Assessment of the use of partographs in the region of Analamanga

Background: Maternal mortality is associated with an ever-worrying trend in Madagascar. The partograph, set up by the WHO, is topical when it comes to maternal and child mortality-reducing strategies, especially in developing countries. This study assesses the effect of partograph use on maternal and neonatal mortality in maternity wards of ten basic health centres (BHC) and three hospitals located in the districts of Avaradrano, Atsimondrano, Ambohidratrimo, including the district hospital (DH) of Ambohidroa.Methods: Across-sectional survey was conducted in selected districts, using parturients’ medical records during year 2010. Data were derived from the partographs of women meeting the following criteria: a spontaneous onset of labour, an uniparous pregnancy, a term birth, a foetal cephalic presentation, with no extra complication.Results: Neither maternal nor neonatal death was found where a partograph has been used. Partograph use rate is 64.8%. The main reasons for not using partographs include absence of training and lack of skilled health personnel. 128 abnormalities were identified with a correct management rate of 60.9%.Conclusions: Although implementation of the partograph appears to be easy and inexpensive, its use still collides with huge difficulties. It requires a qualified aid and a suitable environment to have a positive and significant impact on maternal and perinatal mortalities related to birth

Facteurs associés à la tuberculose chez l’enfant au Centre Hospitalier Universitaire Mère-Enfant de Tsaralalàna, Antananarivo: une étude cas-témoins

Introduction: A Madagascar, la tuberculose reste un problème de santé publique majeur, l'incidence s'élevant à 16% depuis 2009. Le présent travail a pour objet d'identifier les facteurs de risque de tuberculose chez l'enfant. Méthodes: Nous avons mené une étude rétrospective de type cas-témoins sur les facteurs de risque de la tuberculose chez les enfants de 0 à 15 ans au Centre Hospitalier Universitaire Mère-Enfant de Tsaralalàna, de Janvier 2009 à Décembre 2011. Les enfants diagnostiqués de tuberculose dont le diagnostic a été retenu par des éléments de certitude ou par le score pédiatrique de la tuberculose  représentent les cas. Les enfants hospitalisés durant la même période, non tuberculeux et de même âge, sont classés témoins. L'Odds Ratio quantifie les associations. Résultats: Au total, 91 cas et 173 témoins ont été inclus. Parmi les cas, 73,62% présentent une  malnutrition. De fortes associations sont démontrées avec : la malnutrition sévère (OR=6 (IC95% 2,43-15,61 (p<10-5))) ; le contage tuberculeux (OR=4,71 (IC95% 1,76-12,7 (p=0,003))) ; la non  vaccination par le BCG (OR=4,21 (IC95% 1,99-8,99 (p < 2.10-5))) ; le niveau intellectuel maternel bas (OR=4,17 (IC95% 0,67-28,14 (p=0,06))) ; la taille de la fratrie à partir de 5 (OR=4,5). Des associations faibles sont retrouvées pour les autres facteurs étudiés. Les cas présentent une létalité de 18,7% contre 6,3% chez les témoins (p<10-5) ; 64,7 % des décès sont dus aux formes méningées. Conclusion: La tuberculose reste un fléau chez les enfants, avec une lourde responsabilité de la pauvreté rassemblant presque tous les facteurs sus-cités.Key words: Facteurs de risque, Madagascar, pédiatrie, tuberculos

Family planning: formal health care providers’ challenges in the district of Antananarivo Avaradrano

Background: Recorded contraceptive prevalence may not represent all the women using contraceptives. Nevertheless, it serves as a fundamental tool in decision-making at Ministry and international level. This study aims to determine the actual contraceptive prevalence and identify factors determining users’ positions about modern contraception and local services deliveries in the district of Antananarivo Avaradrano.Methods: A cross-sectional survey was conducted, where an interviewer-administered questionnaire has been used to collect data. Targeted female respondents aged 18-39 were asked about their contraceptive use, knowledge and information sources on family planning, perception of social support and perception on the local health care providers.Results: Contraceptive prevalence is underestimated. Moreover, it is higher among women aged 35 to 39 and those having two children or more, but lower among those who have reached university level of education. Women who are able to tell two benefits of family planning, informed by the community health agents (CHA), and deciding with their partners on contraception use are more likely to use contraceptives on a regular basis. Women complain on their poor relationship with health care providers and doubt about their real competence.Conclusions: This study demonstrates the evidence of an underestimation of contraceptive prevalence. The challenge is how to collect reliable data, thus recording systems have to be improved. Besides, government efforts in increasing contraceptive use ought to be targeted on adolescents and young people aged 20-25, the couple itself, health-care provider – woman relationship, and on the CHA’s activities.