Éducation des mères et gravité de l’état des enfants présentés aux urgences de l’hôpital Joseph-Raseta-Befelatanana, Madagascar. Quelles implications ?

Abstract

The parents 'educational conditions are one of the factors of health inequalities among children. During May 2009, the parents' instruction level of children admitted at the triage unit of a Pediatric Service in Antananarivo, Madagascar was evaluated and related to the severity of their children' health status and to the mode of reference. All the surviving children (from 2 months to 15 years old) were included in this study. Patients were classified by the IMCI guideline and we analyzed the educational level of their mothers. Each patient was classified as severe illness or without severe illness, according to IMCI algorithm. The quality of referring physician was recorded: public physicians, liberal physicians, nurses, or without referral. Among 296 children, 9 (3%) died before admission, 217 (75.6%) were included. Among them, 123 (56.7%) had a severe illness and 38,2% general signs of danger. The severity (92.3 versus 54.4%; P = 0.003), the number of severe dehydration (15.4 versus 3.9%; P = 0,027) and malnutrition (15.4 versus 4.4%; P = 0.039) were related with a poor parents educational level. The referral agents were mostly liberal physicians (56.7%), public physicians (26.7%) or nurses (1.8%). Mothers with higher educational level preferred to attend liberal physicians (58 versus 41.9%; P = 0.1). The reference delay was shorter if there was a severe illness (6.41 versus 19.6 days; P < 0.000) or no medical referral (51.1 versus 24.4%; P > 0.000). Despite the fact that access to hospital care was respectful of a two-step process (85.3%), the number of patients with severe illness was high among families with low educational level. Theses results suggest to educate in priority the mother with low education, in order to recognize the general signs of danger and facilitate early first health care.

Childhood Dysglycemia: Prevalence and Outcome in a Referral Hospital

“…IMCI was introduced in Madagascar in 1995, and is currently used in the main hospitals and 90% of districts to triage severely ill children [28], [29].…”

“…The pediatric department of Befelatanana Hospital (75 beds) admits on average 3000 children per year [29]. The frequency of severe illness and general signs of danger is high in the admissions unit (56.7% and 38.2%, respectively) [29].…”

“…The frequency of severe illness and general signs of danger is high in the admissions unit (56.7% and 38.2%, respectively) [29]. In-patient mortality rate dropped from 16% in 1998 (with 47.6% of deaths attributed to diarrhea) to 7% in 2009 [29]. Patients (or their parents) have to pay hospital fees and buy all necessary medical supplies (i.e.…”

“…Incoming children are usually received at the admissions unit where a team of doctors and nurses are on duty 24 hours. The IMCI algorithm is used to triage the severity of children and determine who will be admitted to the ward, referred to peripheral units, or sent back home with a prescription [22], [29]. According to hospital guidelines, all children with general signs of danger, and all children brought in at night, are admitted to the pediatric ward, whatever their IMCI status.…”

Parental Perceptions of Giardiasis: A Study in an Outpatient Paediatric Hospital Setting in Havana, Cuba

“…The parents' educational level is one of the factors of health inequalities among children [35]. Education is important for health because of the opportunities it creates to obtain better material living conditions; well-educated people are less likely to be unemployed, and more likely to have full-time jobs, fulfilling work, and high income.…”