Evaluation of direct costs associated with the management of clinical stage of malaria in children under five years old in Gabon

BACKGROUND: Malaria is one of the leading causes of morbidity and mortality in African countries. It is one of the leading causes of hospital visits and hospitalization in pediatric wards for children under 5 years old. Interestingly however, the economic burden of this disease remains unknown in these endemic countries including Gabon. The purpose of this study is to assess the direct hospital cost for the management of malaria in children under 5 years old at the Libreville University Hospital Centre (CHUL, Centre Hospitalier Universitaire de Libreville) in Gabon. METHODS: This research work is a retrospective study using a comprehensive review of medical records of patients seen at the CHUL over a two-year period extending from January 2018 through December 2019. The study focused on children under 5 years old, admitted for malaria in the paediatric ward of the CHUL. The analysis targeted specifically direct hospital costs, which excluded salary and wages of health care workers. The monetary currency used in this study was the CFA francs, as that currency is the one used in Central Africa (as reference, 1 Euro = 656 CFA francs). RESULTS: For the set timeframe, 778 patient records matched the study criteria. Thus, out of 778 admitted patients, 58.4% were male while 41.5% were female. Overall, the average age was 13.2 months (± 13.8 months). The total cost incurred by the hospital for the management of these 778 malaria patients was 94,922,925 CFA francs (144,699.58 €), for an average expense per patient topping at 122,008 CFA francs (185.99 €). The highest expenditure items were hospitalizations (44,200,000 CFA francs, 67,378.1 €), followed by drugs (26,394,425 CFA francs, 40,235.4 €) and biomedical examinations (14,036,000 CFA francs, 21,396.34 €). CONCLUSION: The financial burden for managing malaria in the paediatric ward seems to be very high, not only for the hospital, but also for families in spite of the government medical insurance coverage in some cases. These findings bring new insights as to the urgency to develop policies that foster preventive initiatives over curative approaches in the management of malaria in children in endemic countries

Sociocultural and therapeutic aspects of the childhood epilepsy in Gabon

L’épilepsie survient à tout âge, mais les causes, l’expression clinique, les complications et le retentissement social, sont fonction de l’âge des sujets. En Afrique subsaharienne, les données épidémiologiques, les données portant sur la scolarisation et le retentissement de l’épilepsie de l’enfant sont peu accessibles. Afin d’évaluer les aspects socioculturels et thérapeutiques de l’épilepsie de l’enfant au Gabon, nous avons réalisé une revue de la littérature sur l’épilepsie de l’enfant en Afrique subsaharienne et deux enquêtes transversales, l’une sur les connaissances, attitudes et pratiques et les représentations socioculturelles de l’épilepsie de l’enfant auprès des enseignants et des personnels de santé, l’autre sur la qualité de vie des enfants souffrant d’épilepsie et de leurs parents. En Afrique subsaharienne, les données sur l’épilepsie de l’enfant sont diluées dans les études étendues à la population entière. La prévalence de l’épilepsie de l’enfant varie de 2 à 297 ‰ et son incidence de 17 à 930 / 100 000 personnes-années. Les facteurs périnataux, les crises fébriles et les facteurs infectieux sont les plus décrits alors que les facteurs génétiques demeurent peu étudiés. La prise en charge de l’enfant reste limitée à cause de l’insuffisance des ressources humaines, des moyens diagnostics et de l’accès aux traitements antiépileptiques mais aussi à cause de la persistance des préjugés et des croyances négatives sur l’épilepsie communément retrouvées parmi les enseignants, les enfants en âge scolaire et dans la population. Les enfants épileptiques sont une source d’angoisse, de perturbations socioprofessionnelles et scolaires pour leurs parents et de leur fratrie. Les enquêtes ont retrouvé un niveau de connaissance bas, une persistance de croyances négatives, notamment celles qui considèrent l’épilepsie comme une affection contagieuse ou transmissible, une maladie psychiatrique ou un retard mental ou encore une maladie surnaturelle. Ces considérations rencontrées indifféremment en milieu urbain ou rural semblent tenir leur explication dans la conception culturelle de l’épilepsie qui renvoie cette maladie à une cause extérieure ; un animal ou un mauvais esprit. En milieu rural, les enfants n’ont généralement pas d’avis médical, mais la scolarisation reste supérieure à 50 % indépendamment de leur milieu de vie. La non-scolarisation est liée aux comorbidités, à l’attitude réfractaire des parents et de certains chefs d’établissements scolaires. L’anxiété, les troubles du comportement, les troubles cognitifs et les troubles de la sociabilité restent élevés. La qualité de vie des parents de l’enfant épileptique est altérée. Ce travail sera étendu à d’autres localités du Gabon pour inclure plus d’enfants épileptiques et mettre en place une cohorte. Cette cohorte pourra servir à l’évaluation de la fraction attribuable des infections (notamment celle du paludisme grave) dans la survenue de l’épilepsie ; l’évaluation du stigma chez l’enfant épileptique et leurs parents et à la mise en place de programmes d’éducation thérapeutique et de promotion de la santé auprès des familles, des enseignants et des personnels de santé.Epilepsy occurs at any age, but the causes, clinical manifestations, complications and social impact, depend on the age of the subjects. In Sub-Saharan Africa epidemiological data, data on enrollment and the impact of the child's epilepsy are difficult to access. To assess the socio-cultural and therapeutic aspects of the child's epilepsy in Gabon, we conducted a review of the literature on child epilepsy in SSA and two cross-sectional surveys, one on knowledge, attitudes, practices and socio-cultural representations of childhood epilepsy in teachers and health workers, the other on the impact of epilepsy on the children with epilepsy and their parent. In SSA, the data on child epilepsy drowned in studies extended to the general community. The prevalence of childhood epilepsy varies from 2.04 to 297/1000 and its incidence from 17 to 930/100.000 person-years. Perinatal factors, febrile seizures and infectious factors are most described while genetic factors remain poorly studied. The care of the child remains limited due to the lack of human resources, diagnostic means and access to AEDs but also because of the persistence of prejudices and negative beliefs about epilepsy commonly found in teachers, school children and in the community. Children with epilepsy are a source of anxiety, disruption of socio-professional and academic activities for parents and their siblings. The surveys found a low level of knowledge, persistence of negative beliefs, including those that consider epilepsy as a contagious or communicable disease, psychiatric illness or mental retardation or a supernatural disease. These considerations found in urban and rural areas could be explained by the cultural conception of epilepsy that links the disease to an external cause, to an animal, or an evil spirit. In rural areas, children usually have no medical advice, but enrollment is still above 50% regardless of their living environment. Non-enrollment is related to comorbidities, the refractory attitude of parents and some school heads. Anxiety, behavioral disorders, cognitive disorders and disorders of sociability remain high. The quality of life of epileptic children's parents is impaired. This work will be extended to other areas to include more children with epilepsy and build a cohort. This cohort will be used to assess the attributable fraction of infections (including that of severe malaria) in the occurrence of epilepsy; to assess the stigma of epileptic children and their parents and to implement the therapeutic education programs and health promotion with families, teachers and health workers

Actualités sur le neuropaludisme.

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Implementation strategy for advanced practice nursing in Gabon: a multicentermixed method study.Gabonese advanced practice nursing implementation

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Connaissances, attitudes et pratiques concernant les troubles psychiques, les troubles neurocognitifs et l’épilepsie à la sortie des études en santé

International audienceIntroductionLes données épidémiologiques sur les troubles psychiques, les troubles neurocognitifs et l’épilepsie mettent en évidence des maladies ubiquitaires, présentes dans toutes cultures et latitudes, avec des prévalences élevées, notamment dans les pays en développement.ObjectifsL’objectif principal était d’évaluer les connaissances, attitudes et pratiques (CAP) concernant les troubles psychiques, les troubles neurocognitifs et l’épilepsie auprès de futurs médecins, pharmaciens et infirmiers dans plusieurs pays à faible et moyen revenus.Patients et méthodesIl s’agit d’une étude descriptive transversale multicentrique en cours de réalisation dans 12 pays. Nous avons utilisé l’initiative STROBE pour développer la méthodologie d’étude. Le recrutement est exhaustif pour les étudiants qui répondent aux critères d’inclusion. Les investigateurs collectent les réponses auprès des étudiants par le biais d’un auto questionnaire lié à un système de gestion de base de données relationnelle et réalisent une conférence apportant des éléments sur le contexte de la recherche épidémiologique.RésultatsL’étude pilote menée au Gabon a inclus 75 étudiants (45 étudiants en médecine, 2 étudiants en pharmacie et 28 étudiants en soins infirmiers). Un score moyen de 15,37 ± 1,69 points sur 20 points a été retrouvé. Le score de connaissances était plus faible que le score d’attitudes et pratiques (p < 0,001). Les questions avec un pourcentage faible de bonnes réponses portaient sur la définition, le diagnostic des maladies ainsi que les effets indésirables des traitements.DiscussionLe niveau de connaissances, attitudes et pratiques des étudiants en santé était correct au Gabon. Le taux faible de participation observé doit nous amener à porter une attention particulière à la méthodologie de recrutement des étudiants dans l’étude.ConclusionIl est nécessaire de poursuivre cette étude pour évaluer les CAP dans les autres pays

From Real-world Individuals' Data to National Health Indicators: Multiphase Pilot Study in Gabon

International audienceBACKGROUND: Achieving health goals requires informed decision-making supported by transparent, reliable, and relevant health information. This helps decision makers, such as health managers, to better understand the functioning of their health system and improve their ability to respond quickly to health demands. To achieve this, the health system needs to be supported by a digitized decision-making information system. In Sub-Saharan African countries, inadequate digital infrastructure, including limited internet connectivity and insufficient access to appropriate computer software, makes it difficult to collect, process, and analyze data for health statistics. The processing of data is done manually in this case; however, this situation affects the quality of the health statistics produced and compromises the quality of health intervention choices in these countries. OBJECTIVE: This study aimed to describe the conceptual approach of a data production and dissemination platform model proposed and implemented in Gabon. More precisely, it aimed to present the approach applied for the multidimensional analysis of the data production and dissemination process in the existing information system and present the results of an evaluation of the proposed model implemented in a real context. METHODS: The research was carried out in 3 phases. First, a platform was designed and developed based on the examination of the various data production and indicator generation procedures. Then, the platform was implemented in chosen health facilities in Gabon. Finally, a platform evaluation was carried out with actual end users. RESULTS: A total of 14 users with 12 years of average experience in health data management were interviewed. The results show that the use of the proposed model significantly improved the completeness, timeliness, and accuracy of data compared with the traditional system (93% vs 12%, P<.001; 96% vs 18%, P<.001; and 100% vs 18%, P<.001; respectively). CONCLUSIONS: The proposed model contributes significantly to the improvement of health data quality in Gabon

Knowledge, attitudes, and behavior among key people involved in the employment of people with epilepsy in southern Benin.

International audienceThis study aimed to investigate knowledge, attitudes, and behavior among individuals working to achieve, or promote, the employment and retention in employment of people with epilepsy (PWE) in Benin. We interviewed 300 subjects using a self-administered questionnaire. Knowledge: 93% had heard of epilepsy; 8.8% had at least one person with epilepsy (PWE) in their family; and 67.3% had witnessed a person having epileptic seizures. Attitudes and behavior: 95.3% and 95%, respectively, expressed their views that PWE should be able to enter mainstream education and that PWE should marry; 76.4% considered PWE equal to themselves; and 28.6% reported they would not hire a PWE. We found some associations between demographic characteristics and knowledge, attitudes, and behavior among respondents. A few unhelpful aspects of knowledge, attitudes, and behavior were identified. Our study showed a fairly high level of accurate knowledge of epilepsy, but some misperceptions and unhelpful attitudes and practices toward PWE in Benin were noted. This study's findings can be used to help plan appropriate strategies based on correcting misperceptions concerning inclusion and retention in employment of PWE in Benin

Impact of knowledge, attitudes, and sociocultural factors on school enrollment of children with epilepsy in Gabon

International audiencePerceptions, beliefs and culture influence attitude towards epilepsy in sub-Saharan Africa. Misconceptions on epilepsy contribute to the persistence of negative attitudes in children with epilepsy particularly on their school enrollment. The aim of the study was to assess knowledge, attitudes, and sociocultural factors affecting schooling of children with epilepsy in Gabon