A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar.

Background: Madagascar needs major efforts to achieve the UN Sustainable Development Goals, despite the considerable reduction of child mortality during past years. In this context, implementation of emergency triage assessment and treatment (ETAT) plays an important role. In recent years, ETAT training activities rarely took place in Madagascar. To strengthen ETAT in Madagascar, a pilot training course was conducted in December 2019 at the University Hospital Mahajanga. Objectives: This study aims to evaluate if the ETAT+ pilot training content matches clinical needs in Madagascar and whether participants achieved their learning objectives. Methods: In this cross-sectional mixed-methods study, a 41-item questionnaire was used at the end of the ETAT+ training to evaluate their learning experience from the 12 participants (paediatricians, physicians, nurses and midwives). Six weeks after the training, guided interviews were conducted among five participants to describe how training content could be transferred into clinical practice in five health facilities. Results: Results suggest that this pilot project designed to contribute to the re-establishment of ETAT in Madagascar meets participants' needs and is adapted to clinical realities in terms of transmitted knowledge, skills and competencies. However, results also show that considerable multi-disciplinary efforts are needed to advance ETAT+ implementation in Madagascar. Conclusion: Implementation processes of ETAT training programmes need re-evaluation to assure their validity to contribute to quality of care improvements efficiently. Further operational research is required to evaluate sustainable, innovative implementation strategies adapted to contexts in Madagascar. Contributions of the study: This study aims to evaluate an updated Malagasy version of the Emergency Triage Assessment and Treatment Plus (ETAT+). The training met the participants' needs and was adapted to the clinical realities in Madagascar relating to transmitted knowledge, skills and competencies.

Aspect epidemio-clinique des urgences medicales en neonatalogie a Mahajanga Madagascar

Objectif: evaluer la frequence et la gravite des urgences medicales neonatales et relater les signes d'alerte les plus courants chez les nouveau-nes. Methodes: Nous avons effectue une etude retrospective et descriptive allant du 1er Janvier au 31 Decembre 2009 sur les nouveau-nes hospitalises en neonatalogie au Complexe Mere Enfant au CHU Mahajanga Madagascar. Resultats: Nous avons collige 645 bebes (41;86) en situation d'urgence sur les 1541 admis. Le sexe ratio etait de 0;99. Ces urgences neonatales s'agissaient surtout; par ordre de frequence : d'une infection neonatale (54); de la prematurite (20;3); du retard de croissance intra-uterin (10;5) et de l'anoxie neonatale (6;5). Les signes d'alerte pour les familles et les agents de sante etaient surtout les irregularites thermiques (36;4) soit hypothermie ou hyperthermie; les difficultes respiratoires (7;3); et le tres faible poids de naissance (7). Conclusion: La sensibilisation; l'information et l'education des meres avant la sortie de l'hopital sur les signes d'alerte pouvant survenir chez les nouveau-nes devraient reduire la mortalite neonatale

Earlier versus later continuous Kangaroo Mother Care (KMC) for stable low-birth-weight infants: a randomized controlled trial.

AIM: The aim of this study was to examine the effectiveness of earlier continuous Kangaroo Mother Care (KMC) for relatively stable low-birth-weight (LBW) infants in a resource-limited country. METHODS: A randomized controlled trial was performed in LBW infants at a referral hospital in Madagascar. Earlier continuous KMC (intervention) was begun as soon as possible, within 24 h postbirth, and later continuous KMC (control: conventional care) was begun after complete stabilization (generally after 24 h postbirth). Main outcome measure was mortality during the first 28 days postbirth. This trial was registered with ClinicalTrials.gov, NCT00531492. RESULTS: A total of 73 infants (intervention 37, control 36) were included. Earlier continuous KMC had higher but no statistically different mortality in the first 28 days postbirth (1 vs. 2; risk ratio, 1.95; 95% CIs, 0.18-20.53; p = 1.00). There were no differences in incidence of morbidities. Body weight loss from birth to 24 h postbirth was significantly less in earlier KMC infants compared with later KMC infants. (-34.81 g vs. -73.97 g; mean difference, 39.16 g; 95% CIs, 10.30-68.03; p = 0.01; adjusted p = 0.02). Adverse events and duration of hospitalization were not different between the two groups. CONCLUSION: Further evaluations of earlier continuous KMC including measurement of KMC dose, are needed in resource-limited countries.