity (with ß=-0.54, standard error=0.09 for N gene, and ß=-0.44, standard error=0.09 for ORF1ab gene, p<0.001). Participants with higher Ct values corresponding to lower viral loads had shorter viral clearance time than those of lower Ct values or higher viral loads. Conclusion: Approximately 1 out of 7 tested miners had SARS-CoV-2 infection and the duration of their RT-PCR tests positivity independently correlated with the initial viral load measured by initial Ct values. As participants with lower initial Ct values tended to have longer disease duration, initial RT-PCR Ct values could be used to guide COVID-19 patient quarantine duration particularly at the work place.

Contexte: Pour contrôler la propagation de la maladie à coronavirus 19 (COVID-19) causée par le syndrome respiratoire aigu sévère coronavirus-2 (SRAS-CoV-2), il est nécessaire d'identifier et d'isoler de manière adéquate les patients infectieux, en particulier sur le lieu de travail. Le test de réaction en chaîne par polymérase en temps réel (RT-PCR) est la méthode de confirmation recommandée pour le diagnostic de l'infection par le SRAS-CoV-2. Le but de cette étude était de déterminer la prévalence de l'infection par le SRAS-CoV-2 au Burkina Faso et d'utiliser les valeurs du seuil initial du cycle (Ct) de la RT-PCR comme outil de suivi de la dynamique de la charge virale. Méthodologie: Entre septembre 2021 et février 2022, des écouvillonnages oropharyngés et/ou nasopharyngés de travailleurs symptomatiques COVID-19 et apparemment en bonne santé sélectionnés consécutivement du site minier de Wahgnion dans le sud-ouest du Burkina Faso qui ont consenti à l'étude ont été prélevés selon les deux programme de quart de semaines et testé pour le SRAS-CoV-2 à l'aide d'un test RT-PCR. Les patients positifs pour le virus ont été suivis chaque semaine jusqu'à ce que les tests soient négatifs. L'association des valeurs Ct initiales de la RT-PCR avec la durée de la maladie a été évaluée par une approche de régression linéaire ajustée. Une valeur p bilatérale < 0,05 a été considérée comme statistiquement significative. Résultats: Un total de 1506 participants (92,9% d'hommes) ont été recrutés dans l'étude, avec un âge moyen et une tranche d'âge de 37,1 à 8,7 ans et de 18 à 68 ans, respectivement. La prévalence globale de l'infection par le SRAS-CoV-2 était de 14,3% (216/1506). Sur les 82 patients inclus dans l'étude de suivi, la plus longue durée de test RT-PCR positif, du premier test positif au premier des deux tests RT-PCR négatifs, était de 33 jours (moyenne 11,6 jours, médiane 10 jours, intervalle interquartile 8-14 jours). Les valeurs Ct initiales étaient significativement corrélées à la durée de positivité de la RT-PCR (avec ß=-0,54, erreur standard=0,09 pour le gène N et ß=-0,44, erreur standard=0,09 pour le gène ORF1ab, p<0,001). Les participants avec des valeurs de Ct plus élevées correspondant à des charges virales plus faibles avaient un temps de clairance virale plus court que ceux avec des valeurs de Ct plus basses ou des charges virales plus élevées. Conclusion: Environ 1 mineur testé sur 7 était infecté par le SRAS-CoV-2 et la durée de la positivité de ses tests RTPCR était indépendamment corrélée à la charge virale initiale mesurée par les valeurs Ct initiales. Comme les participants avec des valeurs Ct initiales inférieures avaient tendance à avoir une durée de maladie plus longue, les valeurs Ct initiales de la RT-PCR pourraient être utilisées pour guider la durée de la quarantaine des patients COVID19, en particulier sur le lieu de travail.

Stakeholders' perceived achievements and challenges after the safe motherhood project in Northern Uganda

The Japanese Red Cross Society (JRCS) and the Uganda Red Cross Society (URCS) implemented the Safe Motherhood project topromote mother-friendly society in northern Uganda from 2010 to 2016. The follow-up study has not been conducted and the information on achievements and challenges after the project were limited. To review the safe motherhood project in northern Uganda, the purpose of the study was to explore the stakeholders' perceived achievements and challenges after the project. Study design was qualitative content analysis using interview guides. After the approval of Institutional Review Board Clearance, the study was started (Approval Number: 2017-034). The subjects were informed about the ethical considerations (informed consent, participation on free will, confidentiality, and anonymity) in participating in the research, and they participated after signing the consent form. Six volunteers, 2 health center staff, and 2 former Uganda Red Cross staff were interviewed. Achievements were the acquisition of knowledge, attitudes changes, behavioural changes, linkage of all stakeholders, and positive influence on Safe Motherhood in community. Challenges of sociocultural barriers, attitudes toward women, accessibility and human resources, incentives and facilities, and sustainability of the project were derived from the interview. The study revealed that the project linked all stakeholders to achieve Safe Motherhood in community and all the developed registration systems were taken over. Long-term support is necessary for Safe Motherhood to take root

Improving voluntary medical male circumcision standards adherence and post-procedure follow-up in Uganda: A mixed methods study

Voluntary medical male circumcision (VMMC) has been demonstrated to reduce the transmission of HIV by 60%. Scaling up VMMC services requires that they be of high quality, socially accepted, and effective. We evaluated an intervention aimed at improving VMMC standards adherence and patient follow-up rates in nine facilities in Uganda. We also qualitatively explored why some men return for follow-up care and others do not. The completeness and quality of clinical documentation was poor at baseline, but significantly improved at endline. We observed significant improvements in management systems; supplies, equipment, and environment; and monitoring and evaluation. Due to the volume of missing data, results were less clear for registration, group education, and information, education and communication; individual counselling and HIV testing; and infection prevention. Significant improvements were also observed in follow-up rates at 48 hours and 7 days, and 6 weeks. Interviews revealed the importance of peers, including female partners, in deciding to get circumcised and in seeking follow-up care. Among the men who did not return for follow-up services, most reported they had no problems and did not see it as necessary. For those who did have mild or moderate adverse events, follow-up care was often sought at a facility closer to the patients' home rather than the circumcising facility. However, information systems were unable to capture this. Applying improvement approaches to VMMC services can promote improved standards adherence and follow-up rates and should be integrated into scale-up plans

How long are Elderly Patients Followed up with Mammography after the Diagnosis of Breast Cancer? A Single-Centre Experience in a Developing Country

BACKGROUND:The effect of breast cancer on elderly South African (SA) patients is not well characterised. The lack of data with regard to disease burden; post-treatment surveillance and breast cancer relapse poses a challenge to providing optimum follow-up care to this group of patients. OBJECTIVES:To assess the effect of breast cancer and adherence to post-treatment surveillance programmes among the local elderly population attending the breast oncology clinics at Addington and Inkosi Albert Luthuli Central hospitals in Durban; KwaZulu-Natal; SA.METHODS: A retrospective review was undertaken of all patients aged =65 years diagnosed with breast cancer during 2007. Hospital records were reviewed for a period of 5 years to ascertain the stage of the disease; treatment received; adherence to post-treatment surveillance mammograms; incidence of new mammographic findings and recurrence; site of recurrence; mode of detection of recurrence; disease-free survival; and overall survival rates at 5 years.RESULTS:In our study; the incidence of breast cancer in the elderly population was 26.7%. A significant percentage of patients (56.3%) were diagnosed at an advanced stage of disease. Of the 46.9% who had received surveillance mammography; only 6.3% received their post-treatment surveillance mammograms on time; in accordance with international recommendations. New mammographic findings were detected in 26.7% of patients during the 5-year follow-up. During the follow-up period; 15.6% of the total number of study patients presented with disease recurrence. Eighty percent of cases of recurrence were detected clinically. The overall survival at 5 years was 65.6%. CONCLUSION:Our study highlights the significant number of elderly patients with advanced disease at diagnosis; poor compliance with internationally recommended annual post-treatment surveillance mammograms; and the relatively low overall 5-year survival rate compared with that of international studies

A Follow-Up Study of a Large Group of Children Struck by Lightning

Background. On 11 November 1994; 26 preadolescent girls; 2 adult supervisors and 7 dogs were sleeping in a tent in rural South Africa when the tent was struck by lightning. Four of the girls and 4 of the dogs were killed. The 2 adults were unharmed; but all but 3 of the children suffered significant injuries. An article in 2002 detailed the event and examined the medical and psychological changes in the surviving girls. Objective. To understand the medical and psychological changes secondary to lightning strike years after injury. Methods. An online questionnaire was prepared that included a checklist of physical and psychological symptoms. Participants were asked to report on both initial and current symptoms. Eleven of the 22 survivors were contacted; and 10 completed the survey. Results. Participants reported that initial physical symptoms generally resolved over time; with ~10 - 20% continuing to experience physical symptoms. Vision problems persisted in 50% of respondents. Psychological symptoms; overall; had a later onset and were more likely to be chronic or currently experienced. Depression and anxiety; specifically; were higher among the survivors than the reported incidence in South Africa. Conclusions.Initial and current/chronic physical and psychological symptoms following lightning strike are reported; adding to the body of literature on the long-term after-effects of lightning strike on survivors. A brief discussion on post-traumatic stress disorder symptomatology and post-lightning shock syndrome is provided

Mobile health for early retention in HIV care: a qualitative study in Kenya (WelTel Retain)

Many people newly diagnosed with HIV are lost to follow-up before timely initiation of antiretroviral therapy (ART). A randomised controlled trial (RCT); WelTel Kenya1; demonstrated the effectiveness of the WelTel text messaging intervention to improve clinical outcomes among patients initiating ART. In preparation for WelTel Retain; an RCT that will evaluate the effect of the intervention to retain patients in care immediately following HIV diagnosis; we conducted an informative qualitative study with people living with HIV (n = 15) and healthcare providers (HCP) (n = 5) in October 2012. Study objectives included exploring the experiences of people living with HIV who have attempted to engage in HIV care; the use of cell phones in everyday life; and perceptions of communicating via text message with HCP. Participants were recruited through convenience sampling. Semi-structured; qualitative interviews were conducted and recorded; transcribed verbatim and analysed using NVivo software. Analysis was guided by the Theory of Reasoned Action and the Technology Acceptance Model. Results indicate that while individuals have many motivators for engaging in care after diagnosis; structural and individual barriers including poverty; depression and fear of stigma prevent them from doing so. All participants had access to a mobile phone; and most were comfortable communicating through text messages; or were willing to learn. Both people living with HIV and HCP felt that increased communication via the text messaging intervention has the potential to enable early identification of problems; leading to timely problem solving that may improve retention and engagement in care during the first year after diagnosis

Nurses' Monitoring of the Road to Health Chart at Primary Healthcare Level in Makhado; Limpopo Province

Background: The Road to Health Chart (RTHC) is a record chart carried by the caregiver that combines essential information on the growth monitoring of a child; immunisation; vitamin A supplementation; deworming medicine and other illnesses. It provides useful information to the parent and healthcare professional. This study sought to determine the challenges faced by professional nurses in monitoring the RTHC during consultation; the degree of implementation of the RTHC programme; and the most utilised aspect of the RTHC at Louis Trichardt Memorial Hospital and surrounding primary healthcare (PHC) clinics. Method: A cross-sectional study was conducted among 128 registered professional nurses. A self-administered questionnaire was used. Results: Ninety-six questionnaires were completed. Most of the respondents were female and aged 40-49 years. The majority of the PHC professional nurses stated that the challenges faced in monitoring the RTHC were staff shortages; lack of equipment; a work overload and unequal distribution of professional nurses on duty per shift. There was poor knowledge on how to identify malnutrition. The majority of PHC professional nurses had not completed their basic courses. Conclusion: PHC professional nurses voiced their concern that challenges encountered during consultations were direct reasons for their poor monitoring of the RTHC. The degree of implementation of the RTHC programme fell short of the norms and standards of the Department of Health and Social Development concerning child health care in South Africa. The most utilised aspect of the RTHC was the expanded programme on immunisation; vitamin A supplementation and deworming medicine

Challenges in the management of early versus late presenting congenital diaphragmatic hernia in a poor resource setting

Background: Despite the advances in management; congenital diaphragmatic hernia (CDH) has continued to pose a significant challenge to paediatric surgeons. This is amplified in a setting like ours where there is a dearth of facilities to cope with the problem of CDH. This study was undertaken to highlight the peculiarities of the management of CDH in a poor resource setting. Methods: All confirmed cases of CDH were prospectively documented from 2003 till date. Results: Seven children were treated from 2003 till date. The diaphragmatic defect was on the left side in six (83.8) and on the right side in one (17.7). All the patients had primary closure of the defect without patch via an abdominal approach. The three patients presenting at birth died while the remaining four patients survived. Conclusion: With inadequate neonatal intensive care facilities; the severe early presenting CDH has a dismal prognosis. In contrast; the late presenting CDH poses more diagnostic challenges; but once identified and appropriate treatment instituted; it has an excellent prognosis. We recommend that physicians should include CDH in the differential diagnosis of patients with birth asphyxia and in patients with chronic respiratory symptoms with failure to thrive

Acute mental health care according to recent mental health legislation. Part III. Structuring space for acute mental health care

Objective: This is the third of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). The study reviewed existing South African standards for mental health care facilities. Architectural principles and implications for the use of space were deducted from recent legislation. Objectives were to evaluate the use of space in the existing physical facilities; to identify appropriate architectural solutions considering identified human rights requirements and to provide provisional cost estimates to align the unit towards its designated functions. Method: Personal interviews were conducted. An on-site assessment and survey was made of existing and potential new spaces. Results: Spatial requirements for implementing the Mental Health Act; No. 17 of 2002 (MHCA) were explored. Principles for spatial design of acute facilities include that: - spaces should communicate clear individual identity; - space should be segregated into zones according to user functionality and privacy; - communal leisure spaces should open into safe contained outdoor spaces; - circulation routes should preferably be circular; - sufficient visual connection should exist between circulation space and group activities; and - open lines of sight should be provided to all access points. The potential options for extension included: - an extensive unused single storey structural shell for a potential office wing on the same floor; - a huge vacant double volume space which could be accessed across the existing flat roof for potential occupational therapy activities; and - the existing roof area could be altered and secured to become an adequate outside leisure and garden area. A proposed concept design in two phases - based on these principles - was submitted to hospital and provincial management. Conclusion: To implement the MHCA without violating the human rights of mental health care users at HJH will require specific adjustment and extension of the current use of space at HJH

Familial Hypercholesterolaemia in South Africans : Tracking Findings and Developments over Time

This review discusses the 1987 article by Wyndham; Seftel; Pilcher and Baker on familial hypercholesterolaemia (FH) and myocardial infarction (MI) in young Afrikaners; in terms of the significance at the time of publication; as well as the relevance of their findings versus current observations on hypercholesterolaemia in South Africa. Risk factors for coronary heart disease (CHD) were investigated in this study; with specific reference to familial hypercholesterolaemia. The significance of Wyndham's article is evaluated with regard to the contributions on hypercholesterolaemia by other South African researchers that preceded this publication. The clinical diagnostic criteria that were applied to identify possible FH at the time of publication are compared with currently employed criteria and guidelines. This review also acknowledges and honours other clinicians and researchers who; like Wyndham et al.; have made significant contributions to the diagnosis and treatment of FH in South Africans

Why Patients Miss Follow-Up Neoplasms: a Prospective Control-Matched Study

Objectives: To investigate missed appointments in a South African tertiary hospital. Study Design: Prospective; descriptive series with controls. Setting: T he ENT/Oncology clinic at Tygerberg Academic Hospital; South Africa. Subjects: 305 patients with a head and neck malignancy who had follow-up appointments over 4 consecutive months between June and September 2006. A control group of 31 patients who attended the clinic was recruited in September 2006. Method: Analysis of the clinic attendance statistics to identify patients who missed follow-up appointments followed by a file review and interview of these patients. The results were compared with a control group. Outcome measures: 1) Incidence rate of failure to attend follow-up. 2) Causative factors Results: 51 (17) booked patients missed their appointments. Non-attenders were most likely to miss their follow-up between 6 and 12 months (17/31) after treatment. No correlations were found between diagnosis; disease stage and missed appointments. Reasons include: transport (19 responses); ill-health (6) and financial constraints (5). State transport was unavailable to almost twothirds of the responders who cited transport as a problem. Conclusions: The 17 missed appointment rate is largely due to transport constraints. The commonest time for patients to miss appointments is the 6-12 month follow-up period. The authors seek to identify patients at risk of missed appointments and suggest interventions to decrease this incidence

Long-term follow up of superficial bladder tumors

Objective: To study the recurrence rate of superficial bladder tumors at Cairo university hospitals. Patients and Methods: Sixty-six patients with superficial transitional cell carcinoma who were treated by either Nd: YAG laser therapy (16 patients) or transurethral resection (50 patients) were followed for a mean of 5.5 years. Results: Local tumor recurrence at the same site of the original tumor occurred in 39of patients while remote recurrence occurred in 33of patients. The total recurrence rate was 59. Tumor progression to invasive carcinoma occurred in 7 patients (11); and 3 patients (4.5) died of disease-related causes. Conclusion: The treatment of superficial TCC may be done by relatively minor endoscopic procedures; but the disease itself is a serious condition that merits close long-term follow-up