Barriers and facilitators to reproductive health service utilization in Cote d'Ivoire: A community-based qualitative study / Barrières et facilitateurs de l'utilisation des services de santé de la reproduction en Côte d'Ivoire : une étude qualitative auprès de la communauté

Introduction: Improving Reproductive Maternal Newborn Child Adolescent Health Plus Nutrition (RMNCAH+N) indicators is a challenge for health systems, especially those in sub-Saharan Africa. The objective of this study was to identify barriers and facilitators to the use of RMNCAH+N services in areas with low indicators in Cote d'Ivoire. Methods: A qualitative case study was conducted in September 2021, with 76 beneficiaries of RMNCAH+N services in the health districts of Boundiali, Toulepleu and Tanda. Individual interviews (09) and focus groups (09) were conducted with community leaders/tradi-practitioners/midwives and pregnant women/ women of childbearing age/men who have or are responsible for a child under the age of 5, respectively. A thematic analysis was performed after coding the data in NVivo 12. Results: Barriers to utilization of RMNCAH+N services were unavailability of certain equipment/amenities, disrespectful care in some RMNCAH+N services, women's lack of financial autonomy, lack of autonomy in decision making, and male healthcare providers. Facilitators identified were geographic accessibility, men's involvement in the mother-child dyad's health, and community awareness. Conclusion: Improving utilization of RMNCAH+N services requires the implementation of interventions that address these barriers and facilitators, such as raising community awareness of RMNCAH+N services and promoting respectful, patient-centered, humanized care among healthcare providers.

Introduction: L'amélioration des indicateurs de santé reproductive, maternelle, néonatale, infantile et adolescente et de la nutrition (SRMNIA+N) représente un challenge pour les systèmes de santé, principalement ceux des pays d'Afrique subsaharienne. Cette étude avait pour objectif d'identifier les barrières et facilitateurs à l'utilisation des services de SRMNIA+N dans les zones à faibles indicateurs en Côte d'Ivoire. Méthodes: Une étude de cas par approche qualitative auprès de 76 bénéficiaires des services de SRMNIA+N a été menée en septembre 2021 dans les districts sanitaires de Boundiali, Toulepleu et Tanda. Des entretiens individuels et des discussions de groupe (focus groups) ont été organisés respectivement auprès des leaders communautaires, tradipraticiens ou matrones et des femmes enceintes ou en âge de procréer et des hommes ayant la charge d'un enfant de moins de 5 ans. Une analyse thématique a été réalisée après codage des données dans NVivo 12. Résultats: Les barrières à l'utilisation des services de SRMNIA+N étaient la non-disponibilité de certains équipements ou commodités, les soins irrespectueux dans certains services de SRMNIA+N, le manque d'autonomie financière et/ou décisionnelle des femmes et la présence de prestataires de sexe masculin. Les facilitateurs identifiés étaient : l'accessibilité géographique, l'implication des hommes dans la santé du couple mère/enfant, la sensibilisation de la population. Conclusion: L'amélioration de l'utilisation des services de SRMNIA+N nécessite la mise en œuvre d'interventions adressant ces barrières et facilitateurs tels que la sensibilisation de la communauté sur les services de SRMNIA+N, la promotion auprès des prestataires de santé des soins humanisés respectueux et centrés sur le patient.

[Socioeconomic factors influencing exclusive breastfeeding among primiparous women in Abidjan (Ivory Coast)]. / Facteurs socioprofessionnels et pratique de l'allaitement exclusif par les primipares à Abidjan (Côte d'Ivoire).

OBJECTIVE: To ensure complete adhesion of primiparous women with exclusive breastfeeding, we need to understand the factors influencing this practice. The objective of this study was to determine the socioeconomic factors related to exclusive breastfeeding of infants less than six months old born to primiparous mothers. METHODS: This cross-sectional descriptive and analytical study was conducted over a two-month period from 4 June to 6 August 2012 in three health facilities in the city of Abidjan. A total of 188 primiparous women were surveyed by a direct face-to-face questionnaire-based interview technique. RESULTS: The mean age of primiparous women was 26.56 ± 5.05 years. The majority (76.60%) were in a couple relationship and 40.43% had completed higher education. 36.17% of women were working, while 23.94% were students. Only 33.51% of women performed exclusive breastfeeding. Exclusive breastfeeding rates decreased progressively with increasing age of the infant, from 46.67% at the age of one month to 16.67% at the age of six months. Factors associated with failure to perform exclusive breastfeeding were marriage, working in the public or private sector, delivery in a private health facility, delivery by caesarean section, living in Cocody, and lack of knowledge concerning exclusive breastfeeding. CONCLUSION: It is essential to take socio-economic factors into account when developing strategies designed to increase exclusive breastfeeding rates and maintenance of exclusive breastfeeding until the age of six months among primiparous women in Abidjan.

Situational analysis and expert evaluation of the nutrition and health status of infants and young children in five countries in sub-Saharan Africa.

BACKGROUND: The poor feeding practices of pregnant women, infants, and young children contribute to the burden of malnutrition and subsequently to childhood morbidity and mortality in sub-Saharan Africa. Gaining insight into the nutritional and health status of infants and young children will help to focus future nutrition programs and actions. OBJECTIVE: To assess the nutrition and health status of infants and young children in five sub-Saharan African countries: Ivory Coast, Senegal, Cameroon, Kenya, and Nigeria. METHODS: Published and gray literature was critically reviewed and enriched with the views of local experts from academia, hospitals, and institutions to assess infants' and children's diet and health in the five sub-Saharan African countries. Subsequently, the Africa Nutriday Conference was held in Senegal in November 2011 to further discuss key challenges, action plans, and recommendations for future research. RESULTS: This review highlighted the need for education of parents and healthcare professionals in order to increase their knowledge of breastfeeding, vaccination programs, and over- and undernutrition. An integrated health and nutrition surveillance is needed both to identify micronutrient deficiencies and to recognize early signs of overweight. These data will help to adapt nutrition education and food fortification programs to the target populations. CONCLUSIONS: Different countries in sub-Saharan Africa face similar nutrition and health issues and are currently not sharing best practices, nutrition programs, and scientific studies optimally. There is a need for closer collaboration among scientists within and between countries.

Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services.

INTRODUCTION: There are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women's, Children's and Adolescents' Health country collaborations, analysts from country and global public health institutions and ministries of health assessed the trends in selected services for maternal, newborn and child health, general service utilisation. METHODS: Monthly routine health facility data by district for the period 2017-2020 were compiled by 12 country teams and adjusted after extensive quality assessments. Mixed effects linear regressions were used to estimate the size of any change in service utilisation for each month from March to December 2020 and for the whole COVID-19 period in 2020. RESULTS: The completeness of reporting of health facilities was high in 2020 (median of 12 countries, 96% national and 91% of districts ≥90%), higher than in the preceding years and extreme outliers were few. The country median reduction in utilisation of nine health services for the whole period March-December 2020 was 3.9% (range: -8.2 to 2.4). The greatest reductions were observed for inpatient admissions (median=-17.0%) and outpatient admissions (median=-7.1%), while antenatal, delivery care and immunisation services generally had smaller reductions (median from -2% to -6%). Eastern African countries had greater reductions than those in West Africa, and rural districts were slightly more affected than urban districts. The greatest drop in services was observed for March-June 2020 for general services, when the response was strongest as measured by a stringency index. CONCLUSION: The district health facility reports provide a solid basis for trend assessment after extensive data quality assessment and adjustment. Even the modest negative impact on service utilisation observed in most countries will require major efforts, supported by the international partners, to maintain progress towards the SDG health targets by 2030.

[Chronic malnutrition among children under five years of age in the northern part of Côte d'Ivoire]. / Malnutrition chronique chez les enfants de moins de 5 ans au nord de la Côte d'Ivoire.

The malnutrition of children under five years of age constitutes a major public health problem in most developing countries. A cross-section study was carried in 2003 in the northern part of Côte d'Ivoire to determine the prevalence of chronic malnutrition and to identify risk factors among children under five years of age living in urban and rural areas of the northern part of Côte d'Ivoire. A total of 292 and 268 children under five years of age residing respectively in urban and rural areas were included in the study. Their median age was 24 months. Chronic malnutrition was more frequent in children from rural areas (39.9%) than in those living in urban areas (16.7%). Malnutrition was significantly associated with the type of food consumed by children under two years of age in urban areas, and it was strongly linked to emaciation of the mother and presence of childhood fever in rural areas. In light of these results, we advocate a healthy diet and adequate health status for the mother and child to improve the nutritional status of children. Moreover, these results need to be completed and complemented by further studies for more detailed information to contribute to a better definition of actions to fight efficiently against malnutrition among children of the northern part of Côte d'Ivoire.

[Evaluation of the quality of prenatal consultations in the health district of Grand Bassam, Côte d'Ivoire]. / Evaluation de la qualité des consultations prénatales dans le district sanitaire de Grand Bassam (Côte d'Ivoire).

Maternal mortality constitutes a major public health problem in Côte d'Ivoire. Better management of pregnant patients and improved quality of pre-natal consultations could contribute to solving this problem. But what is the current situation of these a pre-natal consultations in the medical district of Grand-Bassam? To answer to this question, a descriptive cross-sectional study was carried out between August 26th and September 30th, 2002 in three medical establishments in charge of pre-natal consultations in that District. It was noted that the privacy and the confidentiality during the examination were respected; yet on the other hand, the structures were sometimes unsuited and were insufficiently equipped. The health care professionals were not very accessible or friendly, and they had poor interpersonal communication skill. Recommendations were made to remedy these insufficiencies.

Quality of antenatal and delivery care before and after the implementation of a prevention of mother-to-child HIV transmission programme in Côte d'Ivoire.

OBJECTIVE: To assess whether implementation of a prevention of mother-to-child HIV transmission (PMTCT) programme in Côte d'Ivoire improved the quality of antenatal and delivery care services. METHODS: Quality of antenatal and delivery care services was assessed in five urban health facilities before (2002-2003) and after (2005) the implementation of a PMTCT programme through review of facility data; observation of antenatal consultations (n = 606 before; n = 591 after) and deliveries (n = 229 before; n = 231 after) and exit interviews of women; and interviews of health facility staff. RESULTS: HIV testing was never proposed at baseline and was proposed to 63% of women at the first ANC visit after PMTCT implementation. The overall testing rate was 42% and 83% of tested HIV-infected pregnant women received nevirapine. In addition, inter-personal communication and confidentiality significantly improved in all health facilities. In the maternity ward, quality of obstetrical care at admission, delivery and post-partum care globally improved in all facilities after the implementation of the programme although some indicators remained poor, such as filling in the partograph directly during labour. Episiotomy rates among primiparous women dropped from 64% to 25% (P < 0.001) after PMTCT implementation. Global scores for quality of antenatal and delivery care significantly improved in all facilities after the implementation of the programme. CONCLUSIONS: Introducing comprehensive PMTCT services can improve the quality of antenatal and delivery care in general.

Quality of normal delivery care in Côte d'Ivoire.

The aim of this study was to assess the quality of normal delivery care in Côte d'Ivoire. A total of 229 women were included in a cross-sectional study conducted in four urban maternity wards between 2002 and 2003. Observation checklists and exit-interviews were used to examine various dimensions of care. The results showed that the overall quality of care was poor, despite most women giving birth with a professional midwife. A vaginal examination was performed systematically at admission but blood pressure was measured in less than half of the women. The partograph was completed during labour in only 5% of cases. Episiotomy and uterine revision rates were high at 24% and 32%, respectively. There was a lack of universal hygiene precautions and women received little support during labour. Our results question the quality of labour, delivery and postpartum care by skilled attendants in Côte d'Ivoire.