Introduction
Médecins Sans Frontières (MSF) est présent Kouroussa depuis juin 2017 et a fourni des services de soutien aux structures de santé publiques (l'hôpital préfectoral de Kouroussa, les 13 centres de santé de la préfecture et 6 postes de santé), ainsi que des services de santé communautaires pour les enfants de 0 à 5 ans. Au niveau de l'hôpital préfectoral MSF, assure la prise en charge gratuite des cas de paludisme simple et grave, de la malnutrition et autres pathologies. Au niveau des centres de santé et des postes de santé, MSF assure le traitement gratuit des cas simples de paludisme, de la malnutrition, de la diarrhée et d'infections des voies respiratoires, mais aussi assure le transport des cas graves de ces structures vers l'hôpital préfectoral de la préfecture. Au niveau communautaire, MSF assure à travers des agents et relais communautaires, la prise en charge gratuite des cas simples de paludisme, le dépistage de la malnutrition, la prise en charge des cas de diarrhée, le suivi du calendrier de vaccination des enfants et le transfert des cas complexes vers les formations sanitaires. Afin d'améliorer et d'évaluer l'impact de ses activités dans la préfecture, MSF réalise chaque année une enquête rétrospective sur la mortalité avec un volet qui évalue le comportement par rapport à la recherche des soins dans la communauté. MSF mène également des activités de recherche opérationnelle visant à améliorer la santé des habitants de la préfecture.
Méthodologie
Une enquête de mortalité rétrospective (avec une composante sur la recherche des soins) en grappe à 2 degrés, a été réalisée dans les 12 sous-préfectures de Kouroussa du 7 au 14 Juin 2019. 45 grappes ont été enquêtées. La période de rappel s’étendait du 15 Juin 2018 (fête de Ramadan 2018) au jour de l’enquête. La population cible était constituée par l’ensemble des personnes résidant dans la préfecture de Kouroussa. L’évaluation de recherche de soins par rapport à la fièvre/paludisme a été réalisée pour les enfants de 0 à 5 ans.
Résultats
5 510 personnes ont été recensées dans 541 ménages, dont 5 283 étaient présentes et vivantes dans les ménages à la fin de l'enquête. La taille moyenne des ménages était 9,8 personnes et les enfants âgés de moins de 5 ans ont représenté 18,8% (95% IC : 17,3-20,3) de l’ensemble des personnes inclus. Pendant la période de rappel, 66 décès ont été rapportés : le taux brut de mortalité était estimé à 0,35 décès/10 000/jour [95% IC: 0,23-0,46; Deff : 1,20] et le taux de mortalité chez les enfants de moins de 5 ans était estimé à 0,81 décès/10 000/jour [95% IC: 0,40-1,20; Deff : 1,89]. Les
décès du a la fièvre/paludisme ont représenté 24,2% (IC 95%: 14,5-36,4) des décès rapportés. 68,2 % (IC 95%: 55,6-79,1) décès ont été survenus dans les ménages. 21,5% (IC 95%: 19,3-23,8) des
enfants de 0 à 5 ans ont eu de la fièvre au cours de deux semaines précèdent le jour de l’enquête. 85,7%(IC 95%: 80,9 - 89,6) d’enfants fiévreux ont eu à rechercher les soins avec 69,1% (IC 95%: 62,9-74,7) dans une structures de santé (y compris les agents/relais communautaires). « L'enfant n'est pas assez malade », a été identifié comme la principale raison de non recherche de soins chez les enfants de moins de 5 ans. 61,4% [95% IC: 54,8-67,7]) des enfants de 0 à 5 ans ont eu accès à des soins de santé gratuits. 66,5% (95% IC : 60,1-72,6) ont eu accès à un test de dépistage du paludisme avec 87,1% (95% IC : 80,8 – 91,9) de ces tests réalisés dans une structure sanitaire. 95,1% (IC 95%: 90,2-98,0) des enfants dont le test de dépistage du paludisme était positif avaient accès à un traitement antipaludique.
Conclusion
Nos résultats montrent une réduction de taux brut de mortalité et taux de mortalité chez les enfants de moins de 5 ans. Le recours aux soins chez les enfants âgés de 0 à 5 ans était élevé, mais les répondants étaient plus susceptibles de rechercher des soins quand ils percevaient la maladie comme «grave». L'accès aux tests de dépistage du paludisme a grandement influencé les chances de
recevoir un traitement de qualité. La majorité des décès sont survenus au sein des ménages, la fièvre/paludisme étant la principale cause de décès.
In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes.
METHODS
A retrospective analysis of EmOC data (2011 and 2012).
RESULTS
A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%).
A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by ‘general practitioners with surgical skills’ and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died.
CONCLUSION
Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.
Outcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé).
METHODS
A retrospective descriptive cohort study, using routine programmatic data from the MSF sexual violence programmes in Masisi and Niangara, DRC, for 2012.
RESULTS
In Masisi, 491 survivors of sexual violence presented for care, compared to 180 in Niangara. Niangara saw predominantly sexual violence perpetrated by civilians who were known to the victim (48%) and directed against children and adolescents (median age 15 (IQR 13–17)), while sexual violence in Masisi was more directed towards adults (median age 26 (IQR 20–35)), and was characterised by marked brutality, with higher levels of gang rape, weapon use, and associated violence; perpetrated by the military (51%). Only 60% of the patients in Masisi and 32% of those in Niangara arrived for a consultation within the critical timeframe of 72 hours, when prophylaxis for HIV and sexually transmitted infections is most effective. Survivors were predominantly referred through community programmes. Treatment at first contact was typically efficient, with high (>95%) coverage rates of prophylaxes. However, follow-up was poor, with only 49% of all patients in Masisi and 61% in Niangara returning for follow-up, and consequently low rates of treatment and/or vaccination completion.
CONCLUSION
This study has identified a number of weak and strong points in the sexual violence programmes of differing contexts, indicating gaps which need to be addressed, and strengths of both programmes that may contribute to future models of context-specific sexual violence programmes.
A caesarean section (C-section) is a life-saving emergency intervention. Avoiding pregnancies for at least 24 months after a C-section is important to prevent uterine rupture and maternal death.
OBJECTIVES
Two years following an emergency C-section, in rural Burundi, we assessed complications and maternal death during the post-natal period, uptake and compliance with family planning, subsequent pregnancies and their maternal and neonatal outcomes.
METHODS
A household survey among women who underwent C-sections.
RESULTS
Of 156 women who underwent a C-section, 116 (74%) were traced; 1 had died of cholera, 8 had migrated and 31 were untraceable. Of the 116 traced, there were no post-operative complications and no deaths. At hospital discharge, 83 (72%) women accepted family planning. At 24 months after hospital discharge (n = 116), 23 (20%) had delivered and 17 (15%) were pregnant. Of the remaining 76 women, 48 (63%) were not on family planning. The main reasons for this were religion or husband's non-agreement. Of the 23 women who delivered, there was one uterine rupture, no maternal deaths and three stillbirths.
CONCLUSION
Despite encouraging maternal outcomes, this study raises concerns around the effectiveness of current approaches to promote and sustain family planning for a minimum of 24 months following a C-section. Innovative ways of promoting family planning in this vulnerable group are urgently needed.
As neonatal care is being scaled up in economically poor settings, there is a need to know more on post-hospital discharge and longer-term outcomes. Of particular interest are mortality, prevalence of developmental impairments and malnutrition, all known to be worse in low-birthweight neonates (LBW, <2500 g). Getting a better handle on these parameters might justify and guide support interventions. Two years after hospital discharge, we thus assessed: mortality, developmental impairments and nutritional status of LBW children.
METHODS
Methods: Household survey of LBW neonates discharged from a neonatal special care unit in Rural Burundi between January and December 2012.
RESULTS
Of 146 LBW neonates, 23% could not be traced and 4% had died. Of the remaining 107 children (median age = 27 months), at least one developmental impairment was found in 27%, with 8% having at least five impairments. Main impairments included delays in motor development (17%) and in learning and speech (12%). Compared to LBW children (n = 100), very-low-birthweight (VLBW, <1500 g, n = 7) children had a significantly higher risk of impairments (intellectual - P = 0.001), needing constant supervision and creating a household burden (P = 0.009). Of all children (n-107), 18% were acutely malnourished, with a 3½ times higher risk in VLBWs (P = 0.02).
CONCLUSIONS
Reassuringly, most children were thriving 2 years after discharge. However, malnutrition was prevalent and one in three manifested developmental impairments (particularly VLBWs) echoing the need for support programmes. A considerable proportion of children could not be traced, and this emphasises the need for follow-up systems post-discharge.
Recurrent measles outbreaks followed by mass vaccination campaigns (MVCs) occur in urban settings in sub-Saharan countries. An understanding of the reasons for this is needed to improve future vaccination strategies. The 2017 measles outbreak in Guinea provided an opportunity to qualitatively explore suboptimal vaccination coverage within an MVC among participants through their perceptions, experiences and challenges.
METHODS
We conducted focus group discussions with caregivers (n=68) and key informant interviews (n=13) with health professionals and religious and community leaders in Conakry. Data were audio-recorded, transcribed verbatim from Susu and French, coded and thematically analysed.
RESULTS
Vaccinations were widely regarded positively and their preventive benefits noted. Vaccine side effects and the subsequent cost of treatment were commonly reported concerns, with further knowledge requested. Community health workers (CHWs) play a pivotal role in MVCs. Caregivers suggested recruiting CHWs from local neighbourhoods and improving their attitude, knowledge and skills to provide information about vaccinations. Lack of trust in vaccines, CHWs and the healthcare system, particularly after the 2014-2016 Ebola epidemic, were also reported.
CONCLUSIONS
Improving caregivers' knowledge of vaccines, potential side effects and their management are essential to increase MVC coverage in urban settings. Strengthening CHWs' capacities and appropriate recruitment are key to improving trust through a community involvement approach.