Formation des mères : stratégie pour améliorer le traitement des infections respiratoires aiguës au Mali

Sangho, Hamadoun; Keita, Abdelaye; Keïta, Haoua Dembélé; Belemou, Boureyma; Keita, Fatoumata; Bamba, S.; Traoré, B; Dia, Amadou Hamath; Sidibé, Toumani

doi:10.3917/spub.120.0023

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Diagnostic tests distinguishing between viral, bacterial and parasitological infections are also needed (Baiden et al 2011b). Meanwhile, other options than CHWs prescribing antibiotic treatment-or mothers, as has just been tested (Sangho et al 2012)-should be considered. Their use as actors of social change inside their community to increase impacts of interventions to prevent pneumonia could be promising (Holloway et al 2009).…”

Section: Discussionmentioning

confidence: 99%

The community case management of pneumonia in Africa: a review of the evidence

Druetz

Siekmans

Goossens

et al. 2013

Health Policy and Planning

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Pneumonia causes around 750 000 child deaths per year in sub-Saharan African (SSA) countries. The lack of accessibility to prompt and effective treatment is an important contributor to this burden. Community case management of pneumonia (CCMp) uses trained community health workers (CHWs) to administer antibiotics to suspected child pneumonia cases in villages. This strategy has been gaining momentum in low- and middle-income countries, and the World Health Organization and United Nations children's fund have recently encouraged countries to broaden community case management to other diseases. Recommendations in favour CCMp are based on three meta-analyses showing its efficacy to reduce childhood mortality and morbidity attributable to pneumonia although most of the studies in the meta-analyses were conducted in Asian countries. This is problematic as community case management strategies have been implemented in very different ways in Asian and SSA countries, partly due to differences in malaria prevalence. Therefore, we conducted a narrative synthesis to systematically review the evidence on CCMp in SSA. Results show that there is a lack of evidence concerning its efficacy and effectiveness in SSA, irrespective of whether case management is integrated with other diseases or not. CHWs encounter difficulties in counting the respiratory rate. Their adherence to the guidelines is poorer when they are required to manage several illnesses or children with severe signs. CCMp thus encompasses issues of over-treatment and missed treatment, with potentially negative consequences such as increased lethality in severe cases and antibiotics resistance. The current lack of evidence concerning its efficacy, effectiveness and the factors leading to successful implementation, coupled with CHWs' poor adherence, demand a thorough examination of the legitimacy of implementing CCMp in SSA countries.

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Section: Discussionmentioning

confidence: 99%

The community case management of pneumonia in Africa: a review of the evidence

Druetz

Siekmans

Goossens

et al. 2013

Health Policy and Planning

View full text Add to dashboard Cite

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Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health workers: results from a large-scale pragmatic trial in rural Niger

et al. 2016

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BackgroundCommunity health workers (CHWs) are recommended to screen for acute malnutrition in the community by assessing mid-upper arm circumference (MUAC) on children between 6 and 59 months of age. MUAC is a simple screening tool that has been shown to be a better predictor of mortality in acutely malnourished children than other practicable anthropometric indicators. This study compared, under program conditions, mothers and CHWs in screening for severe acute malnutrition (SAM) by color-banded MUAC tapes.MethodsThis pragmatic interventional, non-randomized efficacy study took place in two health zones of Niger’s Mirriah District from May 2013 to April 2014. Mothers in Dogo (Mothers Zone) and CHWs in Takieta (CHWs Zone) were trained to screen for malnutrition by MUAC color-coded class and check for edema. Exhaustive coverage surveys were conducted quarterly, and relevant data collected routinely in the health and nutrition program. An efficacy and cost analysis of each screening strategy was performed.ResultsA total of 12,893 mothers and caretakers were trained in the Mothers Zone and 36 CHWs in the CHWs Zone, and point coverage was similar in both zones at the end of the study (35.14 % Mothers Zone vs 32.35 % CHWs Zone, p = 0.9484). In the Mothers Zone, there was a higher rate of MUAC agreement (75.4 % vs 40.1 %, p <0.0001) and earlier detection of cases, with median MUAC at admission for those enrolled by MUAC <115 mm estimated to be 1.6 mm higher using a smoothed bootstrap procedure. Children in the Mothers Zone were much less likely to require inpatient care, both at admission and during treatment, with the most pronounced difference at admission for those enrolled by MUAC < 115 mm (risk ratio = 0.09 [95 % CI 0.03; 0.25], p < 0.0001). Training mothers required higher up-front costs, but overall costs for the year were much lower ($8,600 USD vs $21,980 USD.)ConclusionsMothers were not inferior to CHWs in screening for malnutrition at a substantially lower cost. Children in the Mothers Zone were admitted at an earlier stage of SAM and required fewer hospitalizations. Making mothers the focal point of screening strategies should be included in malnutrition treatment programs.Trial registrationThe trial is registered with clinicaltrials.gov (Trial number NCT01863394).

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Formation des mères : stratégie pour améliorer le traitement des infections respiratoires aiguës au Mali

Cited by 2 publications

References 14 publications

The community case management of pneumonia in Africa: a review of the evidence

The community case management of pneumonia in Africa: a review of the evidence

Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health workers: results from a large-scale pragmatic trial in rural Niger

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