Quality of Care Received by Children from 1 to 23 Months: Realities in The City of Antananarivo

Children's health depends on the proper care they receive from their mothers. This study aims to describe the quality of care received by children from 1 to 23 months in the city of Antananarivo. This is a cross-sectional and analytical study for a period from December 2016 to April 2017 in the city of Antananarivo which is the capital of Madagascar. The study population was made up of 420 mother-child dyads living in the city of Antananarivo. Regarding the care received by children, 47.6%, 95% Confidence Interval (CI) [42.8–52.4] benefit from quality nutrition care, 92.3%, 95% CI [89.8-94.8], have a social care and 45.5%, 95% CI [40.9–50.5] receive health care. The hygiene of life 66.4%, 95% CI [61.6–70.6] and the body hygiene 35.3%, 95% CI [30.6–39.8] improve as the child grows up. The care received by children was complete for the five types in 7.6%, 95% CI [5.1–10.1].  With regard to the profile of the mother, mothers under the age of 18 (OR=3.25, 95% CI [1.07-9.46]) and those who are single (OR=3.47, 95% CI [1.24-9.35]) offer more acceptable care to their infants. Infant care depends on the socio-economic and demographic profile of the mother. Thus, it is important to strengthen the communication strategy on infant first aid gestures and mothers' education on childcare

Epidemio-clinical aspects of congenital rubella syndrome in Madagascar

Background: Congenital rubella syndrome is the first congenital defect preventable by vaccination. The purpose of this study was to provide basic information on the extent and epidemiology of congenital rubella syndrome in Madagascar.Methods: A retrospective and descriptive study from January 2013 to May 2019 was conducted in 8 hospitals in 2 provinces of Madagascar, Antananarivo and Toliara. The study included children who attended the services selected during the study period and who had the following conditions: children aged of 0 to 59 months, regardless of vaccination status, meeting the World Health Organization clinical criteria for congenital rubella syndrome with or without biological confirmation.Results: Of the 152,304 cases of children of all ages who visited or were hospitalized during the study period, 112 clinically confirmed cases of congenital rubella syndrome were identified. The age group 0 to 11 months involved 60 children (53.6%). Congenital heart disease was found in 83.0% of cases, mental backwardness in 43.7% and microcephaly in 26.8%. Twenty-three among (20.5%) them died. The death was due to cardiac diseases in 16 children.Conclusions: Findings confirm that the diagnosis of congenital rubella syndrome is underestimated in current pediatric practice in Madagascar. The introduction of the rubella vaccine in the Expanded Program on Immunization and the implementation of an effective and sustainable surveillance system for congenital rubella syndrome in the country is a proved effective tool for the prevention of this disease

Knowledge, attitude, and practice of care providers about congenital rubella syndrome

Background: Behaviour of healthcare providers when facing an illness is an important part of their struggle. The aim of this study was to assess the level of knowledge, the attitude and the practice of health care providers regarding to the Congenital Rubella Syndrome.Methods: Authors did a descriptive study on the knowledge, the attitude and the practice of healthcare providers about Congenital Rubella Syndrome with 161 healthcare providers working in 8 hospitals in Madagascar. A self-introduced survey was used to collect the data.Results: There were 87% of all healthcare providers included in the study, who said that rubella in the first trimester of pregnancy was the cause of this syndrome for child, 87% knew at least 2 of the 3 major signs of Congenital Rubella Syndrome and more than 80% had a good knowledge of the criteria for diagnosing cases (suspected, clinically confirmed, laboratory confirmed). The referral to a hospital or to a specialist was the most proposed for the management of the case of Congenital Rubella Syndrome. The prescription of an IgG avidity for rubella and advising abortion were the main propositions for mothers having a positive test at the first trimester of pregnancy.Conclusions: A fairly satisfactory level of knowledge of healthcare providers was noted

The burden and treatment of non-communicable diseases among healthcare workers in sub-Saharan Africa: a multi-country cross-sectional study

IntroductionNon-communicable diseases (NCDs), the leading cause of death globally, are estimated to overtake communicable diseases in sub-Sahara Africa, where healthcare workers (HCWs) play a crucial role in prevention and treatment, but are in extreme shortage, thereby increasing the burden of NCDs among this specific population. To provide evidence for policy-making, we assessed the NCD burden, associated factors and treatment among HCWs in four sub-Saharan African countries.Materials and methodsWe conducted a cross-sectional study across four sub-Saharan African countries [Côte d'Ivoire (CIV), Democratic Republic of the Congo (DRC), Madagascar (MDG), and Nigeria (NIG)] between February and December 2022. In a standardized questionnaire, sociodemographic, chronic disease and treatment data were self-reported. We estimated the prevalence of (1) at least one chronic disease, (2) hypertension, and used backward elimination logistic regression model to identify risk factors.ResultsWe recruited a total of 6,848 HCWs. The prevalence of at least one chronic disease ranged between 9.7% in NIG and 20.6% in MDG, the prevalence of hypertension between 5.4% in CIV and 11.3% in MDG. At most, reported treatment rates reached 36.5%. The odds of each of both outcomes increased with age (at least one chronic disease adjusted odds ratio: CIV: 1.04; DRC: 1.09; MDG: 1.06; NIG: 1.10; hypertension: CIV: 1.10; DRC: 1.31; MDG: 1.11; NIG: 1.11) and with BMI (at least one chronic disease: CIV: 1.10; DRC: 1.07; MDG: 1.06; NIG: 1.08; hypertension: CIV: 1.10; DRC: 1.66; MDG: 1.13; NIG: 1.07). Odds of both outcomes were lower among males, except in CIV. In NIG, the odds of both outcomes were higher among medical doctors and odds of hypertension were higher among those working in secondary care. In MDG, working in secondary care increased and working as auxiliary staff decreased the odds of at least one chronic disease.ConclusionThe prevalence of self-reported chronic disease varied across the four sub-Saharan countries with potentially very low treatment rates. We identified several individual (age, sex, and BMI) and occupational (profession, level of healthcare) factors that influence the odds of NCDs. These factors should be taken into account when developing interventions addressing the burden and management of NCDs among HCWs

DÉNUTRITION CHEZ LES MERES DANS LA REGION AMORON’I MANIA MADAGASCAR :RÉALITÉS ET DÉFIS

IntroductionLes mères constituent un groupe vulnérable à la malnutrition à cause des besoins nutritionnels spécifiques liés à la reproduction. La malnutrition chez les mères implique des effets néfastes sur leur santé ainsi que sur le développement et la santé de leurs enfants pendant la vie intra-utérine et l’enfance et même à l’âge adulte. La malnutrition par carence touche essentiellement les pays à moyen et faible revenu dont Madagascar. La dénutrition et l’insuffisance en micronutriments et vitamines affectent de nombreuses femmes dans ces pays. Des interventions visant à lutter contre la malnutrition maternelle ont été identifiées et chaque pays concerné définit ses stratégies de mise en œuvre. Pour Madagascar, la lutte menée depuis plusieurs années n’a pas conduit à une amélioration et la prévalence de la dénutrition maternelle reste élevée. L’objectif général de l’étude est d’approfondir les connaissances sur la dénutrition maternelle afin d’en tirer des éléments qui contribueront à résoudre ce problème. MéthodologieLa région Amoron’i Mania Madagascar a été choisie comme site d’étude à cause de la prévalence la plus élevée de la malnutrition chez les femmes en âge de procréer qu’elle détient. Cinq études ont été réalisées :(i) une étude qualitative de type exploratoire pour collecter des informations sur les habitudes et pratiques alimentaires des mères pendant leur parcours de reproduction, (ii) une étude transversale pour décrire et identifier les déterminants de l’état nutritionnel des mères, (iii) une deuxième étude transversale pour décrire l’alimentation des mères, (iv) une étude de cohorte pour évaluer l’effet de la saison sur l’alimentation et l’état nutritionnel des mères et (v) une deuxième étude qualitative pour apprécier les interventions existantes. La population d’étude est représentée principalement par les mères. D’autres membres de la famille (père, grand-mère) et de la communauté (matrone, agent communautaire) ont été inclus pour la dernière étude qualitative.RésultatsLa description de l’état nutritionnel des mères a montré qu’en période post-récolte, la prévalence de la dénutrition est estimée à 17% selon l’Indice de Masse Corporelle, IMC ( 6 mois) était moins fréquente [ORa(IC95%) = 0.92(0.84-1.00), p=0.050]. L’appréciation des bénéficiaires sur les interventions pour lutter contre la malnutrition maternelle a rapporté les faits suivants :les interventions ayant trait directement aux aliments comme la distribution de nourriture, l’amélioration de la production de l’agriculture et de l’élevage ainsi que l’éducation nutritionnelle, opérées par les ONG sont plus connues. Les interventions spécifiques pour les femmes comme la supplémentation en Fer Acide Folique, le déparasitage et la promotion de la planification familiale, assurées par les centres de santé n’ont pas été identifiées comme moyens de lutte. Les interventions au sein de projets ont été appréciées comme non pérennes car les agents travaillent sur une durée limitée. L’insuffisance de la production agricole et la faible couverture des interventions existantes étaient les principaux problèmes rapportés. Les bénéficiaires ont estimé que les interventions existantes dans la région étaient insuffisantes pour résoudre le problème de malnutrition chez les mères. ConclusionLa fréquence élevée de la dénutrition maternelle observée dans la région Amoron’i Mania confirme qu’elle reste toujours un problème réel, les interventions existantes pour faire face à ce problème étant insuffisantes. La réduction de la prévalence et de l’incidence de la dénutrition maternelle dans un cadre de multisectorialité est un défi à relever. L’Office responsable de la coordination régionale de la lutte contre la malnutrition est sollicité pour l’harmonisation des intervenants et des interventions, pour la priorisation des interventions relatives à l’amélioration de la production de l’agriculture et de l’élevage, pour la priorisation de l’hygiène et surtout, pour l’implication des Ministères responsables de ces secteurs. La mise en place d’un système de prise en charge des femmes dénutries et l’intégration des interventions au sein d’un groupement de femmes sont nécessaires. Les recherches futures s’articuleront sur l’amélioration de la mise en œuvre des interventions existantes pour optimiser les résultats et sur l’identification d’interventions plus efficaces pour la région. ABSTRACTIntroductionDue to specific nutritional needs related to reproduction, mothers are a group vulnerable to malnutrition. Mothers' malnutrition leads to adverse effects on their own health as well as on the children's health, whether throughout intrauterine life, childhood or even adulthood. Malnutrition caused by deficiencies mainly occurs in middle- or low-income countries, including Madagascar. In those countries, undernutrition and micronutrient and vitamin deficiencies affect a lot of women. Interventions to address maternal malnutrition have been identified and each concerned country has defined its own strategy for their implementation. As for Madagascar, although prevention has been going on for years, there has been no improvement and the prevalence of mother's malnutrition remains high. The main objective of this study is to further knowledge of mother's undernutrition and draw from it elements that will contribute to solve the issue. Methodology Madagascar's Amoron'i Mania region was chosen as the study site because of it has the highest prevalence of malnutrition among women of childbearing age. Five studies were conducted: (i) an exploratory qualitative study to collect information on the mothers' habits and practices during their reproductive course, (ii) a cross-sectional study to describe and identify the determining factors of the mother's nutritional status, (iii) a second cross-sectional study to describe mothers' diet, (iv) a cohort study to assess the impact of seasons on the mothers' diet and nutritional status, and (v) a second qualitative study to assess the existing intervention. The study population is mainly represented by mothers. Other family members (father, grandmother) and community members (matron, community worker) were included in the last qualitative study. Results The assessment of the mothers' nutritional status showed that, in the post-harvest period, undernutrition's prevalence was estimated at 17% according to the Body Mass Index, BMI ( 6 months) was less frequent [ORa (IC 95%) = 0.92 (0.84-1.00), p=0.050]. The beneficiaries’ assessment of the interventions to combat mothers' malnutrition reported the following facts. Food-related interventions such as food distribution, improvement of agriculture and livestock, and nutrition education, operated by NGO, are better known. Specific interventions for women, such as Folic Acid Iron supplementation, deworming and family planning promotion, provided by health centers, have not been identified as addressing malnutrition. Interventions within projects have been assessed as unsustainable because they work for a limited period of time. Inadequate agricultural production and low coverage of existing interventions were the main problems reported. The beneficiaries assessed that the interventions existing in the region were insufficient to solve the issue of maternal malnutrition.Conclusion The high frequency of mothers' undernutrition observed in Amoron'i Mania region confirms that it is still a real problem. The existing interventions to address this issue are insufficient. Reducing mothers' undernutrition prevalence and incidence in a multisectoral setting is a challenge. The regional office responsible for coordinating the fight against malnutrition is asked to ensure the harmonization of stakeholders and interventions, the prioritization of interventions related to improving agricultural and livestock production and hygiene, and the involvement of the ministries in charge of these sectors. The management of maternal undernutrition and the integration of the interventions within a group of women in the community are necessary. Future research will focus on improving the implementation of existing interventions to optimize the results and identifying more effective interventions for the region.Doctorat en Santé Publiqueinfo:eu-repo/semantics/nonPublishe

Habitude alimentaire des mères pendant la grossesse et l’allaitement, région Amoron’i Mania Madagascar: étude qualitative

Introduction: L'alimentation des mères est très importante à cause des besoins nutritionnels spécifiques pour la reproduction. La présente étude vise à décrire les habitudes alimentaires des mères pendant la grossesse et l'allaitement et répertorier les facteurs influençant ces habitudes. Méthodes: Une étude qualitative a été menée auprès des femmes enceintes et allaitantes vivant dans la région Amoron'i Mania, Madagascar. Huit focus group (6 à 10 femmes par groupe) et 23 entretiens individuels ont été réalisés pour collecter les données. L'analyse thématique a été utilisée et a porté sur la description des habitudes alimentaires à partir de la conduite de l'alimentation des femmes et sur les déterminants socioculturels et économiques des habitudes décrites. Résultats: Pendant la période de grossesse et d'allaitement, l'habitude alimentaire des femmes ne varie pas considérablement exceptée au tout début de l'allaitement. Elles ont une alimentation faiblement diversifiée et monotone, pauvres en fruits et légumes et pauvre en protéines. C'est au tout début de l'allaitement, pendant la pratique de la tradition appelée « mifana », que les femmes bénéficient d'une alimentation plus riche que d'habitude. Ces habitudes alimentaires sont influencées par le type de productions agricoles de la région et leur disponibilité dans l'année (autoconsommation), le pouvoir d'achat (en cas de pénurie) ainsi que la tradition. Conclusion: L'habitude alimentaire des mères semble inadéquate. Approfondir les connaissances sur les déterminants de leur pratique alimentaire est nécessaire

Connaissances et perceptions de la malnutrition par la population rurale des Hautes Terres Centrales, Madagascar

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Habitude alimentaire des mères pendant la grossesse et l’allaitement, région Amoron’i Mania Madagascar: étude qualitative

Introduction: Women's dietary habits are very important due to the specific nutritional requirements for reproduction. This study aimed to describe women's dietary habits during pregnancy and breastfeeding and to identify factors influencing these habits. Methods: We conducted a qualitative study of pregnant and breastfeeding women living in Amoron'i Mania region, Madagascar. Eight focus groups (6-10 women per group) and 23 individual interviews were carried out to collect data. Thematic analysis was used and focused on the description of women's dietary habits on the basis of dietary behaviours as well as of sociocultural and economic determinants of the described habits. Results: During pregnancy and breastfeeding, women's dietary habits did not vary considerably except at the very beginning of breastfeeding. They had a little diversified and monotonous diet, poor in fruit and vegetables and poor in proteins. At the very beginning of breastfeeding, during the practice of "mifana" tradition, women had a diet more rich than usual. These dietary habits were influenced by the type of agricultural products in the region and by their availability during the year (self-consumption)as well as by purchasing power (in case of shortage) and tradition. Conclusion: Mothers' dietary habits appear to be inadequate. This study highlights the importance of improving knowledge of the determinants of mothers' dietary behaviours.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Facteurs associés à l’abandon du traitement anti-tuberculeux dans la ville d’Antananarivo, Madagascar : Factors associated with tuberculosis treatment default in Antananarivo city, Madagascar

Résumé : Une étude épidémiologique analytique, basée sur un recueil rétrospectif de données, ayant inclus 442 patients, a été effectuée dans un des centres de traitement de la tuberculose de la ville d’Antananarivo, pour identifier les facteurs liés à l’abandon du traitement. Les résultats montrent que les hommes abandonnent plus le traitement que les femmes (OR = 1,81 [1,13 ; 3,03] ). Parmi ceux qui habitent loin du centre, les malades de moins de 30 ans ont tendance à être plus irréguliers dans le suivi du traitement (OR = 3,43 [1,16 ; 10,15] ). Il n’existe pas de relation statistiquement significative entre l’abandon au traitement et l’âge, la forme clinique, le régime thérapeutique et la résidence. Les responsables de chaque centre de traitement devraient être plus vigilants vis-à-vis des tuberculeux de sexe masculin et des jeunes patients. Ils devraient adapter les modalités de suivi selon ces facteurs de risque à l’abandon

Socioeconomic determinants of malnutrition among mothers in the Amoron’i Mania region of Madagascar: a cross-sectional study

Abstract Background Maternal malnutrition, which has been a problem in Madagascar for several years, has been rising despite interventions to improve the situation. This study aims to identify the socioeconomic determinants of malnutrition among mothers who are one of the most vulnerable groups. Methods A cross sectional study was carried out among 670 mothers aged 18 to 45 living in the Amoron’i Mania region of Madagascar. The study was conducted during the post-harvest period. The nutritional status of mothers was assessed by anthropometry. A Body Mass Index (BMI) lower than 18.5 kg/m2 or an arm circumference lower than 220 mm were used to define malnutrition. Data on the characteristics of the mothers and their households were also collected. Multiple logistic regression was used to identify factors associated with maternal malnutrition. Results The prevalence of maternal undernutrition is estimated at 17% (95% CI: 14–20) according to BMI and 9% (95% CI: 7–11) for Mid Upper Arm Circumference (MUAC). In the multivariate analysis, using BMI, the factors significantly associated with malnutrition were: the household size equal to or greater than 6 (AOR = 1.59 [1.04–3.42], p = 0.029) and use of unsafe water source (AOR = 1.99 [1.02–3.85], p = 0.030). For the MUAC, the factors associated are: use of unsafe water source (AOR = 2.82 [1.01–7.97], p = 0.041) and increased number of children under five years old (AOR = 1.38 [1.02–1.89], p = 0.025). Conclusion This study confirmed the importance of mothers’ malnutrition in the study area. Fight against maternal malnutrition needs interventions to improve access to safe drinking water and to promote family planning