Réduction de la mortalité infanto-juvénile par une meilleure prise en charge de la malnutrition et du VIH

En RCA, il est globalement ressorti des différents rapports de suivi des indicateurs des OMD que les progrès sont les plus lents en ce qui concerne l'OMD1 (Eradiquer l'extrême pauvreté et la faim), l´OMD 4 (Réduire la mortalité des enfants de moins de 5 ans), l'OMD 5 (Améliorer la santé maternelle) et l'OMD 6 (Combattre le VIH/Sida, le Paludisme et les autres maladies). A l'heure actuelle, dans la plupart des pays à ressources limitées, le cercle vicieux reliant la malnutrition au VIH/SIDA sous tendue par la pauvreté potentialise la mortalité infanto-juvénile. Mondialement, le taux de mortalité des enfants de moins de 5 ans a été réduit de 35 %, passant de 88‰ en 1990 à 57,2 ‰ en 2010 malgré l'accroissement de la population.

Strategies de reduction de la mortalite maternelle en Republique Centrafricaine

Mortalité maternelle est un grave problème de santé publique en RCA avec un taux de 1355 décès pour 100.000 naissances vivantes. Quatre principales difficultés sont à la base de ce problème: a) Difficultés liées à l´accès aux soins. b) Difficultés liées à l´insuffisance et à la répartition inégale du personnel de santé. c) Difficultés liées à la prise en charge des urgences obstétricales et au système de référence. d) Difficultés liées à l´utilisation des services de santé. La réduction de la mortalité maternelle peut utiliser un certain nombre de stratégies efficaces et réalisables en Centrafrique. Cependant, le manque d´un guide clair et explicite limite la mise en oeuvre et la coordination de ces stratégies. Trois options politiques complémentaires ont été définies dans l´objectif de réduire la mortalité maternelle en Centrafrique: 1- Renforcement des capacités nationales en matière de la santé de la reproduction. 2- Renforcement des capacités nationales en matière de la santé de la reproduction. 3- Mobilisation des différentes ressources en faveur de la lutte contre la mortalité maternelle.

Central African Field Epidemiology and Laboratory Training Program: building and strengthening regional workforce capacity in public health.

The Central African Field Epidemiology and Laboratory Training Program (CAFELTP) is a 2-year public health leadership capacity building training program. It was established in October 2010 to enhance capacity for applied epidemiology and public health laboratory services in three countries: Cameroon, Central African Republic, and the Democratic Republic of Congo. The aim of the program is to develop a trained public health workforce to assure that acute public health events are detected, investigated, and responded to quickly and effectively. The program consists of 25% didactic and 75% practical training (field based activities). Although the program is still in its infancy, the residents have already responded to six outbreak investigations in the region, evaluated 18 public health surveillance systems and public health programs, and completed 18 management projects. Through these various activities, information is shared to understand similarities and differences in the region leading to new and innovative approaches in public health. The program provides opportunities for regional and international networking in field epidemiology and laboratory activities, and is particularly beneficial for countries that may not have the immediate resources to host an individual country program. Several of the trainees from the first cohort already hold leadership positions within the ministries of health and national laboratories, and will return to their assignments better equipped to face the public health challenges in the region. They bring with them knowledge, practical training, and experiences gained through the program to shape the future of the public health landscape in their countries.

Policy brief on improving access to artemisinin-based combination therapies for malaria in Central African Republic

In the Central African Republic (CAR) malaria is a major public health problem and hampers socioeconomic development. It accounts for 40 percent of complaints and 10 percent of deaths in health facilities (15;17). Pregnant women, who make up 4 percent of the population, and children under 5 years of age, who represent 17.3 percent, are the groups most vulnerable to malaria owing to their low levels of immunity. For many years, uncomplicated malaria was treated with chloroquine, amodiaquine, and a sulfadoxine-pyrimethamine combination. Resistance to these drugs has developed since 1986, as several studies have documented (3;8;9). Between 2002 and 2004, there was a steady increase in resistance to 40.9 percent in the case of chloroquine and 22.8 percent in the case of sulfadoxine-pyrimethamine. Following the recommendation of the World Health Organization, the national health authorities reviewed the national malaria management guidelines and opted for the use of artemisinin-based combination therapies (ACTs) as the front-line drug instead of the formerly recommended sulfadoxine-pyrimethamine combination (10­14). Several factors limit implementation of the revised national malaria management guidelines, including (i) unavailability of ACTs in CAR owing to high cost and supply problems; (ii) nonadherence of health professionals, community health workers, and licensed dispensers (private-sector and community-based pharmacies); and (iii) continued availability of antimalarials formerly used in single-drug therapy. Any strategy designed to facilitate access to treatment must take account of the rural poor who are particularly ill served by the health system. It is this problem of accessibility that is being addressed by the home management of malaria (PECADOM) strategy. This is a community-based strategy that enlists the participation of community health workers, mothers, and traditional practitioners in the home management of uncomplicated malaria. It relies on the services provided by the private, formal, and informal health sectors. Home management complements and extends the outreach of public health services (1;2;5).