Evaluation of maternal and child care continuum in Guinea: a secondary analysis of two demographic and health surveys using the composite coverage index (CCI).

INTRODUCTION: The composite coverage index (CCI) is the weighted average coverage of eight preventive and curative interventions received along the maternal and childcare continuum. This study aimed to analyse maternal and child health indicators using CCI. METHODS: We performed a secondary analysis of demographic and health surveys (DHS) focused on women aged 15 to 49 and their children aged 1 to 4. This study took place in Guinea. The CCI (meeting the need for planning, childbirth assisted by qualified healthcare workers, antenatal care assisted by qualified healthcare workers, vaccination against diphtheria, pertussis, tetanus, measles and Bacillus Calmette-Guérin, taking oral rehydration salts during diarrhoea and seeking care for pneumonia) is optimal if the weighted proportion of interventions is > 50%; otherwise, it is partial. We identified the factors associated with CCI using the descriptive association tests, the spatial autocorrelation statistic and multivariate logistic regression. RESULTS: The analyses involved two DHS surveys, with 3034 included in 2012 and 4212 in 2018. The optimal coverage of the CCI has increased from 43% in 2012 to 61% in 2018. In multivariate analysis, in 2012: the poor had a lower probability of having an optimal CCI than the richest; OR = 0.11 [95% CI; 0.07, 0.18]. Those who had done four antenatal care visits (ANC) were 2.78 times more likely to have an optimal CCI than those with less OR = 2.78 [95% CI;2.24, 3.45]. In 2018: the poor had a lower probability of having an optimal CCI than the richest OR = 0.27 [95% CI; 0.19, 0.38]. Women who planned their pregnancies were 28% more likely to have an optimal CCI than those who had not planned OR = 1.28 [95% CI;1.05, 1.56]. Finally, women with more than 4 ANC were 2.43 times more likely to have an optimal CCI than those with the least OR = 2.43 [95% CI; 2.03, 2.90]. The spatial analysis reveals significant disparities with an aggregation of high partial CCI in Labé between 2012 and 2018. CONCLUSION: This study showed an increase in CCI between 2012 and 2018. Policies should improve access to care and information for poor women. Besides, strengthening ANC visits and reducing regional inequalities increases optimal CCI.

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.

Facilitators and barriers to COVID-19 vaccination among healthcare workers and the general population in Guinea.

INTRODUCTION: The advent of the effective COVID-19 vaccine was the most eagerly expected worldwide. However, this hope quickly became hesitation and denial in many countries, including Guinea. Understanding the reasons for low vaccine coverage is essential to achieving herd immunity leading to disease control. This study aimed to comprehend the facilitators and barriers to the acceptance COVID-19 vaccine in Guinea. METHODS: The survey focused on healthcare workers (HCWs) and the general population (GP) in 4 natural regions in Guinea from 23 March 2021 to 25 August 2021. We used the Fishbein integration model to study the behaviours of HWCs and GP regarding vaccination. A mixed cross-sectional study collected knowledge, attitudes, norms, and perceptions. Regression and thematic content analysis identified the main facilitators and barriers to vaccination. RESULTS: We surveyed 3547 HCWs and 3663 GP. The proportion of people vaccinated was 65% among HCWs and 31% among the GP. For HCWs: the main factors associated with vaccination against COVID-19 were as follows: absence of pregnancy AOR = 4.65 [3.23-6.78], being supportive of vaccination AOR = 1.94 [1.66-2.27] and being an adult AOR = 1.64 [1.26-2.16]. Regarding the GP, the following factors increased the odds of vaccination: absence of pregnancy AOR = 1.93 [CI 1.01-3.91], being favourable for vaccination AOR = 3.48 [CI 2.91-4.17], being an adult AOR = 1.72 [CI 1.38-2.14] and being able to get the vaccine AOR = 4.67 [CI 3.76-5.84]. Semi-interviews revealed fear, lack of trust, and hesitant perception of the government as potential barriers to vaccination. CONCLUSION: This study suggests that beliefs and negative perceptions are potential barriers to vaccination against COVID-19 among HCWs and the GP. Policies should emphasise practical strategies to mitigate these barriers among young people and pregnant women. Lastly, there is a need to improve access to vaccines in the GP.

Factors Associated with Malaria Preventive Measures among Pregnant Women in Guinea.

Background: Malaria control interventions have been scaled up, particularly those in pregnant women in Guinea. Despite that, coverage of key malaria preventive measure (MPM) indicators remains low. Therefore, it is vital to understand the reasons behind that, especially for the low coverage of sulfadoxine-pyrimethamine (SP) and long-lasting insecticide-treated bed nets (LLIN). Methods: We conducted a cross-sectional survey in nine district hospitals in Guinea. Pregnant women received for delivery were interviewed to collect sociodemographic and obstetrical parameters. Associated factors with MPMs were investigated through univariate analysis and classification and regression tree (CART). Results: A total of 2248 parturients participated in this study. Among pregnant women using mosquito nets (63.5% (61.4%, 65.5%)), only 41.2% (39.1%, 43.3%) had used it regularly during the last two weeks preceding delivery. Similarly, most pregnant women (57.9% (55.8%, 59.9%)) had received less than three doses of SP, and only a few pregnant women (23.9% (22.1%, 25.7%)) have benefited from full MPMs. Parturient's age, marital status, time spent in residence, place of residence, level of education, distance from home to the health centre, health conditions, occupation, head of the household's occupation, the presence of garbage and stagnant water in the neighbourhood, source of running water, and the number of pregnancies were significantly statistically associated with MPMs in pregnant women. However, the number of antenatal care visits (ANC), means of transportation used by the pregnant woman to accomplish ANCs, and stagnant water in the neighbourhood were the three preponderant factors. Conclusion: The low coverage of SP and LLINs among pregnant women requires revitalising some strategies, especially improving ANC coverage and more efforts to reduce inequalities in access to those services due to sociodemographic status. Education on the benefits of these MPMs should also be emphasised.

Coronary artery to pulmonary artery collateral as the principal source of pulmonary blood supply in pulmonary atresia and ventricular septal defect with absent left pulmonary artery.

Pulmonary atresia and ventricular septal defect is associated with variable sources of pulmonary blood supply. We present a case of a coronary artery to pulmonary artery collateral as the principal source of pulmonary blood supply.

Rural vulnerability and institutional dynamics in the context of COVID-19: A scoping review.

This study reviewed the impact of the coronavirus disease 2019 (COVID-19) on pre-existing vulnerabilities in rural communities using the scoping review strategy. It focused on manuscripts published on the topic in 2020. Based on 39 studies that met our inclusion criteria (out of 507 studies), we note that COVID-19 is exacerbating pre-existing rural vulnerabilities, including poverty, remoteness, socio-economic marginalisation and high unemployment. There is limited evidence that rural communities are resilient to the pandemic. Reduction in household expenditures and the community food system are the only reported forms of resilience. Although local institutions are supporting rural communities in responding to the impacts of the pandemic, several institutional dynamics undermine the effectiveness of the response. The increased risk of the pandemic is likely to reduce incomes and standards of living amongst poor communities. Thus, coping strategies were identified such as starting small gardens in communities, diet changes, targeting community markets with produce rather than retailers and food swap using social media, with food swap being the most adopted coping strategy. Although this study does not offer a comprehensive picture of the levels and nature of vulnerability, resilience and institutional dynamics of rural communities in different parts of the world reveal the limitations of existing knowledge of the vulnerability of rural communities in the context of COVID-19. This underscores the importance of further studies on rural vulnerability in the context of COVID-19 that will enable evidence-based responses to the pandemic in rural contexts.

Health-Related Quality of Life of Tuberculosis Patients during the COVID-19 Pandemic in Conakry, Guinea: A Mixed Methods Study.

The COVID-19 pandemic has had a significant impact on all facets of life and has exacerbated many challenges faced by people living with tuberculosis (TB). This study aimed to assess the health-related quality of life (HRQoL) of TB patients in Guinea during the first wave of the COVID-19 pandemic. A mixed methods study was conducted using two validated tools to assess HRQoL and qualitative interviews among TB patients enrolled in treatment at 11 health centers in Conakry, Guinea. Logistic regression was used to identify factors associated with the deterioration of HRQoL. We included 439 participants in the study, among whom 44% and 31% experienced pain and anxiety, respectively. We found that an increase in the number of household size and the distance from participants' residence to the health centers were significantly associated with lower HRQoL. Qualitative interviews highlighted nutritional and financial issues, which were exacerbated during the COVID-19 pandemic and beliefs that the Guinean Government's assistance plan was insufficient. This study supports the implementation of specific relief plans for TB patients, which includes nutritional and psychological support, especially those whose movements are limited by travel restrictions, preventing access to TB care, reducing work opportunities and exacerbating financial needs and stress.

[Epidemiological and clinical profile of children with Coronavirus disease (COVID-19) at the Center for the Treatment of Epidemics and Infection Prevention (CTEIP) of the University Hospital of Donka in Conakry]. / Profil épidémiologique et clinique des enfants atteints de la maladie à coronavirus (COVID-19) au Centre de Traitement des Epidémies et Prévention des Infections (CTEPI) du CHU de Donka à Conakry.

COVID-19 is caused by SARS-CoV-2 virus, which is genetically similar to severe acute respiratory syndrome (SARS) virus. In pediatrics, it has a benign clinical course. Since the outbreak of COVID-19 pandemic in Guinea, whose epicenter was Conakry, pediatric cases have been reported at the CTEIP in Donka. The purpose of this study was to determine their epidemiological profile. We conducted a descriptive cross-sectional study of children aged 0-16 years admitted to the CTEIP, Donka, over a period of four months. Out of 7308 patients, coming predominantly from 5 communes of Conakry and hospitalized in the CTEPI, 189 were aged between 0 and 16 years (2 .59%). The majority of patients were within the age-group 0-4-years (38.62%) with a sex-ratio (F/M) of 1.52; 62.96% were students, 70% of children lived in Conakry, 28.57% of mothers were traders and contact persons (39.68%); 37.57% of fathers were civil servants, 2.65% of children had a history of sickle cell disease and 1.59% had allergic rhinitis. Asymptomatic patients accounted for 52.38% of cases and diagnosed patients were 74.6%. Symptoms included fever, rhinorrhea, headache, cough, abdominal pain, sneezing, diarrhea, physical asthenia. The incidence of COVID-19 among children hospitalized in the CTEIP of Donka is low. Children aged 5 years and older are more affected and nearly 50% are asymptomatic. Common symptoms are fever, headache, rhinorrhea, cough, abdominal pain, sneezing, diarrhea, physical asthenia.

[Dissection of the abdominal aorta revealing Takayasu´s disease: about a case in Guinea]. / Dissection de l´aorte abdominale révélatrice de la maladie de Takayasu: à propos d´un cas en Guinée.

Takayasu´s disease (TD) is a chronic inflammatory arteriopathy affecting the aorta, its main branches and the pulmonary arteries. It was first described in 1908 by the Japanese ophthalmologist Mikito Takayasu. The study involved a 78-year-old patient with no known history of cardiovascular disease, admitted with abdominal pain, pain in the right lower limb when walking, insomnia. These symptoms had progressed over 1 year. Physical examination showed normal heart rate of 87 beats per minute without pathological noises, with absence of right pedal pulse, blood pressure 120/78 mmhg, free lungs, flexible abdomen, and a beating mass in the right iliac fossa whose auscultation showed continuous murmur. The remainder of the physical examination was normal. Abdominal CT angiography confirmed extensive aortic dissection at the abdominal aorta with synchronous opacification of both channels, thrombotic aneurysm of the primitive iliac arteries measuring 48mmx100mm on the right and 38mm x 90mm on the left, with no visible fissurization. We report a case abdominal aorta dissection associated with thrombus formation in the primary iliac arteries revealing Takayashu´s disease treated in the Department of Cardiology at the Ignace Deen National Hospital. The rate of abdominal aorta dissection in patients with Takayasu´s disease is rare. It is most often diagnosed in the occlusive phase. Prognosis depends on possible complications.