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.

Career mobility of maternal care providers in Mali: a mixed method study on midwives and obstetric nurses.

BACKGROUND: An important strategy to reduce maternal and child mortality in Mali is to increase the number of deliveries assisted by qualified personnel in primary care facilities, especially in rural areas. However, placements and retention of healthcare professionals in rural areas are a major problem, not only in Mali but worldwide, and are a challenge to the health sector. The purpose of this study was to map the mobility of midwives and obstetric nurses during their work lives, in order to better understand their career paths and the role that working in rural areas plays. This article contributes to the understanding of career mobility as a determinant of the retention of rural health professionals. METHODS: A mixed method study was conducted on 2005, 2010, and 2015 cohorts of midwives and obstetric nurses. The cohorts have been defined by their year of graduation. Quantitative data were collected from 268 midwives and obstetric nurses through questionnaires. Qualitative data had been gathered through semi-structured interviews from 25 midwives and stakeholders. A content analysis was conducted for the qualitative data. RESULTS: Unemployment rate was high among the respondents: 39.4% for midwives and 59.4% for obstetric nurses. Most of these unemployed nurses and midwives are working, but unpaid. About 80% of the employed midwives were working in urban facilities compared to 64.52% for obstetric nurses. Midwives were employed in community health centers (CSCom) (43%), referral health centers (CSRef) (20%), and private clinics and non-governmental organizations (NGO) (15%). The majority of midwives and obstetric nurses were working in the public sector (75.35%) and as civil servants (65.5%). The employment status of midwives and obstetric nurses evolved from private to public sector, from rural to urban areas, and from volunteer/unpaid to civil servants through recruitment competitions. Qualitative data supported the finding that midwives and obstetric nurses prefer to work as civil servant and preferably in urban areas and CSRef. CONCLUSION: The current mobility pattern of midwives and obstetric nurses that brings them from rural to urban areas and towards a civil servant status in CSRef shows that it is not likely to increase their numbers in the short term in places where qualified midwives are most needed.

[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.

Vaccination antitetanique des femmes en age de procreer a Bamako au Mali

Au Mali malgre l'existence d'une politique nationale de vaccination; la couverture vaccinale du tetanos neonatal reste faible .Selon l'Enquete Demographique et de Sante (EDS) IV du Mali; le taux de naissances protegees contre le tetanos neonatal est de 56 %. L'objectif de cette etude etait d'etudier l'etat de la vaccination antitetanique (VAT) chez les femmes en age de procreer (FAP) de la commune V du District de Bamako. L'etude a ete menee au Mali dans la commune V du District de Bamako. C'etait une etude de type transversal realisee de juillet a octobre 2006. La population cible etait composee de femmes en age de procreer et de prestataires de sante. Au total; 262 personnes dont 200 femmes en age de procreer et 62 prestataires de sante ont ete interrogees. La tranche d'age 14 23 ans representait 39 % des FAP. Parmi les FAP interrogees; 27;4 % ne savaient pas que la vaccination antitetanique a pour but d'eviter le tetanos maternel et neonatal La majorite des FAP soient 61;8 % pensaient qu'une seule dose de VAT suffisait pour etre protegee. Parmi les FAP enquetees; 76;2 % ont ete vaccinees dont 66;7 % avaient recu entre 2 et 10 doses de VAT. Les femmes n'ayant recu aucune dose de VAT etaient les nullipares et les primipares. Les principales raisons evoquees par les femmes qui n'avaient pas recu de doses de vaccin etaient la meconnaissance (47;6 %); le manque de temps (14;3 %) et la negligence (23;8 %).Le personnel de sante interroge a evoque des ruptures en VAT de moins d'une semaine; dans 7 /11 centres de sante. Le renforcement de la communication pour le changement de comportement (CCC) pour la vaccination antitetanique et le respect du calendrier vaccinal permettront d'augmenter la couverture vaccinale antitetanique. Pour eviter les ruptures de stocks; nous recommandons une dotation reguliere et suffisante des centres de sante en vaccin antitetanique

[Formative research on community-based vital events registration in Mali]. / Recherche formative sur l’enregistrement d’évènements vitaux en milieu communautaire au Mali.

OBJECTIVES: The under-five mortality rate in Mali is high, with most deaths occurring in the community where there is no reliable vital events registration. The objective of this study was to collect data on community-based vital events registration in the Niono and Baroueli districts of the Segou region, in order to improve the community-based vital events registration system. METHODS: Data collection for this cross-sectional, descriptive, and qualitative study was conducted in May 2010. Participants included health and administrative workers, community members, women's associations, and non-governmental organizations. Data collection methods included individual interviews and focus groups, as well as document review. Data were entered and codified with Modalisa version 5.1. RESULTS: Pregnancy registration was performed exclusively by health workers in health facilities and was not performed before the third month of pregnancy due to concerns about losing the pregnancy (due to sorcery or spells). Birth registration was performed in administrative and health structures and at the community level, but after an interval of about 7 days. Childhood deaths were rarely registered because the community did not understand the importance of this registration, and because of problems accessing the structures in which deaths are registered. Community opinions were favourable to the implementation of an improved system involving relays (community-based volunteers). CONCLUSION: Improvements to vital events registration in this setting should make use of relays by increasing the awareness and involvement of the population.

[Knowledge and practices of traditionnal birth attendant on birth asphyxia in Kolokani (Mali)]. / Connaissance et pratique des accoucheuses traditionnelles sur l'asphyxie du nouveau-ne dans le district sanitaire de Kolokani.

INTRODUCTION: In Mali, according to the DHS IV in 2006, the neonatal mortality rate is 46 per thousand live births and is higher in rural areas (61‰) than in urban areas (45‰). The proportion of home births is 54%.The aim of our study was to assess the knowledge and practices of traditional birth attendants (TBAs) on pregnancy and newborn asphyxia in the health district of Kolokani. METHODOLOGY: It was a descriptive cross-sectional study conducted in the health district Kolokani 1st September to 04 October 2004. The study population consisted of traditional birth attendants TBAs. Our study covered 10% of the villages is Kolokani 28 villages randomly selected in 22 health areas. A total of 43 TBAs were interviewed. Data were entered with software EPI-Info version 6 and analyzed on SPSS11. RESULTS: TBAs have said that the main pathologies compromising reproductive health were toxoplasmosis (79%), pelvic pain (74.4%), malaria (46.5%). The main diseases were heralds of a difficult delivery were toxoplasmosis (16.2%), pelvic pain (16.2%), polyhydramnios (11.6%), but 67.4% of TBAs unaware of these pathologies.The main actions carried out before and during childbirth were displays of loin cloth (48.8%), floor sweeping (34.8%), display of drawsheet (30.2%), incantations (27.9%), the knotted strings "tafo" (32.5%). Deliveries conducted by TBAs have been estimated at 52% for all areas. CONCLUSION: At the end of our study we recommend TBA training to reduce the risks associated with home births.

INTRODUCTION: Au Mali, selon l'EDSM IV de 2006, le taux de mortalité néonatale est de 46 pour mille naissances vivantes et est plus élevé en zone rurale (61‰)qu'en zone urbaine(45‰).La proportion d'accouchement à domicile est de 54%. L'objectif de notre étude était d'évaluer les connaissances etles pratiques des accoucheuses traditionnelles sur la grossesse et l'asphyxie du nouveau-né dans le district sanitaire de Kolokani. MÉTHODOLOGIE: Il s'agissait d'une étude transversale descriptivemenée dans le district sanitaire de Kolokani du 1er septembre au 04 Octobre 2004. La population d'étude était constituée par les accoucheuses traditionnelles (AT). Notre étude couvrait 10% des villages de Kolokani soit 28 villages sélectionnés de façon aléatoire dans les 22 aires de santé. Au total 43 AT ont étéinterrogées.Les données ont été saisies sur EPI-Info version 6fr, analysé sur SPSS11. RÉSULTATS: Les AT ont déclaré que les principales pathologies compromettant la santé de la reproduction étaient la toxoplasmose (79%), la douleur pelvienne (74,4%), le paludisme (46,5%). Les principales pathologies annonciatrices d'accouchement difficile étaient la toxoplasmose (16,2%), la douleur pelvienne (16,2%), l'hydramnios (11,6%) et par contre 67,4% des AT ignoraient ces pathologies. Les principaux gestes effectués avant et pendant l'accouchement ont été l'étalage de pagne (48,8%), le balayage de sol (34,8%), l'étalage de l'alèze (30,2%), les incantations (27,9%), les cordelettes à nœuds « tafo ¼ (32,5 %).Les accouchements effectués par les AT on été estimés à 52% pour l'ensemble des aires. CONCLUSION: Au terme de notre étude nous recommandons la formation des AT en vue de réduire les risques liés aux accouchements à domicile.

[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.

[Vitamin A supplementation in children under five during a one-week nutrition intensification program in Mali]. / Processus de supplémentation en vitamine A chez les enfants de moins de cinq ans lors d'une semaine d'intensification des activités de nutrition au Mali.

INTRODUCTION: The National Nutrition Week (NNW) is designed to achieve 80% coverage of vitamin A supplementation among children aged 6 to 59 months. The objectives of this study were to describe the modalities of implementation of the NNW in 2006 in Mali and to document parents' and health workers' opinions. METHODS: A qualitative and quantitative cross-sectional study was conducted in two phases in May and June 2006 in four health districts (Kita, Kolondiéba, Dire and town VI of Bamako) selected at random. Individual interviews were conducted with Ministry of Health officials, partners and health workers. The focus groups were conducted with community leaders, carers / mothers of children. The coverage survey was conducted among 1,699 children aged 6 to 59 months. RESULTS: The channels most commonly used to increase public awareness were local radio (6/7 cases), public criers (5/7) and community health workers or traditional leaders (2/7). The main sources of information for mothers were: health workers (39%), relatives / neighbours / friends (37%), local leaders (24%) and radio (25%). Vitamin A supplementation coverage was 90% (1,520/1,699) for children aged 6 to 59 months. CONCLUSION: The NNW achieved its goal, but the National Department of Health should implement a door-to-door strategy and enhance communication in order to change behaviour.

[Training mothers: a strategy to improve the treatment of acute respiratory infections among children in Mali]. / Formation des mères : stratégie pour améliorer le traitement des infections respiratoires aiguës au Mali.

Acute respiratory infections (ARI) are a major public health issue in Mali. The objective of this study was to examine the management of ARI within the community among children aged 2 to 59 months. The study was based on a pilot community intervention over a period of 15 months (June 2008-August 2009) in 4 health districts in Mali. A survey was conducted two weeks before the intervention in order to determine the incidence of ARI. During the intervention phase, 80 community health workers (CHW) and 1,123 mothers were trained, equipped and supervised. 3,532 children aged 2 to 59 months were managed. Two health areas were selected in each district. A "CHW" area (i.e. an area where CHWs were trained and supervised) and a "mother" area (i.e. an area where mothers were trained and supervised) were randomly selected. Among the managed ARI cases, there were more cases of pneumonia in the "mother" areas (29.5%) than in the "CHW" areas (24.9%) (p = 0.003). The study also found that the duration of the prescription period was more appropriate in "CHW" areas (99.5%) than in "mother" areas (97.6%) (p = 0.03). In addition, the reduction in the incidence of complicated cases (before and after intervention) was more significant in "mother" areas (from 69? to 6?, with p = 10?6) than in "CHW" areas (from 24? to 11?, with p = 0.01). The results suggest that mothers with the appropriate training, equipment and supervision are able to manage cases of ARI.