Community volunteers can improve breastfeeding among children under six months of age in the Democratic Republic of Congo crisis

<p>Abstract</p> <p>Background</p> <p>Malnutrition is a major public health problem in developing countries and exclusive breastfeeding is an efficient strategy that can be used to prevent malnutrition and reduce child mortality. The objective of this study is to evaluate the effectiveness of community volunteers in promoting exclusive breastfeeding from birth in an area of endemic malnutrition.</p> <p>Methods</p> <p>This evaluation analyzed the impact of the community-based nutrition project in Katana health district of the Democratic Republic of Congo from 2004 to 2006. Each of the villages in this sector had a nutritional village committee made up of five members responsible for continuously working to raise awareness of the importance of exclusive breastfeeding from birth among pregnant women and community leaders in their respective villages. The program worked with community volunteers with a mean age of 37 years, most of whom were married (86%). Eighty percent of the community volunteers had completed secondary school or a higher level of education. Data related to the period of exclusive breastfeeding and to the number of visits made to the health services for 208 children. The data were compared with data from 178 infants collected from another health sector, which had never developed a community-based nutrition program.</p> <p>Results</p> <p>The duration of exclusive breastfeeding from birth (median, range) was 6 months (2 to 7) in the intervention area compared with 4 months (1 to 6) in the comparison area (p < 0.001). The proportion of infants receiving exclusive breastfeeding at six months of age was higher in the intervention area than in the comparison area: 57.7% (95% Confidence Interval, CI, 50.9 to 64.5) versus 2.7% (95%CI, 1.1 to 6.6) (p < 0.001). The intervention group had a higher mean weight at 12 months (standard deviation): 8.42 kg (1.41) compared to 7.97 kg (1.02), although this difference was not statistically significant (p = 0.055).</p> <p>Conclusions</p> <p>The promotion of breastfeeding by community volunteers in an area of endemic malnutrition in rural Democratic Republic of Congo increased the duration of exclusive breastfeeding from birth.</p

The burden of legionnaires’ disease in Belgium, 2013 to 2017

Background: Legionnaires’ disease (LD) is a severe bacterial infection causing pneumonia. Surveillance commonly underestimates the true incidence as not all cases are laboratory confirmed and reported to public health authorities. The aim of this study was to present indicators for the impact of LD in Belgium between 2013 and 2017 and to estimate its true burden in the Belgian population in 2017, the most recent year for which the necessary data were available. Methods: Belgian hospital discharge data, data from three infectious disease surveillance systems (mandatory notification, sentinel laboratories and the national reference center), information on reimbursed diagnostic tests from the Belgian National Institute for Health and Disability Insurance and mortality data from the Belgian statistical office were used. To arrive at an estimate of the total number of symptomatic cases in Belgium, we defined a surveillance pyramid and estimated a multiplication factor to account for LD cases not captured by surveillance. The multiplication factor was then applied to the pooled number of LD cases reported by the three surveillance systems. This estimate was the basis for our hazard- and incidence-based Disability-Adjusted Life Years (DALYs) calculation. To account for uncertainty in the estimations of the DALYs and the true incidence, we used Monte Carlo simulations with 10,000 iterations. Results: We found an average of 184 LD cases reported by Belgian hospitals annually (2013–2017), the majority of which were male (72%). The surveillance databases reported 215 LD cases per year on average, 11% of which were fatal within 90 days after diagnosis. The estimation of the true incidence in the community yielded 2674 (95% Uncertainty Interval [UI]: 2425–2965) cases in 2017. LD caused 3.05 DALYs per case (95%UI: 1.67–4.65) and 8147 (95%UI: 4453–12,426) total DALYs in Belgium in 2017, which corresponds to 71.96 (95%UI: 39.33–109.75) DALYs per 100,000 persons. Conclusions: This analysis revealed a considerable burden of LD in Belgium that is vastly underestimated by surveillance data. Comparison with other European DALY estimates underlines the impact of the used data sources and methodological approaches on burden estimates, illustrating that national burden of disease studies remain essential

Supporting the intermediate level of health care in urban health areas in Kinshasa (1995-2005), DR Congo

As a result of the decentralization of health systems, some countries have introduced intermediate (provincial) levels in their public health system. This paper presents the results of a case study conducted in Kinshasa on health system decentralization. The study identified a shift from a focus on regulation compliance assessment to an emphasis on health system coordination and health district support. It also highlighted the emergence of a?managerial (as opposed to a bureaucratic) approach to health district support. The performance of health districts in terms of health care coverage and health service use were also found to have improved. The results highlight the importance of intermediate levels in?the health care system and the value of a more organic and managerial rationality in supporting health districts faced with the complexity of urban environments and the integration of specialized multi-partner programs and interventions.Dans un contexte de décentralisation des systèmes de santé, l’objectif de cette étude était d’analyser le soutien du niveau intermédiaire (provincial) du système sanitaire au district de santé en milieu urbain en RD Congo. La méthode est une étude de cas exploratoire dans la ville de Kinshasa, analyse par triangulation des données documentaires, d’entretiens et des données sanitaires de routine de 1995 à 2005. Cette étude a mis en évidence une évolution des fonctions de contrôle du respect des normes vers des fonctions de coordination de l’action sanitaire et de soutien au développement des districts sanitaires. Cette émergence d’une logique plus managériale que bureaucratique s’est accompagnée d’une amélioration des performances des districts de santé en termes de couverture sanitaire et d’utilisation des services. Ces résultats mettent en exergue l’importance du niveau intermédiaire dans le système de santé. Ils plaident en faveur d’une logique managériale dans le soutien au district de santé, qui est confronté à la complexité du milieu urbain et à l’intégration de programmes verticaux et d’interventions de nombreux partenaires

How to improve women’s and partner’s participation to prenatal HIV counseling in rural and urban areas in Kivu, democratic Republic of Congo?

FLWINinfo:eu-repo/semantics/publishedAbstracts of the 6th European Congress on Tropical Medicine and International Health and 1st Mediterranean Conference on Migration and Travel Health, Verona, Italy, 6-10 September 200

Intra-hospotal mortality of children in central Africa: looking at the impact of a training programe and increased supervision

July-Augustinfo:eu-repo/semantics/publishe

Odnosi do tveganja in učenje: empirična analiza igre Stonoge

Results: The intermediate level of the health system, lacking sufficient expertise and funding during the 1980s, was confined to inspection and control functions, answering to the central level of the Ministry of health and provincial authorities. Since the 1990s, faced with the pressing demand for support from health district teams, whose self-management had to deal with humanitarian emergencies, the need to integrate vertical programmes, and cope with the logistics of many different actors, the intermediate heath system developed methods and tools to support heath districts. This resulted in a subsidiary model of the intermediate level, the perceived efficacy of which varies according to the province over recent years.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Legionnaires' disease: Overview of the situation concerning notification in Wallonia (Belgium) in 2012, a retrospective descriptive study based on a capture-recapture method

Background: Legionnaires' disease is a severe form of pneumonia, and although public health medical inspectors must be notified, it is often under-reported. The objectives of this study were to determine the completeness rate of notification of Legionnaires' disease and to estimate the incidence of this disease in Wallonia, the southern part of Belgium, in 2012.Method: This retrospective, transversal descriptive study was based on a capture-recapture method using two sources. An estimation of the total number of Legionnaires' disease cases was calculated using Chapman and Seber's estimators for small numbers, thereby allowing us to estimate the real incidence of this disease in Wallonia as well as the completeness rate of notification.Results: The total number of estimatedLegionellacases for 2012 was 45 (IC 95%:41-48) and the completeness rate was 65% (IC 95%:61-70%). The estimated incidence of Legionnaires' disease in Wallonia was 1.27/100,000 inhabitants.Conclusions: The notification rate ofLegionellamust be improved in Wallonia. Doctors should be made aware of the importance of diagnosing and reporting Legionnaires' disease.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Impact d'un programme de formation et de supervision de la qualité des soins sur la mortalité intra-hospitalière des enfants en afrique central

The study's aim was to evaluate the impact of an in-service training course and supervision of physicians and nurses in terms of quality of care on intra-hospital mortality. The study included 2 cohorts of children. Cohort 1 included 414 children from 0 to 15 yearsold who were followed in the paediatric wards of the provincial hospital of Goma (HPG) between April 1, 2003 and March 31, 2004. Cohort 2 included 996 children from 0 to 15 yearsold where were treated and followed in the same service between January 1, 2005 and December 31, 2005. General and specific mortalities occurring before and after an intervention were compared, as were the ratios of the observed deaths to the predicted deaths through the application of the Goma1 model to cohort 2. Overall mortality decreased by 15,9% (before the intervention) to 4,6% (after the intervention), translating to a total reduction of 71,1%. The ratios between the observed deaths and the predicted deaths were lower than 1, globally and when stratified. The risk of death in the cohort 1 (before the intervention) is 6,8 times higher than in cohort 2 (after the intervention). This shows an improvement of child survival after the intervention. © S.F.S.P. Tous droits réservés pour tous pays.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Understanding couples' attitudes on prenatal HIV testing in the Democratic Republic of Congo

info:eu-repo/semantics/publishe