Background Kangaroo Mother Care (KMC) is a high impact, low technology and cost-effective intervention for the care of preterm and low birth weight newborn. Cote d’Ivoire adopted the intervention and opened the first KMC unit in 2019. This study aimed to assess barriers and facilitators of KMC implementation in Cote d’Ivoire, a year after its introduction, as well as proposed solutions for improving KMC implementation in the country. Method This was a qualitative study, using semi-structured interviews, carried out in September 2020 in the first KMC unit opened at the Teaching Hospital of Treichville. The study involved healthcare providers providing KMC and mothers of newborn who were receiving or received KMC at the unit. A thematic analysis was performed using both inductive and deductive (Consolidated Framework for Implementation Research-driven) approaches. NVivo 12 was used to assist with coding. Results A total of 44 semi-structured interviews were conducted, 12 with healthcare providers and 32 with mothers. The barriers identified were lack of supplies, insufficiency of human resources, lack of space for admission, lack of home visits, lack of food for mothers, lack of collaboration between health services involved in newborn care, increased workload, the beliefs of carrying the baby on the chest, father’s resistance, low rate of exclusive breastfeeding, lack of community awareness. Facilitators identified were training of healthcare providers, strong leadership, the low cost of KMC, healthcare providers’ perceived value of KMC, mothers−healthcare providers’ relationship, mothers’ adherence to KMC and the capacity of the KMC unit to network with external organizations. The proposed solutions for improving KMC implementation were volunteer staff motivation, intensifying education and counselling of mothers and families, the recruitment of a psychologist and the involvement of all stakeholders. Conclusion Our study highlighted the challenges to implement KMC in Cote d’Ivoire with unique and specific barriers to implementation. We recommend to researchers and decision makers to respectively design strategies and adopt intervention that specifically address these barriers and facilitators to a better uptake of KMC. Decision makers should also take into account the proposed solutions for a better implementation and scaling up of KMC.

ObjectiveTo assess and compare the quality of intrapartum and immediate postpartum care across levels of healthcare in Burkina Faso and Côte d’Ivoire using validated process indicators.DesignHealth facility-based cross-sectional study with direct observation of healthcare workers’ practices while caring for mother–newborn pairs during intrapartum and immediate postpartum periods.SettingPrimary healthcare facilities and their corresponding referral hospitals in the Central-North region in Burkina Faso and the Agneby-Tiassa-Mé region in Côte d’Ivoire.ParticipantsHealthcare providers who care for mother–newborn pairs during intrapartum and immediate postpartum periods, the labouring women and their newborns after childbirth.Main outcome measure(s)Adherence to essential best practices (EBPs) at four pause points in each birth event and the overall quality score based on the level of adherence to the set of EBPs observed for a selected pause point.ResultsA total of 532 and 627 labouring women were included in Burkina Faso and Côte d’Ivoire, respectively. Overall, the compliance with EBPs was insufficient at all the four pause points, even though it varied widely from one EBP to another. The adherence was very low with respect to hand hygiene practices: the care provider wore sterile gloves for vaginal examination in only 7.96% cases (95% CI 5.66% to 11.06%) in Burkina Faso and the care provider washed hands before examination in 6.71% cases (95% CI 3.94% to 11.20%) in Côte d’Ivoire. The adherence was very high with respect to thermal management of newborns in both countries (>90%). The overall mean quality scores were consistently higher in referral hospitals in Burkina Faso at all pause points excluding immediate post partum.ConclusionsWomen delivering in healthcare facilities do not always receive proven EBPs needed to prevent poor childbirth outcomes. There is a need for quality improvement interventions.

BackgroundWorld Health Organization has predicted a worldwide rise in the prevalence of diabetes mellitus. Cote d’Ivoire is not exempted as evidenced by such factors as obesity and sedentary life style amongst others. The objective of the study was to determine the prevalence of diabetes mellitus (DM) among children and adolescents in the district of Abidjan in Cote d’Ivoire. MethodsA cross-sectional descriptive survey using a multi-stage sampling approach was conducted from March to April 2013. 1572 children and adolescents aged 02–19 years were surveyed in 687 randomly selected households in three municipalities. Capillary fasting glucose was performed in all subjects, and when abnormal was followed by an Oral Glucose Tolerance Test (OGTT). Definitions of Impaired Fasting Glucose (IFG) and DM (Diabetes Mellitus) were according to International Society for Paediatric and Adolescent Diabetes (ISPAD) Guidelines.ResultsThe prevalence of DM and IFG were 0.4 % and 14.5 % respectively. There was no significant differences between patients with different glycemic status in terms of ethnicity/nationality (p = 0.98) or gender (0.079). In the rural areas, 565 (81.1 %) subjects were normoglycaemic and 132 (18.9 %) subjects hyperglycaemic while there were 773 (88.3 %) normoglycaemic subjects and 102 (11.7 %) hyperglycaemic subjects respectively from the urban areas of residence and this difference was statistically significant (p = 0.000). The prevalence of diabetes mellitus was identical (0.4 %) in the two age groups (2–9 years and 10–19 years). Seventy-seven (4.9 %) children who participated in the study had at least one diabetic parent. The proportion of participants with a diabetic father (59, 3.8. %) was twice the proportion with a diabetic mother (30,1.9 %) and this was statistically significant (p = 0.002). Only 10 out of 228 patients with IFG reported for the follow up OGTT and no impaired glucose tolerance was identified in these patients.ConclusionThe prevalence rate of DM among children and adolescents was 0.4 %. Nationwide awareness campaigns and prevention programmes about diabetes in childhood should be instituted and existing ones strengthened. Adequate commitment from the relevant stakeholders especially the country’s ministry of health is also advocated to stem this looming epidemic.

Introduction Despite the important increase in in-facility births, perinatal mortality rates have remained high and slow to decrease in many developing countries. This situation is attributed to poor childbirth care quality. The reason why women delivering in health facilities do not always receive care of an adequate standard is unclear. We assessed the determinants of childbirth care quality along the care continuum by means of different approaches. Methods A health facility-based cross-sectional study with a direct observation of health care workers’ practices while caring for mother–newborn pairs was carried out in Burkina Faso and Côte d’Ivoire. The performance of a set of essential best practices (EBPs) was assessed in each birth event at the admission, prepushing and immediate postpartum stages. A quality score, in the form of the additive sum of EBPs effectively delivered, was computed for each stage. We used negative binomial regression models and a structural equation modeling analysis to assess the determinants of care quality at each stage and the relationships of the quality delivered at the different stages, respectively. Results A total of 532 and 627 mother–newborn pairs were evaluated in Burkina Faso and Côte d’Ivoire, respectively. In both countries, delivery care quality varied significantly at all stages between health districts. Predelivery care quality was consistently higher in referral hospitals than in primary health care facilities (incident rate ratio (IRR) = 1.02, p < 0.05, and IRR = 1.10, p < 0.05, respectively, for Burkina Faso and Côte d’Ivoire). Quality at admission was poorer among nurses than among midwives in Burkina Faso (IRR = 0.81, p < 0.001). Quality at the admission and predelivery stages was positively correlated with immediate postpartum care quality (β = 0.48, p < 0.001, and β = 0.29, p < 0.001, respectively). Conclusion Quality improvement strategies must target both providers and health facilities, and different inputs are needed depending on the stage in the care continuum.