Prise en charge hospitalière de la malnutrition aigue sévère chez l’enfant avec des préparations locales alternatives aux F-75 et F-100: résultats et défis

Introduction: La mise en oeuvre des directives de l'OMS permettrait de réduire significativement la  mortalité hospitalière due à la malnutrition sévère. Cependant, elle n'est pas effective et la pénurie en  aliments thérapeutiques est l'une des principales causes. L'étude décrit notre expérience sur la prise en charge hospitalière de la malnutrition aigue sévère avec des laits alternatifs aux F75 et F100 composés localement.Méthodes: Il s'agissait d'un essai clinique non randomisé. La prise en charge des patients utilisait les laits composés localement et une évaluation quotidienne du gain pondéral était faite.Résultats: L'étude a porté sur 41 sujets âgés de 6 à 59 mois. Au total, 73,2% avaient le  kwashiorkormarasmique, 17,0% le kwashiorkor, 9,8% le marasme et 41,5% étaient infectés par le VIH. Nous avons noté une prise progressive du poids d'environ 10 g/kg/jour vers le 7ème jour et de 15 à 20  g/kg/jour en fin d'hospitalisation. Le taux de mortalité était de 21,9% soit une réduction de 8,4% des chiffres antérieurs. Conclusion: Malgré les obstacles financiers liés au coût des ingrédients, les  préparations lactées alternatives aux standards F75 et F100, sont adaptables dans notre contexte. En l'absence des formules standards de l'OMS et lorsque la référence vers une structure qui en disposent n'est pas possible, les préparations locales permettraient de réhabiliter efficacement les patients.  D'autres recherches pointues permettraient de tirer les ingrédients uniquement de notre environnement. Elles contribueraient ainsi à minimiser les couts des préparations et de favoriser la pérennisation des laits thérapeutiques locaux.Key words: Malnutrition sévère, laits thérapeutiques F75/F100, ingrédients locaux, enfant

Nurses’ knowledge of tuberculosis, HIV, and integrated HIV/TB care policies in rural Western Cape, South Africa

HIV and tuberculosis (TB) co-infection remain the leading causes of mortality in many developing countries. Several policies for their prevention and management exist; however, progress to meet the World Health Organization’s indicators is slow. As nurses in rural areas are the main health care professionals responsible for the implementation of policies, questions arose about nursing knowledge regarding TB and HIV policies. A concurrent mixed method research approach was used to investigate this issue in a rural area of the Western Cape in South Africa. After a two-step sampling process, data were collected through 44 questionnaires and 12 interviews. We used descriptive and inferential statistics as well as content analysis methods. We found that most of the nurses had insufficient knowledge on certain aspects of policy guidelines that included medications, intensive case findings, and management of multidrug-resistant TB. It is recommended that training be intensified to improve implementation of policies

Responsible Governance for Mental Health Research in Low Resource Countries

Blurb: Taghi Yasamy and colleagues identify challenges facing good research governance in low- and middle-income countries and provide suggestions for a way forward

Responsible Governance for Mental Health Research in Low Resource Countries

Blurb: Taghi Yasamy and colleagues identify challenges facing good research governance in low- and middle-income countries and provide suggestions for a way forward

Positive spill-over effects of ART scale up on wider health systems development: evidence from Ethiopia and Malawi

<p>Abstract</p> <p>Background</p> <p>Global health initiatives have enabled the scale up of antiretroviral treatment (ART) over recent years. The impact of HIV-specific funds and programmes on non-HIV-related health services and health systems in genera has been debated extensively. Drawing on evidence from Malawi and Ethiopia, this article analyses the effects of ART scale-up interventions on human resources policies, service delivery and general health outcomes, and explores how synergies can be maximized.</p> <p>Methods</p> <p>Data from Malawi and Ethiopia were compiled between 2004 and 2009 and between 2005 and 2009, respectively. We developed a conceptual health systems framework for the analysis. We used the major changes in human resources policies as an entry point to explore the wider health systems changes.</p> <p>Results</p> <p>In both countries, the need for an HIV response triggered an overhaul of human resources policies. As a result, the health workforce at health facility and community level was reinforced. The impact of this human resources trend was felt beyond the scale up of ART services; it also contributed to an overall increase in functional health facilities providing curative, mother and child health, and ART services. In addition to a significant increase in ART coverage, we observed a remarkable rise in user rates of non-HIV health services and an improvement in overall health outcomes.</p> <p>Conclusions</p> <p>Interventions aimed at the expansion of ART services and improvement of long-term retention of patients in ART care can have positive spill-over effects on the health system. The responses of Malawi and Ethiopia to their human resources crises was exceptional in many respects, and some of the lessons learnt can be useful in other contexts. The case studies show the feasibility of obtaining improved health outcomes beyond HIV through scaled-up ART interventions when these are part of a long-term, system-wide health plan supported by all decision makers and funders.</p

Interface entre programmes verticaux et services de santé généraux : comment optimiser cette relation dans les systèmes de santé d'Afrique subsaharienne?

In sub-Saharan Africa, the interface between vertical programs and general health services is far from optimal. Our research, conducted in Cameroon, studied the effects of control programs against tuberculosis and HIV/AIDS on the functioning of district hospitals. These programs have both positive and negative effects on hospital services. The net result cannot be reduced to a simple arithmetic in which positive effects would outweigh negative effects. Indeed, some effects jeopardize the structural and systemic capacities to manage local health systems. In addition, real opportunities to develop synergies between programs and general health services and strengthen local health systems are not grasped by stakeholders. We propose to better monitor and rank program effects on general health services; strengthen the stewardship capacities of managers; and ensure that opportunities for sustainable health systems strengthening are seized by all stakeholders.En Afrique subsaharienne, l’interface entre programmes verticaux et services de santé généraux n’est pas optimale. Notre recherche, conduite au Cameroun, a étudié les effets des programmes tuberculose et VIH/SIDA sur le fonctionnement des hôpitaux de district. Ces programmes produisent sur les hôpitaux des effets à la fois positifs et négatifs. Le résultat net ne peut se réduire à une simple arithmétique dont les effets positifs neutraliseraient les effets négatifs. En effet, certains effets affectent en mal les capacités structurelle et systémique à gérer les systèmes locaux de santé. En outre, de réelles opportunités pour développer des synergies et renforcer les systèmes de santé ne sont pas prises par les détenteurs d’enjeux. Nous proposons de mieux monitorer et hiérarchiser les effets des programmes; de renforcer les capacités de stewardship des gestionnaires; et de veiller à ce que les opportunités pour un renforcement durable des systèmes de santé soient saisies.(SP - Sciences de la santé publique) -- UCL, 201