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.
Under-diagnosis of tuberculosis in children remains a major concern worldwide. The World Health Organization (WHO) recommends two new treatment decision algorithms for TB in children less than 10 years presenting with presumptive pulmonary TB. The algorithms are adapted to contexts with, and without radiography, include laboratory testing if available, and aim to facilitate treatment decision by assigning scores to symptoms and radiological features. However, little is known about the feasibility and acceptability of implementing these algorithms in Sub-Saharan Africa settings.
METHODS
Using a qualitative study design, we conducted 45 semi-structured interviews with health workers in nine health facilities in Uganda, Niger and Guinea. We analyzed the data thematically, and using the critical discourse analysis with a deductive and inductive approach to identify contextual barriers and acceptance of the intervention among health workers.
RESULTS
Firstly, discourse analysis shows that health workers identify various socio-cultural factors (e.g.: delays in children arriving at health facilities, stigmatization) and structural factors (e.g. high workload for health workers, lack of resources in the health centres) as the major barriers that make TB diagnosis difficult. In this context, implementation of the algorithms is positively perceived (e.g.: the scoring system was found to be useful and user-friendly) but raises some challenges (e.g.: additional paperwork). Otherwise, results shows that the implementation of the algorithms plays a role in strengthening health worker's sense of autonomy and efficiency, and some paramedical staff (nurses) express the wish to be more directly involved in applying the algorithms.
CONCLUSION
This study found that the new TB algorithms were perceived positively by health workers, and well accepted in the three countries. However, it illustrates the extent to which the implementation of innovative tools in healthcare structures needs to consider the existing system, potential barriers, and opportunities to ensure long-term use.
Early psychosocial stimulation for infants in precarious situations can yield both short- and long-term benefits to cognitive and social development. Comprehensive programmes, covering health, nutrition, and psychosocial stimulation prove most effective in preventing cognitive impairment and enhancing treatment for children with severe acute malnutrition (SAM). The StimNut study assesses the effects of early psychosocial stimulation on maternal mental health and mother-child relationship, as well as the acceptability of integrating such an intervention into the existing Médecins Sans Frontières (MSF) nutrition programme in Koutiala, during a 5-week period.
METHODS
Mixed-methods data were collected through standardised pre- and post- intervention questionnaires and included: a ‘Dusukasi’ screening tool for local perinatal depression-like symptoms; observations of mother-child interactions using an adapted PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes) tool; as well as semi-structured interviews with caregivers, MSF psychosocial workers, and healthcare staff.
RESULTS
149 psychosocial stimulation sessions were conducted with 36 families by three supervised MSF psychosocial workers. Perinatal depression symptoms were found in 53% of mothers before the intervention and 28% after the intervention (p=0.001). Positive changes in the mother-child relationship were observed in 83% of families after the 5-week intervention and more frequent and appropriate responses of the caregivers to the child’s emotional state were noted. Positive changes were also perceived by the mothers as the sessions progressed: their sense of parenting skills was strengthened, their children’s health improved, and the other family members became more involved in childcare practices. The intervention also dismantled healthcare staff prejudices towards mothers of children with SAM, fostering a trusting relationship between them.
CONCLUSIONS
This study demonstrates the positive impact of the early psychosocial stimulation of children with SAM on maternal mental health and the quality of mother-child relationship. As MSF pursues further endeavours in this direction, it is important to recognise the transformative potential these interventions hold for promoting the overall wellbeing of families of children with SAM in humanitarian and low-income countries.