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.
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.
Over 50,000 children in Nigeria’s Gombe state have moderate acute malnutrition (MAM) and are at risk of deteriorating to severe acute malnutrition (SAM). An effective strategy to reduce mortality is through a targeted supplementary feeding programme delivered within community-based management of acute malnutrition (CMAM) interventions. We present findings from an outpatient therapeutic programme (OTP) which used Tom Brown for treating children with MAM. Tom Brown is a locally produced flour blend of sorghum, soybeans, and groundnuts, consumed as a sweetened porridge.
METHODS
We conducted retrospective analysis of patient data from OTP sites in three local government areas between October 2022 and December 2023. Data were extracted for children aged 6-59 months diagnosed with MAM, defined as absence of oedema; weight-for- height z-score (WHZ) ≥-3 and <-2; and/or mid upper arm circumference (MUAC) ≥11.5 and <12.5 cm. Those enrolled for at least 14 days and receiving 1.5 kg per week of Tom Brown were included.
RESULTS
Of the 1,207 cases of MAM treated, 1,089 (90.2%) recovered i.e. had two consecutive visits with WHZ >-2 and MUAC >12.5 and no severe clinical complications; 91 (7.5%) defaulted; 21 (1.7%) did not improve; 4 (<1%) were transferred out; and 2 (<1%) died at the end of follow- up. During treatment, 197 (16.3%) deteriorated to SAM and were switched to ready-to-use therapeutic food. All deaths (n=2) deteriorated to SAM. For children who recovered without deterioration, average enrolment length was 36.3 (±15.8) days and average weight gain was 4.21 (±3.03) g/kg/day.
CONCLUSIONS
With acceptable recovery and low death rates, Tom Brown is a feasible alternative for treatment of MAM. Made with cheaper ingredients, it can potentially reach more children for the same cost, particularly when combined with frequent screening and early diagnosis in the community. Timely follow-up of defaulters may also improve adherence. Research is needed to understand Tom Brown’s effectiveness compared to commercial products or combination with cash-based assistance.
Kismayo is a city in southern Somalia and the capital of Jubaland State. In 2020, the Jubaland State Ministry of Health (MoH) recorded 1094 measles cases: an 8.2-fold increase from 2019. This study sought to estimate measles disease burden and measles vaccination coverage during the 2020-2021 outbreak, while further identifying key barriers and facilitators to measles vaccination and care.
METHODS
We utilised a sequential mixed-method approach with two phases of data collection. Phase one involved a cross-sectional household survey with a standard questionnaire while phase two included key informant interviews and focus group discussions with community members, health care workers and vaccination program administrators.
RESULTS
Of 6664 individuals, 338 measles cases were recorded during the two-year recall period, giving an attack rate of 5% (95%CI:4-5). 17 measles deaths were reported, giving a case fatality ratio of 4% (95%CI:2-6). Measles-specific mortality was 0.04 deaths/day/10000 population (95%CI:0.02-0.05). Initially, 50% of vaccine-eligible children had one or more doses of measles containing vaccine (MCV) and this rose to 69% by the end of the recall period. Thematic analysis led to the grouping of qualitative data into two overarching themes: sociocultural factors and health system factors. Regarding sociocultural factors, respondents gave insights on community measles knowledge and care practices, social responsibility for prevention, security challenges and measles-related rumours. Regarding health system factors, respondents spoke about challenges with health service management and shortcomings in the implementation of the expanded programme on immunisation (EPI) and mass vaccination campaigns.
CONCLUSIONS
Our results show that measles represents a serious health burden for the Kismayo population and that MCV coverage is well below the 95% target for herd immunity. We recommend developing a population-specific approach to risk communication and community engagement, expanding measles care, increasing accessibility for EPI services in health facilities and mobile clinics, and developing improved programmatic strategies for mass vaccination campaigns.
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.