Conference Material > Abstract
Danno K, Worku DT, Adjaho I, Ale F, Katuala Y, et al.
MSF Paediatric Days 2024. 2024 May 4; 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 > Slide Presentation
Danno K, Worku DT, Adjaho I, Ale F, Katuala Y, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/MyxnLeH
Conference Material > Poster
Chara A, Abdullahi M, Ogundipe K, Briskin E, Phelan S, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/2iJ2KobBXf
Conference Material > Poster
Litster M, Sangma M, Kihara M, Nanclares C, de Bartolome Gisbert F, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/Fj2D7kx7k
Conference Material > Poster
Olaleye M, Farley ES, Karinja MN, Lawal AM, Muhammad S, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/dhIP6SLTf8
Conference Material > Abstract
Mairos Ferreira S, Muthengi K, Mohale M, Mokhameleli S, Mathosi L
MSF Paediatric Days 2024. 2024 May 4; 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
Bigirimana T, Thind A, Hawa Diallo O, Kourouma A, Burzio C, et al.
MSF Paediatric Days 2024. 2024 May 4; 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 > Abstract
Shyaka A, Kabongo F, Tolno C, Barry I, Bachy C
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/KTMPcj
CONTEXTE ET OBJECTIFS
Les épidémies de maladies évitables par la vaccination sont récurrentes en Guinée. En 2020, Matoto a enregistré 86% des cas de rougeole rapportés à Conakry. Cette étude avait pour objectif d’évaluer les occasions manquées de vaccination chez les enfants de 0-59 mois.
METHODES
Il s’agissait d’une étude transversale par entretien de sortie dans quatre établissements de santé (ES) de Matoto (Bernay Fotoba, Saint Gabriel, Tombolia, Dabompa) du 11-19 avril 2023. A été considéré comme OMV, tout enfant qui n'avait pas reçu les vaccins indiqués à l’issue de sa visite même s'il avait dépassé l'âge recommandé pour les recevoir selon la politique du pays.
Un échantillon de convenance par défaut a été utilisé avec au minimum, 100 enfants sélectionnés (50 âgés de 0-23 mois et 50 âgés de 24-59 mois) dans chaque ES. Les données ont été recueillies à l'aide d’un questionnaire anonyme standardisé MSF puis saisies dans une base de données Excel développé par MSF où les indicateurs ont été calculés automatiquement. Cette évaluation a reçu les approbations du comité national d’éthique et du comité d’éthique de MSF.
RESULTATS
Sur 357 enfants (0-23 mois=182 ; 24-59 mois=175) éligibles pour une vaccination, 300 ont présenté une OMV soit une prévalence des OMV de 84% (300/357). Parmi les enfants avec OMV, 53% (159/300) avait 24-59 mois. Ceux de 0-23 mois, cible du PEV, représentaient 47% (141/300). Le vaccin antirougeoleux (56%) et le vaccin antipoliomyélitique oral (50%) ont été les plus manqués. Nous notons que 41% (124/300) des enfants avec OMV étaient présents dans ces ES pour une vaccination. Le manque d’information (47%) et les ruptures de vaccins (38%) étaient les principales raisons invoquées par les participants pour justifier les OMV.
CONCLUSIONS
Nos résultats montrent la nécessité d’intégrer l’évaluation des OMV dans le système de santé en tant que processus de routine et d’assurer un approvisionnement constant et suffisant en vaccins et matériel de vaccination.
Conference Material > Abstract
Ostrowski JJ, Parikh K, Umar A
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/3mfOFt
BACKGROUND AND OBJECTIVES
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.
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.
Conference Material > Abstract
Lau DK, Seebacher S, Abdi AM, Bishar S, Nur MB, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/eyJwVt4rop
BACKGROUND AND OBJECTIVES
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.
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.