Impact of an Antenatal Counseling on Use of Modern Family Planning Methods in the Postpartum in Rural Guinea

In Guinea, family planning (FP) uptake remains low. The objective of this study was to compare the impact of two types of antenatal counseling on modern FP uptake in the postpartum in rural Guinea. This was a two-group non-equivalent study comparing the impact of a reinforced antenatal counseling (intervention) to the routine antenatal counseling (control). The study included 404 pregnant women at five rural health centres in Forécariah district, Western Guinea. Each woman was followed up until the ninth month postpartum. The study was conducted from October 12, 2013 to December 30, 2014. Findings showed that at the ninth month postpartum, use of modern FP was significantly higher in the intervention group than in the control group (5.7% and 1.1%, respectively; p=0.024). However, 67.6% and 65.7% of women in the intervention group and the control group, respectively, abstained from sexual intercourse at the sixth month postpartum and had the intention to do so until the child walks. At the ninth month postpartum such women represented 70.5% and 59.5%, respectively. Therefore, a longer study period is recommended to assess the effect of antenatal counseling on use of modern FP in the postpartum in Guinea. Keywords: Antenatal counseling; Family planning; Postpartum; Rural; Guine

The Ebola-effect in Guinea 2014-15: Tangled trends of malaria care in children under-five.

The 2014-15 Ebola outbreak in West Africa was disruptive for the general health services in the affected countries. This study assessed the impact of the outbreak on the reported number and management of malaria in children under-five in rural Guinea.A retrospective cross-sectional study was conducted in nineteen health centres in two rural, malaria-endemic health districts, one at the epicentre of the outbreak (Guéckédou) and one (Koubia) spared by Ebola. Routine surveillance data at health facility level were compared over similar periods of high malaria transmission in both districts before, during and after the outbreak.There were significant declines in the number of visits during the Ebola outbreak (3,700) in Guéckédou compared to before (4,616) and after it (4,195), while this trend remained more stable within the three periods for Koubia. Differences were nonetheless significant in both districts (p<0.001). In 2014, during the peak of the outbreak, the overall number of malaria cases treated exceeded the number of confirmed malaria cases in Guéckédou. There were decreases in antimalarial treatment provision in August and November 2014. In contrast, during 2015 and 2016, the proportion of malaria positive cases and those treated were closely aligned. During the peak of the Ebola outbreak, there was a significant decrease in oral antimalarial drug administration, which corresponded to an increase in injectable antimalarial treatments. Stock-outs in rapid diagnostic tests were evident and prolonged in Guéckédou during the outbreak, while more limited in Koubia.The Ebola outbreak of 2014-15 in Guinea had a significant impact on the admission and management of malaria in children under-five. This study identifies potential challenges in the delivery of care for those at highest risk for malaria mortality during an Ebola outbreak and the need to improve preparedness strategies pre-Ebola and health systems recovery post-Ebola

Monthly trends of visits, malaria cases and their management in under-fives, Guinea.

<p>(A): numbers of all visits and malaria suspect cases in under five children at the health centres in the health districts of Guéckédou and Koubia before (2013), during (2014–2015) and after (2016) the Ebola outbreak in Guinea; (B): numbers of cases tested for malaria, malaria positive, and treated for malaria in under five children at health centres in the health districts of Guéckédou and Koubia before (2013), during (2014–2015) and after (2016) the Ebola outbreak in Guinea.</p

Number of monthly RDT stock-out facility-days in 2013–2016 in Guinea.

<p>Number of monthly RDT stock-out facility-days in 2013–2016 in Guinea.</p

Malaria suspect cases among under-five children attending health centres in the health districts of Guéckédou and Koubia in Guinea from 2013–2016.

<p>Malaria suspect cases among under-five children attending health centres in the health districts of Guéckédou and Koubia in Guinea from 2013–2016.</p

Monthly trends in numbers of oral/injectable antimalarial drug doses administered to under-fives in 2014, Guinea.

<p>Monthly trends in numbers of oral/injectable antimalarial drug doses administered to under-fives in 2014, Guinea.</p