Quality of antenatal care and obstetrical coverage in rural Burkina Faso.

Improving maternal health is one of the Millennium Development Goals of the United Nations. Despite the efforts to promote maternal and neonatal care to achieve this goal, the use of delivery care remains below expectations in Burkina Faso. This situation raises the question of the quality of care offered in maternity wards. The aim of this study was to identify primary healthcare facility and antenatal care characteristics predictive of an assisted delivery in rural Burkina Faso. A cross-sectional study was carried out in Gnagna province (North-East Burkina Faso) in November 2003. The operational capacities of health facilities were assessed, and a non-participating observation of the antenatal care (ANC) procedure was undertaken to evaluate their quality. Scores were established to summarize the information gathered. The rate of professional childbirth (obstetrical coverage) was derived from the number of childbirths registered in the health facility compared to the size of the population. The established scores were related to the obstetrical coverage using non-parametric tests (Kendall). In total, 17 health facilities were visited, and 81 antenatal consultations were observed. Insufficiencies were observed at all steps of ANC (mean total score for the quality of ANC=10.3 +/- 3.0, ranging from 6 to 16, out of a maximum of 20). Health facilities are poorly equipped, and the availability of qualified staff remained low (mean total score for the provision of care was 22.9 +/- 4.2, ranging from 14 to 33). However, these scores were not significantly related to the rate of professional childbirth (tau Kendall=0.27: p=0.14 and 0.01, p=0.93 respectively). The ability of the primary health centres to provide good antenatal care remains low in rural Burkina Faso. The key factors involved in the limited use of professional childbirth relating to maternal health services may be the quality of ANC.

The acceptability to stakeholders of mandatory nutritional labelling in France and the UK--findings from the PorGrow project.

BACKGROUND: Implementing a European Union (EU)-wide mandatory nutrition labelling scheme has been advocated as part a multi-pronged strategy to tackle obesity. The type of scheme needs to be acceptable to all key stakeholders. This study explored stakeholders' viewpoints of labelling in two contrasting food cultures (France and the UK) to see whether attitudes were influenced by sectoral interests and/or national context. METHODS: Using Multi Criteria Mapping, a decision analysis tool that assesses stakeholder viewpoints, quantitative and qualitative data were gathered during tape-recorded interviews. In France and the UK, 21 comparable stakeholders appraised nutritional labelling with criteria of their own choosing (i.e. feasibility, societal benefits, social acceptability, efficacy in addressing obesity, additional health benefits) and three criteria relating to cost (to industry; public sector; individuals). When scoring, interviewees provided both optimistic (best case) and pessimistic (worst case) judgements. RESULTS: Overall, mandatory nutritional labelling was appraised least favourably in France. Labelling performed worse under optimistic (best case) scenarios in France, for five out of eight sets of criteria. French stakeholders viewed labelling as expensive, having fewer benefits to society and as being marginally less effective than UK stakeholders did. However, French interviewees thought implementing labelling was feasible and would provide additional health benefits. British and French stakeholders made similar quantitative judgements on how socially acceptable mandatory labelling would be. CONCLUSIONS: There is agreement between some stakeholder groups in the two different countries, especially food chain operators. However, cultural differences emerged that could influence the impact of an EU-wide mandatory labelling scheme in both countries.

Stakeholder views on policy options for responding to the growing challenge from obesity in France: findings from the PorGrow project.

To explore the perspectives of key stakeholders towards a range of policy options to prevent obesity in France, a multi-criteria mapping method was used to gather quantitative and qualitative data from 21 types of stakeholder groups. During structured interviews, stakeholders appraised a set of pre-defined options by reference to criteria of their own choosing and provided relative weights to their criteria, and overall rankings of the policy options. Efficacy, feasibility and societal benefits were the groups of criteria given most importance by stakeholders. There was most consensus and preference for options related to health education, particularly in schools, compared with options that aimed at changing the environment to prevent obesity, i.e. options around physical activity; options that modified food supply and demand; and information-related options. There was little support for technological solutions or institutional reforms. While there was broad interest in a range of different options, those related to behaviour change through education were the most valued by stakeholders. Raising awareness among policymakers about the convincing scientific evidence for the effectiveness of environmental level policy options will be a crucial first step.

Determinants of nutrition improvement in a large-scale urban project: a follow-up study of children participating in the Senegal Community Nutrition Project.

OBJECTIVE: To study individual determinants of differential benefit from the Senegal Community Nutrition Project (CNP) by monitoring improvement in children's weight-for-age index (WA) or underweight status (WA < -2 Z-scores) during participation. DESIGN: A follow-up study using the CNP child monitoring data. Linear general models compared variations in WA according to 14 factors describing the beneficiaries and CNP services. SETTING: Poor neighbourhoods of Diourbel, a large city in Senegal, West Africa. Over a 6-month period, the CNP provided underweight or nutritionally at-risk 6-35-month-old children with monthly growth monitoring and promotion and weekly food supplementation, provided that mothers attended weekly nutrition education sessions. SUBJECTS: All the children who participated in the first two years of the project (n=4084). RESULTS: Mean WA varied from -2.13 (standard deviation (SD) 0.82) to -1.58 (SD 0.81) Z-scores between recruitment and the end of the follow-up. The lower the child's initial WA, the greater was their increase in WA but the lower was the probability of recovery from underweight. Only 61% of underweight children recovered. Six months of CNP services may not be sufficient for catch-up growth of severely underweight children. The number of food supplement rations received was not a direct indicator of the probability of recovery. After adjustment for services received and initial WA, probability of recovery was lower in girls, in younger children, in twins and when mothers belonged to a specific ethnic group. CONCLUSIONS: Determinants of benefit from CNP differed from the risk factors for underweight. Identification of participants with a lower probability of recovery can help improve outcome. Moreover, an explanation for the lack of recovery could be that many underweight children are stunted but not necessarily wasted.

Use of variety/diversity scores for diet quality measurement: relation with nutritional status of women in a rural area in Burkina Faso.

OBJECTIVES: To develop scores for food variety and diversity to assess the overall dietary quality in an African rural area; and to study their relationship with the nutritional status of women of childbearing age. DESIGN: Cross-sectional. SETTING: Sahelian rural area in the North-East Burkina Faso (West Africa). SUBJECTS: A total of 691 mothers with children below the age of 5 y, selected at random in 30 villages. METHODS: A qualitative recall of women's food consumption during the previous 24 h made it possible to calculate a food variety score (FVS = count of food items consumed) and a dietary diversity score (DDS = count of food groups, among 14 groups). These scores were then divided into terciles. Body mass index (BMI), mid-upper arm circumference (MUAC) and body fat percentage (BFP) were used to determine the women's nutritional status. RESULTS: The overall dietary quality was poor: mean FVS (s.d.) = 8.3 (2.9) food items; mean DDS = 5.1 (1.7) food groups. A clear relationship was shown between both FVS and DDS (in terciles) and most nutritional indices. Women with a FVS in the lowest tercile had a mean BMI of 20.1, while those in the highest tercile had a BMI of 20.9 (P = 0.009). Those in the lowest tercile of DDS had a 22.8% prevalence of underweight vs 9.8% in the highest tercile (P < 0.0001). The latter relationship remained significant even when the subjects' sociodemographic and economic characteristics were accounted for. CONCLUSION: Dietary scores measured at the individual level are good proxies for overall dietary quality of women living in a poor rural African area. These scores were also shown to be linked with the nutritional status of women. FINANCING: IRD financed the study with the assistance of UNICEF for the purchase of anthropometric equipment. The first author received a research allowance from the French Ministry of Research through the doctoral school 393 of Pierre and Marie Curie University (Paris VI).

Body composition unaltered for African women classified as 'normal but vulnerable' by body mass index and mid-upper-arm-circumference criteria.

OBJECTIVE: To test the hypothesis that 'normal but vulnerable' adults, as defined by body mass index (BMI) in combination with mid-upper-arm-circumference (MUAC), are closer to normal than to malnourished ones. For that purpose body composition measurements were compared between normal and low BMI categories and according to MUAC value in an African context and for different age groups. DESIGN: Reanalysis of data from a previous cross-sectional cluster sample nutrition survey. SETTING: A rural area of the Republic of Congo, Central Africa. SUBJECTS: A representative sample (n=544) of non-pregnant women. MAIN OUTCOME MEASURES: Arm muscle area was calculated from measurements of triceps skinfold thickness and MUAC. Peripheral body fat was assessed by the sum of four skinfold thicknesses. The ratio of resistance at high and low frequencies was derived from whole body measurement of multifrequency bioelectrical impedance analysis and used as the extracellular to total body water ratio index. RESULTS: The prevalence of thinness decreased from 18.7% as defined by BMI alone to 9.0% as defined by BMI and MUAC. This difference was due to the group of subjects classified as 'normal but vulnerable' (9.7%). Prevalence of thinness increased with age when assessed by BMI alone, but no longer when assessed by BMI and MUAC. Comparison with the BMI> or =18.5 kg/m(2) category showed that in 'normal but vulnerable' subjects lower BMI was accompanied by lower both fat and lean compartments, in absolute values, but the equilibrium of body water compartments was not altered. In BMI<18.5 women, low MUAC was associated with altered lean tissues, at peripheral and whole body level, whereas fat tissue did not differ. CONCLUSIONS: 'Normal but vulnerable' subjects appeared as 'thin but healthy' rather than malnourished, at all ages, even though their BMI was lower than 18.5 kg/m(2). The new classification of thinness based on BMI and MUAC provides a more specific index of nutritional status when restricting the thin category to more at-risk subjects.