Small for Gestational Age Newborns in French Guiana: The Importance of Health Insurance for Prevention.

Objectives: Small for gestational age (SGA) newborns have a higher risk of poor outcomes. French Guiana (FG) is a territory in South America with poor living conditions. The objectives of this study were to describe risk factors associated with SGA newborns in FG. Methods: We used the birth cohort that compiles data from all pregnancies that ended in FG from 2013 to 2021. We analysed data of newborns born after 22 weeks of gestation and/or weighing more than 500 g and their mothers. Results: 67,962 newborns were included. SGA newborns represented 11.7% of all newborns. Lack of health insurance was associated with SGA newborns (p < 0.001) whereas no difference was found between different types of health insurance and the proportion of SGA newborns (p = 0.86). Mothers aged less than 20 years (aOR = 1.65 [1.55-1.77]), from Haiti (aOR = 1.24 [1.11-1.39]) or Guyana (aOR = 1.30 [1.01-1.68]) and lack of health insurance (aOR = 1.24 [1.10-1.40]) were associated with SGA newborns. Conclusion: Immigration and precariousness appear to be determinants of SGA newborns in FG. Other studies are needed to refine these results.

[The newborn in Western and Central Africa: Understanding prior to acting]. / Le nouveau-né en Afrique de l'Ouest et du Centre : comprendre pour agir.

The newborn was forgotten by public health programs aiming at reducing Under 5 Mortality in Western and Central Africa until the launch of the "Every Newborn Action Plan" in 2014. If neonatal mortality has significantly decreased in the region since 1990 (-35%), the actual number of newborn deaths has increased due to the slow reduction rate combined with high fertility rates. Stillbirths display the same patterns with rates and numbers as high, doubling the number of viable pregnancies ending with the loss of the fetus and/or newborns. The main causes of neonatal mortality are avoidable at very low cost with little qualified health professionals. Although women utilize largely maternal health services, studies show that there is no protective effect against maternal, neonatal death and stillbirth with ANC utilization and institutional delivery, a sign of the extremely poor quality of care in facilities. Public Health program specialists must understand why such cost effective interventions such as immediate breastfeeding, skin to skin care, care for birth asphyxia, hand washing are not systematically practiced by health professionals in health facilities. Many premature babies could also be saved with basic kangaroo mother care.In-depth anthropological studies are required to inform public health program managers and to help them make sound decisions based on a better understanding of behaviors and practices among both health professionals and communities.

Le nouveau-né en Afrique de l'Ouest et du Centre : comprendre pour agir.

The newborn was forgotten by public health programs aiming at reducing Under 5 Mortality in Western and Central Africa until the launch of the "Every Newborn Action Plan" in 2014. If neonatal mortality has significantly decreased in the region since 1990 (-35%), the actual number of newborn deaths has increased due to the slow reduction rate combined with high fertility rates. Stillbirths display the same patterns with rates and numbers as high, doubling the number of viable pregnancies ending with the loss of the fetus and/or newborns. The main causes of neonatal mortality are avoidable at very low cost with little qualified health professionals. Although women utilize largely maternal health services, studies show that there is no protective effect against maternal, neonatal death and stillbirth with ANC utilization and institutional delivery, a sign of the extremely poor quality of care in facilities. Public Health program specialists must understand why such cost effective interventions such as immediate breastfeeding, skin to skin care, care for birth asphyxia, hand washing are not systematically practiced by health professionals in health facilities. Many premature babies could also be saved with basic kangaroo mother care.In-depth anthropological studies are required to inform public health program managers and to help them make sound decisions based on a better understanding of behaviors and practices among both health professionals and communities.

Improving the quality of maternal and newborn health outcomes through a clinical mentorship program in the Democratic Republic of the Congo: study protocol.

BACKGROUND: The Democratic Republic of the Congo (DRC) boasts one of the highest rates of institutional deliveries in sub-Saharan Africa (80%), with eight out of every ten births also assisted by a skilled provider. However, the maternal and neonatal mortality are still among the highest in the world, which demonstrates the poor in-facility quality of maternal and newborn care. The objective of this ongoing project is to design, implement, and evaluate a clinical mentorship program in 72 health facilities in two rural provinces of Kwango and Kwilu, DRC. METHODS: This is an ongoing quasi-experimental study. In the 72 facilities, 48 facilities were assigned to the group where the clinical mentorship program is being implemented (intervention group), and 24 facilities were assigned to the group where the clinical mentorship program is not being implemented (control group). The groups were selected and assigned based on administrative criteria, taking into account the number of deliveries in each facility, the coverage of health zones, accessibility, and ease of implementation of a clinical mentorship program. The main activities are organizing and training a national team of mentors (including senior midwives, obstetricians, and pediatricians) in clinical mentoring, deploying them to mentor all health providers (mentees) performing maternal and newborn health (MNH) services, and providing in-service training in routine and Emergency Obstetrical and Newborn Care (EmONC) to the mentees in health facilities over an 18-month period. Baseline and endline assessments are carried out to evaluate the effectiveness of the clinical mentorship program on the quality of MNH care and the effective coverage of key interventions to reduce maternal and neonatal mortality. Findings will be disseminated nationwide and internationally, as scientific evidence is scarce. A national strategy, guidelines, and tools for clinical mentorship in MNH will be developed for replication in other provinces, thus benefitting the entire country. DISCUSSION: This is the largest project on clinical mentorship aimed to improving the quality of MNH care in Africa. This program is expected to generate one of the first pieces of scientific evidence on the effectiveness of a clinical mentorship program in MNH on a scientifically designed and sustainable model.

Facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care in 72 rural health facilities in the Democratic Republic of the Congo: A cross-sectional study.

Background: Current facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care (EmONC) were assessed in the Kwango and Kwilu provinces of the Democratic Republic of the Congo (DRC). Methods: This is an analysis of the baseline survey data from an ongoing clinical mentoring program among 72 rural health facilities in the DRC. Data collectors visited each of the facilities and collected data through a pre-programmed smartphone. Frequencies of selected indicators were calculated by province and facility type-general referral hospital (GRH) and primary health centers (HC). Results: Facility conditions varied across province and facility type. Maternity wards and delivery rooms were available in the highest frequency of rooms assessed (>95% of all facilities). Drinking water was available in 25.0% of all facilities; electricity was available in 49.2% of labor rooms and 67.6% of delivery rooms in all facilities. Antenatal, delivery, and postnatal care services were available but varied across facilities. While the proportion of blood pressure measured during antenatal care was high (94.9%), the antenatal screening rate for proteinuria was low (14.7%). The use of uterotonics immediately after birth was observed in high numbers across both provinces (94.4% in Kwango and 75.6% in Kwilu) and facility type (91.3% in GRH and 81.4% in HC). The provision of immediate postnatal care to mothers every 15 minutes was provided in less than 50% of all facilities. GRH facilities generally had higher frequencies of available equipment and more services available than HC. GRH facilities provided an average of 6 EmONC signal functions (range: 2-9). Conclusions: Despite poor facility conditions and a lack of supplies, GRH and HC facilities were able to provide EmONC care in rural DRC. These findings could guide the provision of essential needs to the health facilities for better delivery of maternal and neonatal care.

Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review.

INTRODUCTION: Healthcare-associated infections (HCAIs) are the most frequent adverse event compromising patient safety globally. Patients in healthcare facilities (HCFs) in low-income and middle-income countries (LMICs) are most at risk. Although water, sanitation and hygiene (WASH) interventions are likely important for the prevention of HCAIs, there have been no systematic reviews to date. METHODS: As per our prepublished protocol, we systematically searched academic databases, trial registers, WHO databases, grey literature resources and conference abstracts to identify studies assessing the impact of HCF WASH services and practices on HCAIs in LMICs. In parallel, we undertook a supplementary scoping review including less rigorous study designs to develop a conceptual framework for how WASH can impact HCAIs and to identify key literature gaps. RESULTS: Only three studies were included in the systematic review. All assessed hygiene interventions and included: a cluster-randomised controlled trial, a cohort study, and a matched case-control study. All reported a reduction in HCAIs, but all were considered at medium-high risk of bias. The additional 27 before-after studies included in our scoping review all focused on hygiene interventions, none assessed improvements to water quantity, quality or sanitation facilities. 26 of the studies reported a reduction in at least one HCAI. Our scoping review identified multiple mechanisms by which WASH can influence HCAI and highlighted a number of important research gaps. CONCLUSIONS: Although there is a dearth of evidence for the effect of WASH in HCFs, the studies of hygiene interventions were consistently protective against HCAIs in LMICs. Additional and higher quality research is urgently needed to fill this gap to understand how WASH services in HCFs can support broader efforts to reduce HCAIs in LMICs. PROSPERO REGISTRATION NUMBER: CRD42017080943.

Epidemiological features of uterine rupture in West Africa (MOMA Study).

The aim of the study was (1) to assess the incidence of uterine rupture in West Africa; (2) to identify its risk factors there; (3) to assess their predictiveness. The study (MOMA study) was prospective and population based. Data on a large cohort of pregnant women were collected. Univariable and multivariable analysis was used including stepwise logistic regression. We identified 25 cases of clinically symptomatic uterine rupture in a population of 20 326 pregnant women giving an incidence rate of 1.2 uterine ruptures per 1000 deliveries. Five variables were significantly associated with uterine rupture (in both the univariable and multivariable analyses): uterine scars, malpresentation, limping, cephalopelvic disproportion and high parity (>or=7). In conclusion, the incidence of uterine rupture is high in West Africa, even in large cities where essential obstetric care is available and despite the low prevalence of uterine scars. A uterine scar multiplies the risk of uterine rupture by 11. Uterine rupture cannot be predicted from currently known risk factors, including uterine scars. The high case fatality rate (33.3%) and the associated perinatal mortality (52%) bear witness to the absence or inadequacy of health facilities in providing essential obstetric care and to the poor quality of maternal health care, even in major cities.