RESUMO
L'observancepar les gestantes des soins de santé maternelle réalisés par du personnel qualifié est connuepour réduire la probabilité de décès néonatal chez les nouveau-nés. Toutefois, le gain observé par rapport au recours à ces soinsest-il homogène quel que soit l'agent de santé qui réalise l'acte ?L'objectif de ce travail était d'étudier les effets de l'observance des consultations prénatales et du recours aux accouchements assistés par des agents qualifiés en général, et des sage-femmes en particulier, sur la mortalité néonatale au Bénin. Il s'est agi d'une étude transversale qui a consisté à réaliser des analyses secondaires à partir des bases de données du cinquième Enquête Démographique et de Santé (EDS-V) au Bénin. La population d'étude était constituée des enfants nés au cours des cinq années ayant précédé l'EDS-V. La variable dépendante était le décès (1=Oui vs 0=Non) des enquêtés avantle 28ème jour après la naissance. Pour chaque enfant inclus, il a été renseigné l'observance (ou non) des visites de soins prénataux ainsi que le type d'agents ayant procédé à ces actes. Le type de prestataire ayant assisté la mère lors de l'accouchement a également été renseigné. Une régression logistique multivariée a permis d'identifier les facteurs associés à la mortalité néonatale. Au total, 13044 enfants ont été inclus dans l'étude. Parmi ces derniers, 2,64% (IC95% = 2,32-3,01) étaient décédés avant le 28ème jour suivant la naissance. Le risque de décès néonatal était inférieur de 34% (ORa = 0,66 ; IC95% = 0,47-0,93) chez les enfants dont les mères avaient observé les consultations prénatales, réalisées par des sage-femmes, en comparaison aux enfants dont les mères n'avaient pas observé ces visites. Une relation significative n'a pas été observée entre le type de prestataire ayant assisté la mère lors de l'accouchement et la mortalité néonatale. L'étude souligne la nécessité de renforcer les stratégies visant une amélioration de l'offre et de la demande des visites de soins prénataux réalisées par des agents qualifiés en général, et des sage-femmes, en particulier.
Observance by pregnant women of maternal health care provided by qualified personnel is known to reduce the probability of neonatal death in newborns. However, is the gain observed in relation to the Page 53of70RASPVolume 5, Issue1use of this care homogeneous regardless of the health worker who performs the act? The objective of this work was to study the effects of compliance with prenatal consultations and the use of births attended by skilled attendantsin general, and midwives in particular, on neonatal mortality in Benin. This was a cross-sectional study that consisted of carrying out secondary analyzes from the databases of the fifth Demographic and Health Survey (DHS-V) in Benin. The study populationconsisted of children born during the five years preceding the EDS-V. The dependent variable was the death (1=Yes vs 0=No) of respondents before the 28th day after birth. For each child included, information was provided on compliance (or not) with prenatal care visits as well as the type of agents who carried out these acts. The type of provider who assisted the mother during childbirth was also provided. A multivariate logistic regression made it possible to identify the factors associated with neonatal mortality. A total of 13,044 children were included in the study. Of these, 2.64% (95% CI = 2.32-3.01) had died before the 28th day after birth. The risk of neonatal death was 34% lower (ORa = 0.66; 95% CI = 0.47-0.93) in children whose mothers had observed antenatal consultations, carried out by midwives, compared to children whose mothers had not observed these visits. A significant relationship was not observed between the type of provider who assisted the mother during childbirth and neonatal mortality.The study underscores the need to strengthen strategies aimed at improving the supply and demand for antenatal care visits by skilled workers in general, and midwives in particular.
Assuntos
Humanos , Masculino , FemininoRESUMO
Guided by the principle of leaving no one behind by improving equitable access and use of new and existing vaccines, the Immunization Agenda 2030 aims, among other things, to halve the incidence of "zero-dose" at the national level. This study aimed at studying the tends of the prevalence of "zerodose" children from 2000 to 2017 and making predictions for 2030. The study consisted of secondary data analyses from the Multiple Indicator Cluster Surveys (MICS) conducted in Togo. The study population consisted of children aged 12-23 months surveyed during MICS2 in 2000, MICS3 in 2006, MICS4 in 2010 and MICS6 in 2017. The dependent variable was the "zero-dose" vaccination status (1=Yes vs 0=No). The explanatory variables were related to the child, mother, household and environment. The study generated the overall annual percentage changes (APC) and by the independent variables. As a result, the prevalence of children with "zero-dose" expected for 2030 was estimated using Excel 2013 and Stata 16.0 software. In total, 636, 864, 916 and 952 children aged 12-23 months were included for MICS2, MICS3, MICS4 and MICS7, respectively. The prevalence of "zerodose" children decreased from 37.15% in 2000 to 31.72% in 2006, then 30.10% in 2010 and 26.86% in 2017, with an overall APC= - 1.89%. The highest relative annual decrease was from 2000 to 2006. If the historical rate of decrease remains unchanged, we predict that percentage of "zero-dose" children aged 12-23 months will be 20.96% in 2030, with a decrease of 22% compared to 2017, against a target of 50%. We suggest that strengthening strategies to increase full immunization coverage of children will contribute to reducing the percentage of zero dose children. A prerequisite will be a better understanding of the predictors of the "zero-dose" phenomenon in children