Factors Affecting Continuity And Success Of Community-Based Reproductive Health Service Programme In Rural Community Of Northeast Ethiopia

Objective: To assess opportunities and threats towards the continuity and success of Community based reproductive health service programme in Northeast Ethiopia. Design: Community based comparative cross sectional study. Setting: Two districts of Amhara region, Ethiopia, classified as strong and weak community based reproductive health programme areas. Subjects: Seven hundred and ninety two women aged 15-49 years residing in the selected districts of Amhara region. Community based reproductive health workers, programme coordinators and field supervisors were used as informants of qualitative data collection. Main outcome measure: Current use of modern contraceptive methods. Results: Strong versus weak programme areas: knowledge about modern contraceptive method (MCM), was (90% and 86.8%), [OR (95% CI) = 2.87(1.68,4.91)], ever use of MCM (61.1 % and 29.7%), [OR (95% CI) = 3.71(2.72, 5.07)] and current use of MCM (54.8% versus 19.7%), [OR (95% CI) = 4.95(3.53,6.95)]. Method interruption was significantly higher, 37.6% in weak than 10.9% in strongly performing programme area. Causes of defaulting in strong versus weak programme areas were: wanted more pregnancy (4% and 39.5%), fear of contraceptives\' side effects (16% and 31.6%) and lack of method of choice (20% and 2.6%). Type of religion, husband approval, awareness of service existence and client satisfaction remained to be the predictors of current use of MCM in multivariate analysis. Qualitative study findings were found coherent with the quantitative results. Conclusion: Type of religion, husband approval, client satisfaction and awareness of service existence were the predictors of modern contraceptive methods utilisation in the study population. East African Medical Journal Vol. 85 (10) 2008: pp. 487-49

Opportunities And Threats Towards The Continuity And Success Of Community-Based Reproductive Health Service Programme In Rural Community Of Northeast Ethiopia

Objective: To assess opportunities and threats towards the continuity and success of Community-based reproductive health service programme in Northeast Ethiopia. Design: Community-based comparative cross sectional study. Setting: Two districts of Amhara region, Ethiopia, classified as strong and weak community based reproductive health programme areas. Subjects: Seven hundred Ninety two women aged 15-49 years residing in the selected districts of Amhara region. Community-based reproductive health workers, programmeme coordinators and field supervisors were used as informants of qualitative data collection. Main outcome measure: Current use of modern contraceptive methods. Results: Strong versus weak programme areas: knowledge about modern contraceptive method (MCM), was (90% and 86.8%), [OR (95% CI) = 2.87(1.68, 4.91)], ever use of MCM (61.1 % and 29.7%), [OR (95% CI) = 3.71(2.72, 5.07)] and current use of MCM (54.8% versus 19.7%), [OR (95% CI) =4.95(3.53, 6.95)]. Method interruption was significantly higher, 37.6% in weak than 10.9% in strongly performing programme area. Causes of defaulting in strong versus weak programme areas were: wanted more pregnancy (4% and 39.5%), fear of contraceptives\' side effects (16% and 31.6%) and lack of method of choice (20% and 2.6%). Type of religion, husband approval, awareness of service existence and client satisfaction remained to be the predictors of current use of MCM in multivariate analysis. Qualitative study findings were found coherent with the quantitative results. Conclusion: Type of religion, husband approval, client satisfaction and awareness of service existence were the predictors of modern contraceptive methods utilisation in the study population. East African Medical Journal Vol. 85 (3) 2008: pp. 138-14

Managing acute malnutrition in infants aged less than six months: a qualitative assessment in Niger public hospitals

Quality management of severe acute malnutrition (SAM) in infants < 6 months of age is a key strategy within the “1000 days window of opportunity”. It prevents early child death, secures optimal growth and forms a foundation for full adulthood potentials. Most studies to date on management of SAM in infants relied on informants from Non-Governmental Organizations staff or government public health officials but little is known from hospital practitioners. From June to August 2013, a qualitative appraisal of hospital practitioners’ views on the current quality of care for malnourished infants was conducted in the eight main hospitals of Niger. These eight hospitals included two National Referral Hospitals (Lamordé and Zinder) and six Regional Referral Hospitals (Poudrière, Dosso, Tahoua, Maradi, Diffa and Agadez). Authorization for the review was given by the Ministry of Health of Niger. Health workers (HW) present during surveyors’ visits were included in the study. Two (2) specific objectives were considered: 1) Determine HW perceptions and current use of the Supplemental Suckling Technique (SST) and 2) Collect HW propositions on feasibility to organize outpatient treatment of SAM in infants less than six months. Self-designed interview guide was used. Data were analysed manually and saturation in the occurrence of responses were the criteria used to retain items. The Supplemental Suckling Technique (SST), though firmly recommended by national guidelines to ensure continuation of breastfeeding and adequate nutrients intake from supplemental milks especially in a small infant, was rarely used. Main reasons advanced by staff were work overload, inadequate training, and lack of compliance from mothers. Before being discharged from hospital, mothers were counseled on continuation of treatment, follow up visits at peripheral health center (PHC) and feeding options at home. However, hospital staff had no indication whether mothers were seen at the referred PHC, nor if counseling was practiced at home. The proposed outpatient treatment model for selected cases without medical complications should relieve hospital caseloads, strengthen referral and improve breastfeeding support to mothers after discharge from hospital.Keywords: Malnutrition, infant feeding, inpatient treatment, qualitative assessment, Nige

Composition de la poudre des feuilles sèches de moringa oleifera dans trois régions du Niger

In Niger, the acute and chronic malnutrition constitutes a public health problem among children aged from six to fifty-nine months. The use of local foods was identified in the national protocol of malnutrition management as an alternative for ready to use therapeutic foods that are currently used. Among these local foods, the powder of dried leaves of Moringa oleifera was analyzed in order to know the composition of the powder of dried leaves of Moringa oleifera produced in Niger compared to the available data. To achieve this, four samples from the three main Moringa production regions in Niger namely Tillabéri, Niamey both located in the river basin and southern Maradi of the Sahel-Sudanese zone, were analyzed. The chromatographic analysis hasbeen made in the laboratory of the International Crops Research Institute for the Semi- Arid Tropics. The nitrogen extraction technique was done using H2SO4 digestion + salicylic acid + H2O2 and selenium. It was measured using the calorimetry auto analyzer, based the Bertholet reaction. Total phosphorous, iron, zinc, potassium, calcium, magnesium, sodium and copper was also extracted, using the same method. Phosphorus was measured by calorimetry using the method of molybdo-phosphate reduced to ascorbic acid. The other elements were measured using atomic spectroscopy absorption. The results correspond to the average of two parallel tests. Five standards enabled to make the calibration and a control sample was analyzed in the same conditions. The test is valid if the regression is about 0,9950 - 0,9999. The powder of dried leaves of Moringa produced in Niger turned out be rich in proteins with an average of 24, 8 % (Confidence Interval at 95%: 19, 34-30, 24) with values going from 21,58% in Tillabéri to 28,72% in Niamey and in micronutrients. According to regions, the composition varies for iron between 51,9 and 55,12 mg/100g, 0,45 and 1,58 mg/100g for zinc, 1192,5and 1957,5 mg/100g for calcium, 414,37 and 714,37 mg/100g for magnesium,1587 and 2037 mg/100g for potassium, 207,75 and 326,25 mg/100g for sodium, 32 and 61 mg/100g for phosphorus. These results are close to those revealed by earlier studies.Key words: Moringa oleifera, composition, powder, dry, leaves, different, regions, Nige

Mycobacterium ulcerans Disease (Buruli Ulcer) in Rural Hospital, Southern Benin, 1997–2001

Hospital data show that Buruli ulcer is highly endemic in southern Benin

Ankle brachial index combined with Framingham risk score to predict cardiovascular events and mortality - A meta-analysis

CONTEXT: Prediction models to identify healthy individuals at high risk of cardiovascular disease have limited accuracy. A low ankle brachial index (ABI) is an indicator of atherosclerosis and has the potential to improve prediction. OBJECTIVE: To determine if the ABI provides information on the risk of cardiovascular events and mortality independently of the Framingham risk score (FRS) and can improve risk prediction. DATA SOURCES: Relevant studies were identified. A search of MEDLINE (1950 to February 2008) and EMBASE (1980 to February 2008) was conducted using common text words for the term ankle brachial index combined with text words and Medical Subject Headings to capture prospective cohort designs. Review of reference lists and conference proceedings, and correspondence with experts was conducted to identify additional published and unpublished studies. STUDY SELECTION: Studies were included if participants were derived from a general population, ABI was measured at baseline, and individuals were followed up to detect total and cardiovascular mortality. DATA EXTRACTION: Prespecified data on individuals in each selected study were extracted into a combined data set and an individual participant data meta-analysis was conducted on individuals who had no previous history of coronary heart disease. RESULTS: Sixteen population cohort studies fulfilling the inclusion criteria were included. During 480,325 person-years of follow-up of 24,955 men and 23,339 women, the risk of death by ABI had a reverse J-shaped distribution with a normal (low risk) ABI of 1.11 to 1.40. The 10-year cardiovascular mortality in men with a low ABI (< or = 0.90) was 18.7% (95% confidence interval [CI], 13.3%-24.1%) and with normal ABI (1.11-1.40) was 4.4% (95% CI, 3.2%-5.7%) (hazard ratio [HR], 4.2; 95% CI, 3.3-5.4). Corresponding mortalities in women were 12.6% (95% CI, 6.2%-19.0%) and 4.1% (95% CI, 2.2%-6.1%) (HR, 3.5; 95% CI, 2.4-5.1). The HRs remained elevated after adjusting for FRS (2.9 [95% CI, 2.3-3.7] for men vs 3.0 [95% CI, 2.0-4.4] for women). A low ABI (< or = 0.90) was associated with approximately twice the 10-year total mortality, cardiovascular mortality, and major coronary event rate compared with the overall rate in each FRS category. Inclusion of the ABI in cardiovascular risk stratification using the FRS would result in reclassification of the risk category and modification of treatment recommendations in approximately 19% of men and 36% of women. CONCLUSION: Measurement of the ABI may improve the accuracy of cardiovascular risk prediction beyond the FRS