Evaluation de la qualite des soins neonatals dans un hopital de reference du Burkina Faso.

Objectif général : Evaluer la qualité des soins fournis aux nouveau-nés.Matériels et Méthode : Il s’agissait d’une étude transversale à visée descriptive qui s'est déroulée sur quatre mois (15 janvier au 14 Mai 2018) dans l'unité de néonatologie du Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso. Les données générales administratives, les soins néonatals, l’opinion des jeunes mères et des agents de santé étaient évalués. L’outil d’évaluation et d’amélioration de la qualité des soins maternels, néonatals et pédiatriques intégrés de l’Organisation mondiale de la santé adapté au contexte du Burkina Faso était utilisé.Résultats : La qualité des données administratives et générales de l'hôpital était notée 4 sur 5. Les soins néonatals avaient une moyenne de 3 sur 5. Les mères estimaient que le niveau de la qualité des soins néonatals atteignait le score de 4 tandis que les agents de santé jugeaient à 3 la qualité de ces soins. Le score final de l’évaluation était 3 sur 5.Conclusion : Il y a un besoin certain d’amélioration pour atteindre les standards de soins de qualité néonatals dans cet hôpital. La bonne qualité des soins passe par la formation continue du personnel, l’équipement, la disponibilité des médicaments et des intrants, un changement de comportement de tous les acteurs qui interviennent dans le système de soins. Mots clés : Qualité, Evaluation, Soins néonatals English Abstract Assessment of the quality of neonatal care in a referral hospital of Burkina Faso. Objective: To determine the level of quality of care provided to newborns.Materials and Methods: This was a descriptive cross-sectional study over a four-month period from January 15 to May 14, 2018 at the University Teaching Pediatric Hospital Charles de Gaulle Neonatal Care Unit, Ouagadougou, Burkina Faso. Administrative data, neonatal care, opinion of young mothers and caregivers have been evaluated. The World Health Organization's assessment and quality improvement tool for integrated maternal, neonatal and pediatric care adapted to the context of Burkina Faso was used.Results: The quality of the administrative and general data was rated 4 out of 5. The quality of the neonatal care was rated 3 out of 5 including neonatal health services, infection control practices, availability of materials and products rated 3 out of 5 and availability of drugs, management of sick newborns, and monitoring and follow-up of sick newborns, each rated 4 out of 5. In their opinion, mothers rated the quality of neonatal care as high. 4 while health workers rated the quality of this care as high. The final evaluation score of 3 out of 5 meant that there is a definite need for improvement to reach the standards of neonatal quality care in this hospital.Conclusion: Improving the quality of neonatal care at CHUP CDG is essential for reducing neonatal and infant mortality. This quality involves continuous training of staff, equipment, the availability of medicines and inputs, a change in behavior of all the actors involved in the health care system. Keywords: Quality of care, Assessment, Neonatal care, Newborn

Les nouveau-nes de faible poids de naissance en milieu Hospitalier du Burkina Faso

Introduction : Le faible poids de naissance constitue un problème de santé publique dans les pays en développement. Au Burkina Faso, la prévalence est estimée à 9,6 %. Le but de cette étude était d'étudier les nouveau-nés de faible poids de naissance hospitalisé dans un centre de santé de niveau tertiaire du Burkina Faso. Matériels et méthode : Il s’agissait d’une étude rétrospective descriptive et analytique sur les dossiers des nouveau-nés de faible poids de naissance (< 2 500 g) hospitalisés dans l'unité de néonatologie du centre hospitalier universitaire pédiatrique Charles de Gaulle de Ouagadougou au cours de l’année 2017 (1er janvier au 31 décembre). Résultats : La fréquence des FPN était de 24,9 %. L’âge moyen à l'admission des nouveau-nés était de 4,31 ± 5,58 jours ; 53,6 % des nouveau-nés étaient de sexe féminin (ratio F/M de 1,15). Les parents des nouveau-nés résidaient en milieu urbain dans 79,6 % des cas, la mère avait un âge moyen de 26,46 ± 5,46 ans. A l’admission des nouveau-nés, les principaux signes cliniques étaient représentés par les troubles neurologiques, l'hypoglycémie, l'anémie et l'hypocalcémie. L’allaitement mixte était pratiqué chez 55,4 % des nouveau-nés et ils avaient un gain pondéral moyen de 6,38 g/kg/jour. La durée d’hospitalisation était 13,5 jours, le taux de létalité de 4,5 %. Conclusion : Le faible poids à la naissance est fréquent dans notre contexte.  Grâce à une prise en charge adaptée, l'évolution hospitalière chez ce type de nouveau-né semble favorable. Cependant, des études ultérieures à grande échelle permettront de connaître l'impact de cette morbidité sur le développement des enfants qui en sont affectés.   English title: Low birth weight newborns hospitalized in Burkina Faso Introduction: Low birth weight is a public health problem in developing countries. In Burkina Faso, the prevalence was estimated at 9.6%. The aim of this study was to study low birth weight newborns hospitalized in our context.Materials and method: This was a retrospective study on files of low birth weight newborns hospitalized at CHUP-CDG in 2017 (from 1st January to 31st December).Results: The frequency of FPN was 24.9%. The mean age of the newborns was 4.31 ± 5.58 days; 53.6% of the newborns were female (M:F sex ratio 1:1.16). The parents of the newborns lived mainly in urban areas (79.6%), the mother had an average age of 26.46 ± 5.46 years. On admission, the main clinical signs were represented by neurological disorders, hypoglycemia, anemia and hypocalcemia. Mixed breastfeeding was practiced in 55.4% of newborns and they had a weight gain of 6.38 g / kg / day. The hospital stay was 13.5 days, the lethality rate 4.5%.Conclusion: Low birth weight is frequent in our context. With appropriate care, the hospital course of this type of newborn appears favorable. However, further large-scale studies are needed to assess the real burden of this morbidity on the development of children-affected

Changes in body mass index and hemoglobin concentration in breastfeeding women living with HIV with a CD4 count over 350: Results from 4 African countries (The ANRS 12174 trial)

Introduction: Breastfeeding is recommended for infants born to HIV-infected women in low-income settings. Both breastfeeding and HIV-infection are energy demanding. Our objective was to explore how exclusive and predominant breastfeeding changes body mass index (BMI) among breastfeeding HIV1-positive women participating in the ANRS12174 trial (clinical trial no NCT0064026). Methods: HIV-positive women (n = 1 267) with CD4 count >350, intending to breastfeed HIV-negative infants were enrolled from Burkina Faso, South Africa, Uganda and Zambia and counselled on breastfeeding. N = 1 216 were included in the analysis. The trial compared Lamivudine and Lopinavir/Ritonavir as a peri-exposure prophylaxis. We ran a linear mixed-effect model with BMI as the dependent variable and exclusive or predominant breastfeeding duration as the key explanatory variable. Results: Any breastfeeding or exclusive/predominant) breastfeeding was initiated by 99.6% and 98.6% of the mothers respectively in the first week after birth. The median (interquartile range: IQR) duration of the group that did any breastfeeding or the group that did exclusive /predominant breastfeeding were 9.5 (7.5; 10.6) and 5.8 (5.6; 5.9)) months, respectively. The median (IQR) age, BMI, CD4 count, and HIV viral load at baseline (day 7) were 27 (23.3; 31) years, 23.7 (21.3; 27.0) kg/m2, 530 (432.5; 668.5) cells/μl and 0.1 (0.8; 13.7)1000 copies/mL, respectively. No major change in mean BMI was seen in this cohort over a 50-week period during lactation. The mean change between 26 and 50 weeks after birth was 0.7 kg/m2. Baseline mean BMI (measured on day 7 postpartum) and CD4 count were positively associated with maternal BMI change, with a mean increase of 1.0 kg/m2 (0.9; 1.0) per each additional baseline-BMI kilogram and 0.3 kg/m2 (0.2; 0.5) for each additional CD4 cell/μl, respectively. Conclusion: Breastfeeding was not negatively correlated with the BMI of HIV-1 infected Sub-Saharan African mothers. However, a higher baseline BMI and a CD4 count >500 cells/μl were associated with maternal BMI during the exclusive/ predominant breastfeeding period. Considering the benefits of breast milk for the infants and the recurrent results from different studies that breastfeeding is not harmful to the HIV-1-infected mothers, this study also supports the WHO 2016 guidelines on infant feeding that mothers living with HIV should breastfeed where formula is not safe for at least 12 months and up to 24 months, given that the right treatment or prophylaxis for the infection is administered. These findings and conclusions cannot be extrapolated to women who are immune-compromised or have AIDS