Validity of using mobile phone surveys to evaluate community health worker program in Mali.

BACKGROUND: The monitoring and evaluation of public health programs based on traditional face-to-face interviews in hard-to-reach and unstable regions present many challenges. Mobile phone-based methods are considered to be an effective alternative, but the validity of mobile phone-based data for assessing implementation strength has not been sufficiently studied yet. Nested within an evaluation project for an integrated community case management (iCCM) and family planning program in Mali, this study aimed to assess the validity of a mobile phone-based health provider survey to measure the implementation strength of this program. METHODS: From July to August 2018, a cross-sectional survey was conducted among the community health workers (ASCs) from six rural districts working with the iCCM and family planning program. ASCs were first reached to complete the mobile phone-based survey; within a week, ASCs were visited in their communities to complete the in-person survey. Both surveys used identical implementation strength tools to collect data on program activities related to iCCM and family planning. Sensitivity and specificity were calculated for each implementation strength indicator collected from the phone-based survey, with the in-person survey as the gold standard. A threshold of ≥ 80% for sensitivity and specificity was considered adequate for evaluation purposes. RESULTS: Of the 157 ASCs interviewed by mobile phone, 115 (73.2%) were reached in person. Most of the training (2/2 indicators), supervision (2/3), treatment/modern contraceptive supply (9/9), and reporting (3/3) indicators reached the 80% threshold for sensitivity, while only one supervision indicator and one supply indicator reached 80% for specificity. In contrast, most of the stock-out indicators (8/9) reached 80% for specificity, while only two indicators reached the threshold for sensitivity. CONCLUSIONS: The validity of mobile phone-based data was adequate for general training, supervision, and supply indicators for iCCM and family planning. With sufficient mobile phone coverage and reliable mobile network connection, mobile phone-based surveys are useful as an alternative for data collection to assess the implementation strength of general activities in hard-to-reach areas.

[Tetanus vaccination of women of childbearing age in Bamako (Mali)]. / Vaccination antitetanique des femmes en age de procreer a Bamako au Mali.

In Mali, despite the existence of a national vaccination policy, coverage of neonatal tetanus remains low. According to the Demographic and Health Survey (DHS) IV Mali, the rate of births protected against neonatal tetanus is 56%.The objective of this study was to investigate the status of tetanus toxoid (TT) in women of reproductive age (WRA) in the municipality V of Bamako District.The study was conducted in Mali in the municipality V of the Bamako District. This was a cross-sectional study conducted from July to October 2006. The target population was composed of women of reproductive age and health care providers. A total of 262 people, including 200 women of childbearing age and 62 health care providers were interviewed.The age group 14-23 years accounted for 39% of WRA. Among the WRA, 27.4% did not know that tetanus vaccination is to prevent maternal and neonatal tetanus. Most of WRA, or 61.8%, thought that a single dose of TT was enough to be protected. Among WRA surveyed, 76.2% were vaccinated where 66.7% had received between 2 and 10 doses of TT. Women who received no dose of TT were nulliparous and primiparous. The main reasons given by women who had not received vaccination were lack of knowledge (47.6%), lack of time (14.3%) and neglect (23.8%). The health personnel interviewed spoke of running out of TT stocks less than a week after receiving new orders, in 7/11 health centers. Strengthening Behaviour Change Communication (BCC) for tetanus vaccination and immunization schedule compliance will increase tetanus vaccination coverage. To avoid stockouts, we recommend a regular and sufficient reorder of TT in health centers.

Au Mali malgré l'existence d'une politique nationale de vaccination, la couverture vaccinale du tétanos néonatal reste faible .Selon l'Enquête Démographique et de Santé (EDS) IV du Mali, le taux de naissances protégées contre le tétanos néonatal est de 56 %. L'objectif de cette étude était d'étudier l'état de la vaccination antitétanique (VAT) chez les femmes en âge de procréer (FAP) de la commune V du District de Bamako.L'étude a été menée au Mali dans la commune V du District de Bamako. C'était une étude de type transversal réalisée de juillet à octobre 2006. La population cible était composée de femmes en âge de procréer et de prestataires de santé. Au total, 262 personnes dont 200 femmes en âge de procréer et 62 prestataires de santé ont été interrogées.La tranche d'âge 14­23 ans représentait 39 % des FAP. Parmi les FAP interrogées, 27,4 % ne savaient pas que la vaccination antitétanique a pour but d'éviter le tétanos maternel et néonatal La majorité des FAP soient 61,8 % pensaient qu'une seule dose de VAT suffisait pour être protégée. Parmi les FAP enquêtées, 76,2 % ont été vaccinées dont 66,7 % avaient reçu entre 2 et 10 doses de VAT. Les femmes n'ayant reçu aucune dose de VAT étaient les nullipares et les primipares. Les principales raisons évoquées par les femmes qui n'avaient pas reçu de doses de vaccin étaient la méconnaissance (47,6 %), le manque de temps (14,3 %) et la négligence (23,8 %).Le personnel de santé interrogé a évoqué des ruptures en VAT de moins d'une semaine, dans 7 /11 centres de santé. Le renforcement de la communication pour le changement de comportement (CCC) pour la vaccination antitétanique et le respect du calendrier vaccinal permettront d'augmenter la couverture vaccinale antitétanique. Pour éviter les ruptures de stocks, nous recommandons une dotation régulière et suffisante des centres de santé en vaccin antitétanique.

[Smoking at school in a commune of Bamako, Mali]. / Tabagisme en milieu scolaire dans une commune de Bamako au Mali.

Heavy smoking causes 4 million deaths worldwide, more than 70% being in the developing countries. The purpose of our study was to determine the prevalence of heavy smoking and to identify the factors which influence it in school settings in Bamako. We carried out a cross-sectional investigation in April 2009, in 8 randomly selected schools in a town of Bamako, with a sample of 328 pupils over 11 years of age.The investigation included 328 pupils, among them, 72.3% were boys. The age of the pupils varied between 12 and 23 years. The age group 12-15 ans was the most represented with 66.2%. It appears that 47.6% of the pupils smoked cigarettes at least once. We found that 14% of the pupils (46/328), all boys, were regular smokers. Among these heavy smokers, 37% smoked more than 5 cigarettes per day and 52% had consumption period of more than 12 months. The factors supporting the heavy smoking were: father smoker (22.56%), other family member smoker (56.4%), smoker teachers (52.7%). The main motivations which pushed the pupils to smoke were promiscuity (63%) pleasure (22%) and snobbery (13%). While 85.9% of the pupils knew the harmfulness of the tobacco, 38.7% learned it at school, but 76,5% were unaware of the existence of a law on tobacco sale and consumption in Mali.The prevalence of heavy smoking among pupils was of 14% in an inciting environment. We recommend intensifying the communication for behavior change and applying the tobacco law.

Le tabagisme est la cause de 4 millions de décès dans le monde dont plus de 70% dans les pays en développement. Notre étude avait pour but de déterminer la prévalence du tabagisme et d'identifier les facteurs qui l'influencent en milieu scolaire à Bamako.Nous avons réalisé une enquête transversale en avril 2009, dans 8 écoles choisies de façon aléatoire dans une commune de Bamako, avec un échantillon de 328 élèves de plus de 11 ans.L'enquête a concerné 328 élèves dont 72,3% de garçons. L'âge des élèves variait entre 12 et 23 ans. La tranche d'âge 12­15ans était la plus représentée avec 66,2%. Il ressort que 47,6% des élèves ont fumé au moins une fois de la cigarette. Nous avons trouvé que 14% des élèves (46/328) étaient fumeurs réguliers dont 100% de garçons. Parmi ces tabagiques, 37% fumaient plus de 5 cigarettes par jour et 52% avaient une durée de consommation supérieure à 12 mois. Les facteurs favorisant le tabagisme étaient: père fumeur (22,56%), entourage familial fumeur (56,4%), enseignants fumeurs (52,7%). Les principales motivations qui poussaient les élèves à fumer étaient la promiscuité (63%) le plaisir (22%) et le snobisme (13%). Si 85,9% des élèves connaissaient la nocivité du tabac, 38,7% l'ont appris à l'école mais 76,5% ignoraient l'existence d'une loi sur la vente et la consommation du tabac au Mali.La prévalence du tabagisme chez les élèves était de 14% dans un environnement incitatif. Nous recommandons d'intensifier la communication pour le changement de comportement et d'appliquer la loi sur le tabac.