Evaluation de la mise en oeuvre du dépistage de la malnutrition aiguë sévère chez les enfants de moins de cinq ans par les mères dans la région du Centre-Ouest au Burkina Faso

La malnutrition constitue une des causes majeures de mortalité chez les enfants de moins de 5 ans au Burkina Faso. Plusieurs stratégies de lutte ont été expérimentées parmi lesquelles le dépistage de la malnutrition par les mères dans les ménages. Dénommée « stratégie PB-mère » elle a consisté en la mesure du périmètre brachial (PB) des enfants par la mère. La présente étude vise à évaluer cette stratégie dans la région sanitaire du centre ouest. Une approche évaluative à devis mixte, quantitative et qualitative a été utilisée. Les données quantitatives ont été collectées avant et pendant l’intervention à travers les outils de suivi du projet. Pour le volet qualitatif, une étude de cas dans trois districts et une revue documentaire ont été réalisées. Les données qualitatives collectées à travers des interviews et focus-group auprès d’informateurs clés, ont été traitées avec le logiciel QDA miner Lite tandis que le logiciel Excel a été utilisé pour les données quantitatives. Toutes les composantes de la stratégie PB-mère ont été mises en oeuvre dans les districts sanitaires. Certains facteurs ont été favorables à la mise en oeuvre de la stratégie, tels la prise des mesures anthropométriques à domicile, l’implication des agents de santé à base communautaire et des mères. Les obstacles identifiés étaient la faible implication des acteurs du système de santé, les ruptures en intrants et l’incompréhension du système de motivation par les acteurs de mise en oeuvre. L’évaluation de la stratégie PB mères a montré une bonne adhésion des mères et le dépistage effectif des enfants malnutris dans la communauté.Mots-clés: Malnutrition, Stratégie PB-mère, évaluationEnglish Title: Assessment of the implementation of screening for severe acute malnutrition in under 5 children by the mothers in the Central West region of Burkina FasoEnglish AbstractMalnutrition is one of the leading causes of death among under 5 children in Burkina Faso. Several control strategies have been tested, including maternal detection of malnutrition in households. Called the "PBmother strategy" it consisted of measuring the brachial perimeter (BP) of the children by the mothers. The purpose of this study is to assess this strategy in its implementation context in health region of centre west in Burkina Faso. An evaluative approach with mixed, quantitative and qualitative methods was used. Quantitative data were collected before and during the intervention through project monitoring tools.  For the qualitative component, a documentary review, interviews and focus group were carried out. The qualitative data was analysed with the QDA miner Lite software while the Excel software was used for quantitative data. All components of the PB-mother strategy have been implemented in health districts. Some factors were favourable to the implementation of the strategy, such as the taking of anthropometric measurements at home, the involvement of community health workers and mothers. The identified obstacles were the low involvement of health system actors, disruptions in inputs and incomprehension of the motivational system by implementation actors. The evaluation of the PB mothers strategy showed that good support from mothers and effective screening of malnourished children in the community.Keywords: Malnutrition, PB-mother strategy, evaluatio

Long-term quality of life in necrotizing soft-tissue infection survivors: a monocentric prospective cohort study

International audienceBackground: Compared to other life-threatening infection survivors, long-term health-related quality of life (QOL) of patients surviving necrotizing soft-tissue infections (NSTI) and its determinants are little known. In this monocentric prospective cohort including NSTI survivors admitted between 2014 and 2017, QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36), the Hospital Anxiety and Depression (HAD), the activity of daily living (ADL), instrumental ADL (IADL) scales and the Impact of Event Scale-Revised (IES-R). The primary outcome measure was the SF-36 physical component summary (PCS). NSTI patients were compared according to intensive care unit (ICU) admission status. ICU survivors were matched on SAPS II with non-NSTI related septic shock survivors.Results: Forty-nine NSTI survivors were phone-interviewed and included in the study. Median PCS was decreased compared to the reference population [- 0.97 (- 2.27; - 0.08) SD]. Previous cardiac disease was the only variable associated with PCS alteration [multivariate regression coefficient: - 8.86 (- 17.64; - 0.07), p = 0.048]. Of NSTI survivors, 15.2% had a HAD-D score ≥ 5 and 61.2% an IES-R score ≥ 33. ICU admission was not associated with lower PCS [35.21 (25.49-46.54) versus (vs) 41.82 (24.12-51.01), p = 0.516], but with higher IES-R score [14 (7.5-34) vs 7 (3-18), p = 0.035] and a higher proportion of HAD-D score ≥ 5 (28.6 vs 4.0%, p = 0.036). Compared to non-NSTI septic shock-matched controls, NSTI patients had similar PCS [33.81 (24.58; - 44.39) vs 44.87 (26.71; - 56.01), p = 0.706] but higher HAD-D [3.5 (1-7) vs 3 (1.5-6), p = 0.048] and IES-R scores [18 (8-35) vs 8 (3-19), p = 0.049].Conclusions: Long-term QOL in NSTI survivors is severely impaired, similarly to that of non-NSTI septic shock patients for physical compartments, but with more frequent depressive and/or post-traumatic stress disorders. Only ICU admission and previous cardiac disease were predictive of QOL impairment

Long-term Quality of Life in Adult Patients Surviving Purpura Fulminans: An Exposed-Unexposed Multicenter Cohort Study

International audienceAbstract Background Long-term health-related quality of life (HR-QOL) of patients surviving the acute phase of purpura fulminans (PF) has not been evaluated. Methods This was a French multicenter exposed-unexposed cohort study enrolling patients admitted in 55 intensive care units (ICUs) for PF from 2010 to 2016. Adult patients surviving the acute phase of PF (exposed group) were matched 1:1 for age, sex, and Simplified Acute Physiology Score II with septic shock survivors (unexposed group). HR-QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36) questionnaire, the Hospital Anxiety and Depression (HAD) scale, the Impact of Event Scale–Revised (IES-R), and the activity of daily living (ADL) and instrumental ADL (IADL) scales. The primary outcome measure was the physical component summary (PCS) of the SF-36 questionnaire. Results Thirty-seven survivors of PF and 37 of septic shock were phone-interviewed at 55 (interquartile range [IQR], 35–83) months and 44 (IQR, 35–72) months, respectively, of ICU discharge (P = .23). The PCS of the SF-36 was not significantly different between exposed and unexposed patients (median, 47 [IQR, 36–53] vs 54 [IQR, 36–57]; P = .18). There was also no significant difference between groups regarding the mental component summary of the SF-36, and the HAD, IES-R, ADL and IADL scales. Among the 37 exposed patients, those who required limb amputation (n = 12/37 [32%]) exhibited lower PCS (34 [IQR, 24–38] vs 52 [IQR, 42–56]; P = .001) and IADL scores (7 [IQR, 4–8] vs 8 [IQR, 7–8]; P = .021) compared with nonamputated patients. Conclusions Long-term HR-QOL does not differ between patients surviving PF and those surviving septic shock unrelated to PF. Amputated patients have an impaired physical HR-QOL but a preserved mental health. Clinical Trials Registration NCT03216577

Long-term quality of life in adult patients surviving purpura fulminans: an exposed-unexposed multicenter cohort study

International audienceBACKGROUND : Long-term health-related quality of life (HR-QOL) of patients surviving the acute phase of purpura fulminans (PF) has not been evaluated.METHODS : This was a French multicenter exposed-unexposed cohort study enrolling patients admitted in 55 intensive care units (ICUs) for PF from 2010 to 2016. Adult patients surviving the acute phase of PF (exposed group) were matched 1:1 for age, sex, and Simplified Acute Physiology Score II with septic shock survivors (unexposed group). HR-QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36) questionnaire, the Hospital Anxiety and Depression (HAD) scale, the Impact of Event Scale-Revised (IES-R), and the activity of daily living (ADL) and instrumental ADL (IADL) scales. The primary outcome measure was the physical component summary (PCS) of the SF-36 questionnaire.RESULTS : Thirty-seven survivors of PF and 37 of septic shock were phone-interviewed at 55 (interquartile range [IQR], 35-83) months and 44 (IQR, 35-72) months, respectively, of ICU discharge (P = .23). The PCS of the SF-36 was not significantly different between exposed and unexposed patients (median, 47 [IQR, 36-53] vs 54 [IQR, 36-57]; P = .18). There was also no significant difference between groups regarding the mental component summary of the SF-36, and the HAD, IES-R, ADL and IADL scales. Among the 37 exposed patients, those who required limb amputation (n = 12/37 [32%]) exhibited lower PCS (34 [IQR, 24-38] vs 52 [IQR, 42-56]; P = .001) and IADL scores (7 [IQR, 4-8] vs 8 [IQR, 7-8]; P = .021) compared with nonamputated patients.CONCLUSIONS : Long-term HR-QOL does not differ between patients surviving PF and those surviving septic shock unrelated to PF. Amputated patients have an impaired physical HR-QOL but a preserved mental healt