Conference Material > Slide Presentation
Formation virtuelle comme catalyseur d’amelioration des soins neonataux au CSREF de Douentza / Mali
Rubona F, Ibongu E, Bah AJ, Dianouni F, Wepnyui H
MSF Paediatric Days 2024. 4 May 2024; DOI:10.57740/rleZ6pb8
Français
Conference Material > Abstract
Mairos Ferreira S, Muthengi K, Mohale M, Mokhameleli S, Mathosi L
MSF Paediatric Days 2024. 4 May 2024; DOI:10.57740/wrwUr6Xhz
BACKGROUND AND OBJECTIVES
This research emerges from Lesotho's diverse landscapes, where children’s stories remain largely unheard in the realm of health policy. The study aims to harness these narratives to drive equity, inclusivity, and human rights in health interventions, positioning youth not just as beneficiaries but as active participants in all health interventions.
METHODS
This research represents a meta-analysis of a larger, cross-sectional, qualitative research project, focused on understanding childrens’ narratives and experiences on their health and wellbeing. The study employed Participatory Learning Approach (PLA) tools, notably Social and Resource Mapping, Body Mapping, and Cause and Effect Analysis, to delve into these narratives. It involved a purposeful sample of 180 children, ranging from 6 to 19 years old, including school-goers, herd boys, children with disabilities, and teenagers. It occurred in diverse regions of Lesotho (Lowlands, Mountains, Foothills, and Senqu River Valley). This comprehensive approach also encompassed 18 Focus Group Discussions, enriched by Key Informant Interviews with local stakeholders.
RESULTS
Key findings from this study highlight significant issues in health, Water, Sanitation and Hygiene (WASH), education, nutrition, and child protection. The study underscores the challenges in accessing general healthcare services, particularly stressing the importance of sexual and reproductive health in high HIV/AIDS prevalence areas. The need for improved water and sanitation infrastructure is critically emphasised. In education, children and youth advocate for greater equity and inclusivity. The impact of climate change on nutrition is evident, leading to food insecurity and malnutrition, with high prevalence of stunting. Participants highlighted key facets of child protection, emphasising the increased vulnerability and exploitation of children and youth, alongside a considerable risk of gender-based and sexual violence.
CONCLUSIONS
Participants powerful testimonies advocate for a paradigm shift towards more inclusive and youth-involved policymaking, challenging the dominance of adult-centric approaches and calling for a holistic integration of their perspectives in programmes and policies.
This research emerges from Lesotho's diverse landscapes, where children’s stories remain largely unheard in the realm of health policy. The study aims to harness these narratives to drive equity, inclusivity, and human rights in health interventions, positioning youth not just as beneficiaries but as active participants in all health interventions.
METHODS
This research represents a meta-analysis of a larger, cross-sectional, qualitative research project, focused on understanding childrens’ narratives and experiences on their health and wellbeing. The study employed Participatory Learning Approach (PLA) tools, notably Social and Resource Mapping, Body Mapping, and Cause and Effect Analysis, to delve into these narratives. It involved a purposeful sample of 180 children, ranging from 6 to 19 years old, including school-goers, herd boys, children with disabilities, and teenagers. It occurred in diverse regions of Lesotho (Lowlands, Mountains, Foothills, and Senqu River Valley). This comprehensive approach also encompassed 18 Focus Group Discussions, enriched by Key Informant Interviews with local stakeholders.
RESULTS
Key findings from this study highlight significant issues in health, Water, Sanitation and Hygiene (WASH), education, nutrition, and child protection. The study underscores the challenges in accessing general healthcare services, particularly stressing the importance of sexual and reproductive health in high HIV/AIDS prevalence areas. The need for improved water and sanitation infrastructure is critically emphasised. In education, children and youth advocate for greater equity and inclusivity. The impact of climate change on nutrition is evident, leading to food insecurity and malnutrition, with high prevalence of stunting. Participants highlighted key facets of child protection, emphasising the increased vulnerability and exploitation of children and youth, alongside a considerable risk of gender-based and sexual violence.
CONCLUSIONS
Participants powerful testimonies advocate for a paradigm shift towards more inclusive and youth-involved policymaking, challenging the dominance of adult-centric approaches and calling for a holistic integration of their perspectives in programmes and policies.
Conference Material > Abstract
Danno K, Worku DT, Adjaho I, Ale F, Katuala Y, et al.
MSF Paediatric Days 2024. 4 May 2024; DOI:10.57740/OMKnX6
BACKGROUND AND OBJECTIVES
Hypothermia is a major risk factor for high neonatal mortality. In January, night-time temperatures in Kano State can drop below 20°C. We conducted a study to elucidate the incidence of neonatal hypothermia at Garan Gamawa maternal and child health (MCH) clinic in Kano City, with an aim to improve midwifery care and reduce hypothermia-related neonatal mortality.
METHODS
The data of neonates born in January 2022 were collected retrospectively in February 2022. Hypothermia was defined as “axillary temperature below 35.5°C” in accordance with MSF Essential Obstetric and Newborn Care guidelines, 2019. Statistical analysis was done using a one-sided test for binomial proportions. Qualitative data was garnered by non-participatory observation (NPO) in the delivery room and postnatal care (PNC) ward to observe the warm chain and the interactions between staff and mothers. Individual semi-structured in-depth interviews were also conducted with eight MCH staff.
RESULTS
Amongst the 206 newborns included, 55 (26.69%, Wilson confidence interval 21.13- 33.13%, p value < 0.00001) developed hypothermia. From the NPO, contributing factors to hypothermia included: absence of skin-to-skin at birth; a delay of 40 minutes between birth and baby being put to the breast for their first feed; constant draught of outside air into delivery room; absence of heating system in delivery room and PNC ward; and the need to go outside during transfer between the delivery room and PNC ward. In-depth interviews illustrated that midwives prioritised dressing the babies rather than encouraging Kangaroo Mother Care (KMC), and that the warm chain was prone to interruption during a complicated delivery and when there were multiple labouring mothers. Additionally, some midwives were not aware of the definition of neonatal hypothermia.
CONCLUSIONS
The proportion of hypothermic neonates was significant, and several contributing factors were identified. Recommendations include the installation of a door into the delivery room and appropriate heating systems in both the delivery room and PNC ward. Training of MCH staff is required to build knowledge and skills regarding the maintenance of the warm chain, and highlighting the importance of immediate skin-to-skin at birth and KMC, which have an important role in preventing hypothermia and must be encouraged.
Hypothermia is a major risk factor for high neonatal mortality. In January, night-time temperatures in Kano State can drop below 20°C. We conducted a study to elucidate the incidence of neonatal hypothermia at Garan Gamawa maternal and child health (MCH) clinic in Kano City, with an aim to improve midwifery care and reduce hypothermia-related neonatal mortality.
METHODS
The data of neonates born in January 2022 were collected retrospectively in February 2022. Hypothermia was defined as “axillary temperature below 35.5°C” in accordance with MSF Essential Obstetric and Newborn Care guidelines, 2019. Statistical analysis was done using a one-sided test for binomial proportions. Qualitative data was garnered by non-participatory observation (NPO) in the delivery room and postnatal care (PNC) ward to observe the warm chain and the interactions between staff and mothers. Individual semi-structured in-depth interviews were also conducted with eight MCH staff.
RESULTS
Amongst the 206 newborns included, 55 (26.69%, Wilson confidence interval 21.13- 33.13%, p value < 0.00001) developed hypothermia. From the NPO, contributing factors to hypothermia included: absence of skin-to-skin at birth; a delay of 40 minutes between birth and baby being put to the breast for their first feed; constant draught of outside air into delivery room; absence of heating system in delivery room and PNC ward; and the need to go outside during transfer between the delivery room and PNC ward. In-depth interviews illustrated that midwives prioritised dressing the babies rather than encouraging Kangaroo Mother Care (KMC), and that the warm chain was prone to interruption during a complicated delivery and when there were multiple labouring mothers. Additionally, some midwives were not aware of the definition of neonatal hypothermia.
CONCLUSIONS
The proportion of hypothermic neonates was significant, and several contributing factors were identified. Recommendations include the installation of a door into the delivery room and appropriate heating systems in both the delivery room and PNC ward. Training of MCH staff is required to build knowledge and skills regarding the maintenance of the warm chain, and highlighting the importance of immediate skin-to-skin at birth and KMC, which have an important role in preventing hypothermia and must be encouraged.
Conference Material > Abstract
Gonzalez Arias M, Buero MM, Salem Z, Yang SL, Valori AV
MSF Paediatric Days 2024. 4 May 2024; DOI:10.57740/2fBEz60O
BACKGROUND AND OBJECTIVES
Since 2015, MSF OCBA has supported Abs General Hospital (AGH) with an 88-bed capacity neonatal ward. In the recent years, annual admissions in the service escalated to an average of 3000 but with persistently high inpatient neonatal mortality rates, usually above 20%. Main causes of mortality in 2022 were prematurity (45%), perinatal asphyxia (21%) and sepsis (20%). To tackle this problem we performed an initial mortality analysis and used it to develop a workplan, which was then implemented during March – April 2023. The plan focused on improving compliance with zero-separation practices and adherence to neonatal care protocols and on reducing nosocomial infection. Specific activities, among many, included ensuring enough space for mothers to stay with their newborns in the ward and implementing a breastfeeding group with weekly meetings. Here we present our assessment of whether and how these measures may have affected neonatal mortality.
METHODS
Inpatient mortality rates of pre- and post-implementation period were compared from aggregated monthly data in MSF ́s Health Management Information System (HMIS). We conducted analysis stratified by year and by predefined periods – pre-implementation periods: January to August 22 and September 22 to February 23 (reference period) and post- implementation period: May to December 23. Mortality rate ratios (MRR) were calculated using negative binomial regression adjusted for month of admission.
RESULTS
1050 neonatal deaths and 5733 exits were included in the analysis period. Our data showed a 24% decrease in overall neonatal mortality (MRR = 0.76, 95%CI 0.60-0.95, p=0.02) during the post-implementation period compared to the reference period, with the reduction affecting all three main causes of mortality equally (prematurity accounted for 46% of all deaths post-implementation, sepsis 21%, and perinatal asphyxia 20%). A significant decrease in mortality (26%) was seen in 2023 when compared to 2022 (MRR = 0.74, 95%CI 0.65-0.85, p<0.05).
CONCLUSIONS
Neonatal mortality is usually an important challenge in MSF settings. Here we describe some low-cost strategies that have likely contributed to reducing inpatient mortality. A comprehensive approach to neonatal care with involvement of locally-hired staff seems essential for good outcomes and continuity. This experience provides valuable insights for healthcare professionals working in similar settings.
Since 2015, MSF OCBA has supported Abs General Hospital (AGH) with an 88-bed capacity neonatal ward. In the recent years, annual admissions in the service escalated to an average of 3000 but with persistently high inpatient neonatal mortality rates, usually above 20%. Main causes of mortality in 2022 were prematurity (45%), perinatal asphyxia (21%) and sepsis (20%). To tackle this problem we performed an initial mortality analysis and used it to develop a workplan, which was then implemented during March – April 2023. The plan focused on improving compliance with zero-separation practices and adherence to neonatal care protocols and on reducing nosocomial infection. Specific activities, among many, included ensuring enough space for mothers to stay with their newborns in the ward and implementing a breastfeeding group with weekly meetings. Here we present our assessment of whether and how these measures may have affected neonatal mortality.
METHODS
Inpatient mortality rates of pre- and post-implementation period were compared from aggregated monthly data in MSF ́s Health Management Information System (HMIS). We conducted analysis stratified by year and by predefined periods – pre-implementation periods: January to August 22 and September 22 to February 23 (reference period) and post- implementation period: May to December 23. Mortality rate ratios (MRR) were calculated using negative binomial regression adjusted for month of admission.
RESULTS
1050 neonatal deaths and 5733 exits were included in the analysis period. Our data showed a 24% decrease in overall neonatal mortality (MRR = 0.76, 95%CI 0.60-0.95, p=0.02) during the post-implementation period compared to the reference period, with the reduction affecting all three main causes of mortality equally (prematurity accounted for 46% of all deaths post-implementation, sepsis 21%, and perinatal asphyxia 20%). A significant decrease in mortality (26%) was seen in 2023 when compared to 2022 (MRR = 0.74, 95%CI 0.65-0.85, p<0.05).
CONCLUSIONS
Neonatal mortality is usually an important challenge in MSF settings. Here we describe some low-cost strategies that have likely contributed to reducing inpatient mortality. A comprehensive approach to neonatal care with involvement of locally-hired staff seems essential for good outcomes and continuity. This experience provides valuable insights for healthcare professionals working in similar settings.
Conference Material > Abstract
Bigirimana T, Thind A, Hawa Diallo O, Kourouma A, Burzio C, et al.
MSF Paediatric Days 2024. 4 May 2024; DOI:10.57740/EFc46s
English
Français
BACKGROUND AND OBJECTIVES
In 2016, UNAIDS identified the Prevention of Mother-to-Child Transmission of HIV (PMTCT) as a significant challenge in the fight against HIV/AIDS in Guinea. This abstract presents the key findings of an evaluation conducted on the PMTCT component of MSF's HIV project in Guinea, implemented since the early 2000’s. The main objective of the evaluation was to assess its relevance, coherence, effectiveness, efficiency, impact, and sustainability.
METHODS
A mixed quantitative and qualitative methodology was applied, including a desk review of MSF project documents, field observations, and interviews with key stakeholders. The data were analysed by triangulation and benchmarking to ensure internal validity. Quantitative indicators provided information on the number of women receiving PMTCT treatment and the rate of HIV mother-to-child transmission (MTCT) in health facilities supported by MSF, allowing the measurement of the effectiveness of the intervention. The quality of data and the lack of primary data from 2011 to 2015 was the main limitation, hindering the calculation of statistical significance (p-value) for the observed change in the rate of MTCT of HIV.
RESULTS
MSF's PMTCT intervention was highly relevant and aligned with the country's needs. It demonstrated effectiveness through the significant number of women receiving PMTCT treatment, the establishment of a platform for viral load testing, drug supply support, and a reduction in the HIV MTCT rate. The rate of MTCT in health facilities supported by MSF decreased from 35.9% to 12% [7 – 12] between 2010 and 2021. The challenges relating to data accuracy, monitoring activities, the follow-up of babies born from HIV-infected mothers, and the readiness of the MoH to take over the programme were identified, highlighting the need for improvement to enhance the effectiveness and efficiency. Sustainability efforts remained low as the Guinean health system lacked enough funding to take over the programme.
CONCLUSIONS
The evaluation affirms the positive impact of the PMTCT intervention in reducing MTCT of HIV, even if project target (5%) was not achieved. Recommendations aim to strengthen investment in PMTCT and enhance the hand-over strategy to ensure sustainability after MSF exit.
In 2016, UNAIDS identified the Prevention of Mother-to-Child Transmission of HIV (PMTCT) as a significant challenge in the fight against HIV/AIDS in Guinea. This abstract presents the key findings of an evaluation conducted on the PMTCT component of MSF's HIV project in Guinea, implemented since the early 2000’s. The main objective of the evaluation was to assess its relevance, coherence, effectiveness, efficiency, impact, and sustainability.
METHODS
A mixed quantitative and qualitative methodology was applied, including a desk review of MSF project documents, field observations, and interviews with key stakeholders. The data were analysed by triangulation and benchmarking to ensure internal validity. Quantitative indicators provided information on the number of women receiving PMTCT treatment and the rate of HIV mother-to-child transmission (MTCT) in health facilities supported by MSF, allowing the measurement of the effectiveness of the intervention. The quality of data and the lack of primary data from 2011 to 2015 was the main limitation, hindering the calculation of statistical significance (p-value) for the observed change in the rate of MTCT of HIV.
RESULTS
MSF's PMTCT intervention was highly relevant and aligned with the country's needs. It demonstrated effectiveness through the significant number of women receiving PMTCT treatment, the establishment of a platform for viral load testing, drug supply support, and a reduction in the HIV MTCT rate. The rate of MTCT in health facilities supported by MSF decreased from 35.9% to 12% [7 – 12] between 2010 and 2021. The challenges relating to data accuracy, monitoring activities, the follow-up of babies born from HIV-infected mothers, and the readiness of the MoH to take over the programme were identified, highlighting the need for improvement to enhance the effectiveness and efficiency. Sustainability efforts remained low as the Guinean health system lacked enough funding to take over the programme.
CONCLUSIONS
The evaluation affirms the positive impact of the PMTCT intervention in reducing MTCT of HIV, even if project target (5%) was not achieved. Recommendations aim to strengthen investment in PMTCT and enhance the hand-over strategy to ensure sustainability after MSF exit.
Conference Material > Slide Presentation
Gonzalez Arias M, Buero MM, Salem Z, Yang SL, Valori AV
MSF Paediatric Days 2024. 4 May 2024; DOI:10.57740/rqziQFZGbh
Conference Material > Abstract
Rubona F, Ibongu E, Bah AJ, Dianouni F, Wepnyui H
MSF Paediatric Days 2024. 4 May 2024; DOI:10.57740/Q5PYoCL
BACKGROUND AND OBJECTIVES Le Centre de Sante de Référence de Douentza fait face à des nombreux défis des soins néonataux exacerbés par le contexte d’accès très limités. Plusieurs initiatives ont été envisagées notamment le support continu du Pédiatre, analyses des causes des décès et définition des plans d’action, formation au lit des malades. Pour accéder et accompagner le personnel soignant, une formation virtuelle intersectionnelle des soins néonataux a été réalisée pendant 2,5 mois pour une équipe de 7 staffs (infirmières et médecins). Le partage de cette expérience a comme objectif de montrer les bonnes pratiques possibles dans ces contextes. CASE DESCRIPTION Après cette formation virtuelle interactive, l’équipe a pris l’initiative d’identifier les grands défis à relever pour améliorer les soins néonataux à travers une évaluation approfondie (arbre à problèmes) des pratiques de soins dans le projet. La collecte d’informations comprenait des observations sur place à travers des entretiens avec le personnel de santé et avec des accompagnants, des dossiers des patients ainsi que les audits de décès. Définition et implémentation du plan d’amélioration qui a permis : • Réorganisation de la salle de néonatologie en fonction du degré d’urgence : rouge, orange, vert, zone de réanimation. • Meilleure acceptance en interne et sensibilisation sur les soins de la mère kangourou et zéro séparation. • Mise en place et maitrise du protocole de prise en charge (PEC) et de la réanimation néonatale. • Consensus et adoption des critères de PEC (admissions, référence, soins palliatifs). • Travail en amont avec l’équipe de la Promotion de santé et engagement communautaire pour le recours précoce aux soins.
CONCLUSIONS La formation virtuelle a permis non seulement d’interagir, d’acquérir des nouvelles connaissances mais aussi l ́analyse et détection des causes profondes du problème, proposer des interventions ciblées à court et moyen terme ; définir le chronogramme d’implémentation ainsi que les indicateurs de suivi. Des changements perceptibles sont opérés et continueront pour des soins néonataux appropriés.
Conference Material > Slide Presentation
Mairos Ferreira S, Muthengi K, Mohale M, Mokhameleli S, Mathosi L
MSF Paediatric Days 2024. 4 May 2024; DOI:10.57740/x3w9-jj42
Conference Material > Poster
Guardiola M, Skidmore J, Kituyi M, Sagrado MJ, Tembo K
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/esTV2iD
Conference Material > Poster
Kowalski M, Minka Obama B, Catho G, Dewez JE, Merglen A, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/DCmLugFl15
Français