Variations in the use of malaria preventive measures among pregnant women in Guinea: a secondary analysis of the 2012 and 2018 demographic and health surveys.

BACKGROUND: Despite its effectiveness, the optimal use of the combination of insecticide-treated nets (ITN) and intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) remains low in malaria-endemic areas. Therefore, this study analyzed its variations and predictors in Guinea. METHODS: This study was a secondary analysis of the 2012 and 2018 Guinea Demographic and Health Surveys (DHS). It included women who had given birth 3 years before each DHS, slept on ITN and took at least one dose of SP. Use was complete if a pregnant woman slept on ITNs and took SP (at least two doses in 2012; at least three doses in 2018). Moran indices were used to determine spatial autocorrelation and classification methods to identify malaria preventive measures (MPM) predictors. RESULTS: In 2012, 60.88% of pregnant women had incomplete use of MPMs compared with 79.11% in 2018. Associated factors with incomplete MPMs in 2012 were as follows: having an indirect link with the head of household (AOR = 2.23, 95% CI 1.08-4.61) and performing at least 4 ANC visits (AOR = 0.66, 95% CI 0.44-0.99). In 2018: Living in households of 2 to 5 people (AOR = 0.54, 95% CI 0.36-0.80), have a man as the head of the household (AOR = 0.56, 95% CI 0.35-0.89), perform the first ANC in the second trimester of pregnancy (AOR = 0.74, 95% CI 0.54-0.99), perform at least 4 ANC visits (AOR = 0.47, 95% CI 0.36-0.62), have a job (AOR = 0. 67, 95% CI 0.50-0.88), give birth in a public health facility (AOR = 0.53, 95% CI 0.39-0.72) and the middle wealth quintile (AOR = 1.56, 95% CI 1.07-2.26). Analyses revealed a global autocorrelation (Moran index = 0.0009, p = 0.2349) and high-high clusters in Mamou in 2012. In 2018, autocorrelation was found (I Moran = 0.0169, p ≤ 0.05), with spatial clusters in 4 regions. CONCLUSION: The link with the head of household and the number of ANC visits were the main factors in MPMs. It is essential to implement strategies at the household level and health system level and monitor them to reduce inequality across regions.

Scaling severe acute malnutrition treatment with community health workers: a geospatial coverage analysis in rural Mali.

BACKGROUND: In 2015, the Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated Community Case Management (iCCM). This paper aims to analyze the impact of including community health workers (CHWs) as treatment providers outside the Health Facilities (HFs) on the coverage of SAM treatment when scaling up the intervention in the three largest districts of the Kayes Region in Mali. METHODS: A baseline coverage assessment was conducted in August 2017 in the three districts before the CHWs started treating SAM. The end-line assessment was conducted one year later, in August 2018. Coverage was assessed by the standardized methodology called Semi-Quantitative Evaluation of Access and Coverage (SQUEAC). The primary outcome was treatment coverage and other variables evaluated were the geographical distribution of the HFs, CHW's sites and overlapping between both health providers, the estimation of children with geographical access to health care and the estimation of children screened for acute malnutrition in their communities. RESULTS: Treatment coverage increased in Kayes (28.7-57.1%) and Bafoulabé (20.4-61.1%) but did not in Kita (28.4-28.5%). The decentralization of treatment has not had the same impact on coverage in all districts, with significant differences. The geospatial analyses showed that Kita had a high proportion of overlap between HFs and/or CHWs 48.7% (39.2-58.2), a high proportion of children without geographical access to health care 70.4% (70.1-70.6), and a high proportion of children not screened for SAM in their communities 52.2% (51.9-52.5). CONCLUSIONS: Working with CHWs in SAM increases treatment coverage, but other critical aspects need to be considered by policymakers if this intervention model is intended to be scaled up at the country level. To improve families' access to nutritional health care, before establishing decentralized treatment in a whole region it must be considered the geographical location of CHWs. This previous assessment will avoid overlap among health providers and ensure the coverage of all unserved areas according to their population densities need. TRIAL REGISTRATION: ISRCTN registry with ID 1990746. https://doi.org/10.1186/ISRCTN14990746.

Cost-effectiveness of district-wide seasonal malaria chemoprevention when implemented through routine malaria control programme in Kita, Mali using fixed point distribution.

BACKGROUND: Seasonal malaria chemoprevention (SMC) is a strategy for malaria control recommended by the World Health Organization (WHO) since 2012 for Sahelian countries. The Mali National Malaria Control Programme adopted a plan for pilot implementation and nationwide scale-up by 2016. Given that SMC is a relatively new approach, there is an urgent need to assess the costs and cost effectiveness of SMC when implemented through the routine health system to inform decisions on resource allocation. METHODS: Cost data were collected from pilot implementation of SMC in Kita district, which targeted 77,497 children aged 3-59 months. Starting in August 2014, SMC was delivered by fixed point distribution in villages with the first dose observed each month. Treatment consisted of sulfadoxine-pyrimethamine and amodiaquine once a month for four consecutive months, or rounds. Economic and financial costs were collected from the provider perspective using an ingredients approach. Effectiveness estimates were based upon a published mathematical transmission model calibrated to local epidemiology, rainfall patterns and scale-up of interventions. Incremental cost effectiveness ratios were calculated for the cost per malaria episode averted, cost per disability adjusted life years (DALYs) averted, and cost per death averted. RESULTS: The total economic cost of the intervention in the district of Kita was US $357,494. Drug costs and personnel costs accounted for 34% and 31%, respectively. Incentives (payment other than salary for efforts beyond routine activities) accounted for 25% of total implementation costs. Average financial and economic unit costs per child per round were US $0.73 and US $0.86, respectively; total annual financial and economic costs per child receiving SMC were US $2.92 and US $3.43, respectively. Accounting for coverage, the economic cost per child fully adherent (receiving all four rounds) was US $6.38 and US $4.69, if weighted highly adherent, (receiving 3 or 4 rounds of SMC). When costs were combined with modelled effects, the economic cost per malaria episode averted in children was US $4.26 (uncertainty bound 2.83-7.17), US $144 (135-153) per DALY averted and US $ 14,503 (13,604-15,402) per death averted. CONCLUSIONS: When implemented at fixed point distribution through the routine health system in Mali, SMC was highly cost-effective. As in previous SMC implementation studies, financial incentives were a large cost component.

Measuring the impact of seasonal malaria chemoprevention as part of routine malaria control in Kita, Mali.

BACKGROUND: Seasonal malaria chemoprevention (SMC) is a new strategy recommended by WHO in areas of highly seasonal transmission in March 2012. Although randomized controlled trials (RCTs) have shown SMC to be highly effective, evidence and experience from routine implementation of SMC are limited. METHODS: A non-randomized pragmatic trial with pre-post design was used, with one intervention district (Kita), where four rounds of SMC with sulfadoxine + amodiaquine (SP + AQ) took place in August-November 2014, and one comparison district (Bafoulabe). The primary aims were to evaluate SMC coverage and reductions in prevalence of malaria and anaemia when SMC is delivered through routine programmes using existing community health workers. Children aged 3-59 months from 15 selected localities per district, sampled with probability proportional to size, were surveyed and blood samples collected for malaria blood smears, haemoglobin (Hb) measurement, and molecular markers of drug resistance in two cross-sectional surveys, one before SMC (July 2014) and one after SMC (December 2014). Difference-in-differences regression models were used to assess and compare changes in malaria and anaemia in the intervention and comparison districts. Adherence and tolerability of SMC were assessed by cross-sectional surveys 4-7 days after each SMC round. Coverage of SMC was assessed in the post-SMC survey. RESULTS: During round 1, 84% of targeted children received at least the first SMC dose, but coverage declined to 67% by round 4. Across the four treatment rounds, 54% of children received four complete SMC courses. Prevalence of parasitaemia was similar in intervention and comparison districts prior to SMC (23.4 vs 29.5%, p = 0.34) as was the prevalence of malaria illness (2.4 vs 1.9%, p = 0.75). After SMC, parasitaemia prevalence fell to 18% in the intervention district and increased to 46% in the comparison district [difference-in-differences (DD) OR = 0.35; 95% CI 0.20-0.60]. Prevalence of malaria illness fell to a greater degree in the intervention district versus the comparison district (DD OR = 0.20; 95% CI 0.04-0.94) and the same for moderate anaemia (Hb < 8 g/dL) (DD OR = 0.26, 95% CI 0.11-0.65). The frequency of the quintuple mutation (dhfr N51I, C59R and S108N + dhps A437G and K540E) remained low (5%) before and after intervention in both districts. CONCLUSIONS: Routine implementation of SMC in Mali substantially reduced malaria and anaemia, with reductions of similar magnitude to those seen in previous RCTs. Improving coverage could further strengthen SMC impact. Trial registration clinical trial registration number NCT02894294.

[Out-of-center blood pressure measurements in dialysis patients: Feasibility and comparison of methods]. / Mesures hors centre de la pression artérielle chez les hémodialysés chroniques : faisabilité et comparaison des méthodes.

The European Renal Association-European Dialysis and Transplant Association (ERA-EDTA)/European Society of Hypertension (ESH) recommends out-of-center blood pressure measurements, self-blood pressure measurement or ambulatory blood pressure measurement in dialysis patients. However, the feasibility of out-of-center blood pressure measurements in routine care is not known. The objective of our study was to quantify it as "a priori" i.e. the percentage of hemodialysis to whom out-of-center blood pressure measurements can be proposed and who accept it, as "a posteriori", i.e. the percentage of out-of-center blood pressure measurements made and valid. A systematic out-of-center blood pressure measurements program was implemented from April to October 2019 in our chronic hemodialysis structures. It was proposed to each dialysis patient to carry out after education, an self-blood pressure measurement (Omron M3®), from 2 measurements, to 1 to 2minutes interval, mornings and evenings of 6days without dialysis (validity: 15 measures). Apart from arrhythmic patients, to all patients "not eligible" for self-blood pressure measurement (visually impaired, hemiplegic, neuropsychological disorders, language barrier), a 44-hour ambulatory blood pressure measurement (Microlife WatchBP 03®) was proposed separating 2 hemodialysis sessions; measures every 15minutes from 7 a.m. to 10 p.m. and 30minutes from 10 p.m. to 7 a.m. (validity: 40 measurements/day and 14/night). This is a study evaluating practices recommended for routine care in 18-year-old hemodialysis, having given their consent to the collection and analysis of the data. One hundred twenty nine patients were treated with chronic hemodialysis in our structures during the out-of-center blood pressure measurements campaign. Out-of-center blood pressure measurements could not be done in 21 patients (4 deceased, 2 transplanted and 4 absent before evaluation; 7 arrhythmics; 3 refusals and 1 multiple-disabled). Of these 108 patients (sex ratio 1.25; 69.3±13.5 years), 23 were ineligible for self-blood pressure measurement (visually impaired, neuro- and/or psychological disorders, language barrier). Due to 4 self-blood pressure measurement failures, the feasibility of the self-blood pressure measurement (n=81/129) is 62.8 % (CI95% 54.2-70.7). Of the 24 ambulatory blood pressure measurements performed (23 among those not eligible for self-blood pressure measurement and 1 failure of self-blood pressure measurement), 19 were valid. The "a posteriori" feasibility of out-of-center blood pressure measurements (n=100/129) is 77.5 % (CI95% 69.6-83.4). The feasibility of out-of-center blood pressure measurements in hemodialysis patients is good, making the application of the recommendations possible.

Factors Associated With Home Births in Benin and Mali: Evidence From the Recent Demographic and Health Surveys.

Introduction: Identifying and understanding the factors associated with homebirths can contribute to improving maternal and child health and achieving the Sustainable Development Goals (SDGs). This study aimed to perform a comparative analysis of the factors associated with homebirths in Benin and Mali. Method: This study is based on the most recent data from the Demographic Health Surveys conducted in Mali and Benin in 2018. The dependent variable was homebirth, and the explanatory variables were the individual characteristics of the woman, the distance to the health center, the place of residence, the number of prenatal consultations had, the frequency of media exposure, and the use of the Internet. The primary survey unit (PSU) was considered in the analysis to measure the effect of context on the choice of the place of delivery. Further, descriptive statistics and multilevel logistic regression analysis were used in the study. Results: Educational level was associated with homebirth in Benin and Mali; Women with either no education or primary education are more likely to give birth at home. Women who didn't live close to a health facility were more likely to give birth at home than those who didn't face this problem in both countries. Not making visits for antenatal care (ANC) increases the odds of having a homebirth by 31.3 times (CI = 24.10-40.70) in Benin and 12.91 times (CI = 10.21-16.33) in Mali. Similarly, women who went on 1-2 ANC visits were more likely to give birth at home compared with women who made five or more ANC visits in both countries. The number of children per woman was also a significant factor in both countries. Women who often or regularly paid attention to the media messages were less likely to give birth at home compared with those who did not follow relevant media inputs (aOR = 0.42 [CI = 0.26-0.67] in Benin and aOR = 0.65 [CI = 0.50-0.85] in Mali). Conclusion: Increasing the demand and uptake of women's health services by improving the availability and quality of services and establishing community health centers could help reduce the incidence of homebirths that can be risky and, thus, combat maternal and infant mortality.

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.

Impact of Different Levels of Supervision on the Recovery of Severely Malnourished Children Treated by Community Health Workers in Mali.

(1) Background: The Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated community case management (iCCM). This paper evaluates the most effective model of supervision for treating SAM using community health workers (CHWs). Methods (2): This study was a prospective non-randomized community intervention trial with two intervention groups and one control group with different levels of supervision. It was conducted in three districts in rural areas of the Kayes Region. In the high supervision group, CHWs received supportive supervision for the iCCM package and nutrition-specific supervision. In the light supervision group, CHWs received supportive supervision based on the iCCM package. The control group had no specific supervision. (3) Results: A total of 6112 children aged 6-59 months with SAM without medical complications were included in the study. The proportion of cured children was 81.4% in those treated by CHWs in the high supervision group, 86.2% in the light supervision group, and 66.9% in the control group. Children treated by the CHWs who received some supervision had better outcomes than those treated by unsupervised CHWs (p < 0.001). There was no difference between areas with light and high supervision, although those with high supervision performed better in most of the tasks analyzed. (4) Conclusions: Public policies in low-income countries should be adapted, and their model of supervision of CHWs for SAM treatment in the community should be evaluated.

[Study on the clinical and epidemiological characteristics of the first 1030 cases of covid-19 in Mali]. / Etude sur les caracteristiques cliniques et epidemiologiques des 1030 premiers cas de covid-19 au Mali.

AIMS: Since the confirmation of the first cases of COVID-19 in Mali in March 2020 and the outbreakspreading to the whole country, clinical and epidemiological data fromaffected patients are used to characterize the disease. This study was to describe the clinica lsigns and epidemiologicalparameters of COVID-19 in the Malian context. MATERIALS AND METHODS: This is a cross-sectional study. All confirmed cases of COVID-19 in Mali between March 25, 2020 to May 24, 2020 have been included. Clinical and epidemiological data from patients with COVID-19 were extracted from the official line list of cases and the national reference laboratory register. RESULTS: The mean age of the 1,030 patients was 45.6 ± 18.4 years; 67.2% of patients were men. Asymptomatic patients accounted for 31.1%. The most common symptoms on admission were cough (60.8%) followed by fever (47.6%). The largest number of cases was recorded in Bamako. CONCLUSION: SARS-CoV-2 infection of the first 1,030 cases in Mali was marked by the predominance of cough and fever.

BUTS: Depuis la confirmation des premiers cas de COVID-19 au Mali en Mars 2020 et sa propagation à tout le pays, des données cliniques et épidémiologiques des patients atteints sont utilisées pour caractériser la maladie. Cette étude avait pour objectif d'étudier les signes cliniques et épidémiologiques de la COVID-19 dans le contexte malien. MATÉRIELS ET MÉTHODES: Il s'agit d'une étude transversale. Tous les cas confirmés de COVID-19 du Mali entre le 25 Mars 2020 au 24 Mai 2020 ont été inclus. Les données cliniques et épidémiologiques des patients atteints de COVID-19ont été extraites. RÉSULTATS: L'âge moyen descas était de 45,6±18,4 ans ; 67,2% des patients étaient des hommes. Les patients asymptomatiques représentaient 31,1%. Les symptômes les plus courants à l'admission étaient la toux (60,8%) suivi de la fièvre (47,6%). Le plus grand nombre de cas a été enregistré à Bamako. CONCLUSION: L'infection par le SARS-CoV-2 des 1 030 premiers cas au Mali a été marquée par la prédominance de la toux et de la fièvre.

[Clinical and epidemiological characteristic of COVID-19 deaths in Mali]. / Caracteristiques clinique et epidemiologique des deces COVID-19 au Mali.

INTRODUCTION: Mali recorded its first COVID-19's death related case on March 26, 2020. The aim of this study was to evaluate the comorbidity of COVID-19's death related cases in the Malian context. METHOD: A cross-sectional study was conducted between March 25 and October 11, 2020. Community death information was analyzed from the patient descriptive list, and from the hospitalization registry of the treatment sites. RESULT: Of the 3,286 COVID-19 confirmed cases, 132 died making a lethality rate of 4.00% (132/3286). Men were the most represented with 75.76% (100/132). The mean age was 63.77 ± 15.25 years. The mean time of hospital stay was 4.50 days ± 6.35. Diabetes and cardiovascular disease remain the most frequent comorbidities with death patients with 20.45% and 17.42%, respectively. CONCLUSION: The results of this study allow to draw map of patients who died from COVID-19 as well as provide information on the comorbidities for better management of hospitalized patients.

INTRODUCTION: Le Mali a enregistré son premier cas de décès lié à la COVID-19, le 26 mars 2020.Le but de cette étude est d'étudier la comorbidité des cas de décès de COVID-19 dans le contexte malien. MÉTHODE: Il s'agissait d'une étude transversale allant de la période du 25 mars au 11 octobre 2020. Nous avons réalisé une analyse des informations de la liste descriptives des cas pour les décès communautaire et des registres d'hospitalisation des sites de prise en charge. RÉSULTAT: Sur les 3286 cas confirmés par la COVID-19, 132 malades en sont décédés soit une létalité de4,00%. Les hommes étaient les plus représentés avec 75,76 % (100/132). La moyenne d'âge était de 63,77 ans ± 15,25. La durée moyenne d'hospitalisation était de4,50 jours ± 6,35. Le diabète et l'HTA étaient les facteurs de comorbidité les plus fréquents rencontrés dans les cas de décès avec respectivement 20,45% et 17,42%. CONCLUSION: Cette étude a montré que les cas de décès liés au COVID-19 au Mali étaient observés chez les personnes âgées, diabétiques et hypertendues. Ces informations aideront à optimiser la prise en charge des malades hospitalisés.

Predictors of poor nutritional status among children aged 6-24 months in agricultural regions of Mali: a cross-sectional study.

BACKGROUND: The right nutrition during the first 2 years of life can positively impact a child's ability to develop, grow, and learn. Malnutrition remains a public health problem in Mali and little is known about the factors affecting the nutritional status of children. This study aims to assess the magnitude and the predictors of undernutrition in children aged 6-24 months in the poor rural regions of Mali. METHODS: A community-based cross-sectional study was conducted in the villages in the Sikasso and Mopti regions in Mali from January to March 2016, comprising of 959 boys and 856 girls aged 6-24 months. A structured interviewer administered a questionnaire that was used to collect data from the mothers living in 1764 households. Anthropometric measurements were performed using standardized methods in order to identify the factors associated with children suffering from undernutrition (stunting and wasting). Bivariate and multivariate logistic regression analyses were conducted. RESULTS: The results of our study indicated that 23.9 and 28.4% children were underweight and stunted; the prevalence of wasting was 13.9% using the W/H measurement and 16.5% with the MUAC. Overall, the presence of diarrhea in the past 2 weeks (p < 0.001), higher child age (p < 0.001), male sex (p < 0.001), households with the lowest household amenity score (p < 0.002), and households with a low dietary diversity score (p < 001) were significantly associated with chronic malnutrition. The factors significantly associated with acute malnutrition were male sex (p < 0.01), preterm birth (p < 0.03), lower child age (0.001), a high number of siblings (p < 0.03), and living in a household with more months of inadequate food provisioning (p < 0.03). CONCLUSION: Child undernutrition is a critical public health problem in the agricultural regions of Mali. Future efforts should be directed at addressing the food insecurity and at improving the yearlong household availability and accessibility of nutritious food, as well as taking diseases prevention into account.