Prevalence and factors associated with anaemia in children aged 6-24 months living a high malaria transmission setting in Burundi.

BACKGROUND: In very young children, anaemia has been linked to increased morbidity, mortality and poor cognitive development. Although Burundi has a high burden of anaemia, which may be worsened by the high burden of malaria, little is known about the extent of the problem in very young children who are most at risk of severe disease. We estimated the prevalence, and assessed the factors associated with anaemia in children aged 6-24 months using baseline data collected as part of an on-going study evaluating the effect of Micronutrient supplementation on anaemia and cognition among children in high malaria transmission settings in Burundi. METHODS: Between February and March 2020, surveys were conducted in 498 households within the catchment area of Mukenke Health Center. One child aged 6-24 months was selected per household to participate in the survey. Following written informed consent, we administered a questionnaire to the child's primary caregiver to capture information on child's demographics, nutritional status, food intake, health (status, and morbidity and treatment-seeking practices), as well as the household markers of wealth. A physical exam was conducted, and a blood sample was collected to: 1) assess for presence of plasmodium infection using a rapid diagnosis test; 2) estimate the haemoglobin levels using a portable haemocue machine. A stool sample was also collected to examine for the presence of helminth infections. RESULTS: The prevalence of anaemia was 74.3% (95% confidence interval [CI] 61.5%-84.0%), with most of the anaemic study participants classified as having moderate anaemia (59.2%). A total of 62 (12.5%) participants had positive malaria rapid diagnosis tests. Factors significantly associated with higher odds of developing anaemia included not receiving deworming medication (adjusted Odd ratio [aOR] = 3.54, 95% CI 1.79-6.99, p<0.001), the child's home location (Mukenke II: aOR = 2.22, 95% CI 1.89-2.62, p<0.001; Mukenke: aOR = 2.76, 95% CI 2.46-3.10, p<0.001 and Budahunga: aOR = 3.12, 95% CI 2. 94-3.31, p<0.001) and the child's age group (Children aged 6-11 months: aOR = 2.27, 95% CI 1.32-3.91, p<0.001). Education level was inversely associated with less odds of anaemia: child's primary care giver with a secondary (aOR = 0.67; 95% CI: 0.47-0.95, p = 0,024) and tertiary education level (aOR = 0.48; 95% CI: 0.38-0.61, p<0.001). CONCLUSION: Anaemia is highly prevalent among young children in high malaria transmission setting. Anaemia is more prevalent among children who not dewormed and those with malaria. To prevent the long-term adverse outcomes of the anaemia in children, policy makers should focus on improving uptake of the deworming and malaria prevention programs, promote preventive interventions and improve the education of women especially in families with very young children.

Adaptation of the Training Resource Package to Strengthen Preservice Family Planning Training for Nurses and Midwives in Tanzania and Uganda.

BACKGROUND: Tanzania and Uganda have high total fertility and maternal mortality rates, and low contraceptive prevalence rates. High-quality preservice family planning education for nurses and midwives can improve the quality of sexual and reproductive health care, thereby improving health outcomes. DESCRIPTION OF INTERVENTION: In 2015, we worked with relevant stakeholders in Tanzania and Uganda through a series of surveys, assessments, and workshops to adapt modules of the Training Resource Package for Family Planning (TRP), an evidence-based global resource, to improve the quality of preservice family planning education for nurses and midwives. With support, a wide range of stakeholders, including policy makers, program managers, educators from nursing and midwifery training institutions, and representatives from professional associations, identified relevant TRP modules and adapted them to each country's context to inform and develop their own lesson plans in accordance with national policies, guidelines, and standardized preservice education templates. LESSONS LEARNED: Important lessons from the adaptation process include the following: (1) engage relevant ministries of health and education, professional associations, and regulatory councils at each step of the process to increase the acceptability and utility of the TRP; (2) use a context-specific process for adaptation of the TRP, as not one process will fit the needs of all countries; and (3) include nursing and midwifery educators in the adaptation process to create an established pool of trainers who can then cascade the TRP to other educators in their respective schools. Overall, participants in both countries expressed challenges with incorporating competency-based teaching methods into their curricula because they were unfamiliar with such approaches themselves and with reducing the extensive TRP content to fit within the time constraints for preservice education. CONCLUSION: Adaptation of an evidence-based global family planning training resource in Tanzania and Uganda resulted in substantive changes to the curricula of the reproductive health preservice course unit that will support nurses and midwives to provide quality, rights-based family planning services.