Severely malnourished patients can present with bilateral pitting oedema, which is a common sign of Kwashiorkor. However, bilateral pitting oedema can also be an expression of other pathologies. In Mali and DRC, the number of children presenting with bilateral pitting oedema at MSF (Médecins Sans Frontiers/Doctors Without Borders) hospitals are up to 30% (Mali) and 49% (DRC) higher than in other countries, however, the reasons underlying this trend are unknown. Through this qualitative study, we aimed to explore the perspectives and lived experiences of health professionals on the diagnosis and management of children with bilateral pitting oedema. Using a participatory approach, we conducted 21 in-depth interviews, and 2 focus groups with health professionals at MSF health facilities who had worked in the settings of Koutiala (Mali) and Rutshuru (DRC) for at least 6 months. The understanding of the bilateral pitting oedema phenomenon is complex. Health workers described clinical obstacles to reducing mortality, including: i) difficulties making the diagnosis due to a lack of specialized staff and insufficient resources, ii) challenges treating complications that may arise due to the complexity of the diseases associated with bilateral pitting oedema, and iii) lack of scientific evidence in the literature explaining the physiopathology of bilateral pitting oedema. Study participants shared several key recommendations for reducing mortality among children presenting with bilateral pitting oedema, including prevention of bilateral pitting oedema at the community level, standardization of the diagnostic process, strengthening of medical training, and better collaboration both within the medical teams and between teams and the children’s families.

BACKGROUND

In Mali, cancer patients are often diagnosed at stage III or IV. Tumor wounds are more frequent and associated with malodorous exudates, responsible for an altered quality of life and stigmatization of patients. Cinesteam® Cinnamon Dressing is an adsorbent dressing designed to reduce odors. This study aimed at demonstrating the feasibility of routine use of cinnamon dressing in the Malian context, and to assess its effect on tumor wound odors.

PATIENTS AND METHODS

This is a prospective observational pilot study conducted jointly by the oncology department of the Point G University hospital in Bamako and Médecins Sans Frontières France. Included patients suffered from a malignant malodourous wound and were treated with cinnamon dressing. The primary endpoint was wound odor. Secondary endpoints were appetite, duration of dressing efficacy and ease of use.

RESULTS

Forty patients were included in this pilot study. Complete data and follow-up were available for 19 patients only. The odor score reported by patients was significantly decreased after 10 days of cinnamon dressing (odor score 1.7 versus 3.3, t-test 0.00003). Seventeen patients reported that the CINESTEAM® dressing was easy to use, even for patients receiving home-based palliative care in remote areas. The dressing provided an odor control that lasted more than 24 h. One year after inclusion, more than half of the patients had died of their cancer, indicating a very advanced stage at diagnosis. The cinnamon dressing had no effect on appetite, but most of the patients were undergoing palliative chemotherapy, which may account for this result.

CONCLUSION

The use of innovative dressings is feasible, even in very deprived contexts, and might decrease the discomfort linked with unpleasant odors in tumoral wounds. Odor management is crucial to restore self-esteem and to prevent patients' stigma and isolation.

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.