[Using anthropology to improve newborn health care in Cameroon]. / Une anthropologie impliquée pour améliorer les soins aux nouveau-nés au Cameroun.

INTRODUCTION: Policy directions in the health sector are based on research which provides insight into implemented actions and helps to formulate improvement recommendations for health. In Cameroon, an innovative experience of anthropological research on newborn health was followed by a process of appropriating findings by the Ministry of Public Health aiming at improving the quality of care. We suggest reporting this Cameroonian experience of interdisciplinary collaboration and involved research. METHOD: Coinciding with the anthropological study on newborn care in hospital maternities and at home conducted by researchers in the field of anthropology from December 2016 to June 2017, a process of appropriating findings was carried out. This article accurately describes this process both at the peripheral level, during "reflexive returns" in investigated maternity hospitals, and at the central level within the framework of work conducted by the study's steering committee. It reports on the changes that have taken place as a result of the study both at the level of health structures and at the level of national policies and strategies with a view to improving the quality of newborns care. RESULTS: The output of this process is twofold. At the peripheral level, activities of "reflexive returns" led to in situ changes of some harmful practices detrimental to the survival of the newborn, such as inappropriate use of the cradle in the birth room and lack of knowledge relative to the fight against hypothermia through the practice of skin-to-skin contact. At central level, changes concerned communication and strengthening policies and strategies of newborn care. CONCLUSION: The contribution of anthropology in the production evidence-based data is of paramount importance for the implementation of strategies to improve the quality of neonatal care. It opens up new perspectives for the sustainable improvement of the quality of care for newborns.

Une anthropologie impliquée pour améliorer les soins aux nouveau-nés au Cameroun.

INTRODUCTION: Policy directions in the health sector are based on research which provides insight into implemented actions and helps to formulate improvement recommendations for health. In Cameroon, an innovative experience of anthropological research on newborn health was followed by a process of appropriating findings by the Ministry of Public Health aiming at improving the quality of care. We suggest reporting this Cameroonian experience of interdisciplinary collaboration and involved research. METHOD: Coinciding with the anthropological study on newborn care in hospital maternities and at home conducted by researchers in the field of anthropology from December 2016 to June 2017, a process of appropriating findings was carried out. This article accurately describes this process both at the peripheral level, during "reflexive returns" in investigated maternity hospitals, and at the central level within the framework of work conducted by the study's steering committee. It reports on the changes that have taken place as a result of the study both at the level of health structures and at the level of national policies and strategies with a view to improving the quality of newborns care. RESULTS: The output of this process is twofold. At the peripheral level, activities of "reflexive returns" led to in situ changes of some harmful practices detrimental to the survival of the newborn, such as inappropriate use of the cradle in the birth room and lack of knowledge relative to the fight against hypothermia through the practice of skin-to-skin contact. At central level, changes concerned communication and strengthening policies and strategies of newborn care. CONCLUSION: The contribution of anthropology in the production evidence-based data is of paramount importance for the implementation of strategies to improve the quality of neonatal care. It opens up new perspectives for the sustainable improvement of the quality of care for newborns.

Vaccination coverage in Haiti: results from the 2009 national survey.

INTRODUCTION: Since 1977, vaccinations to protect against tuberculosis, diphtheria, tetanus, pertussis, polio, and measles (and rubella since 2009) have been offered to children in Haiti through the routine immunization program. From April to July 2009, a national vaccination coverage survey was conducted to assess the success of the routine immunization program at reaching children in Haiti. METHODS: A multi-stage cluster survey was conducted using a modified WHO method for household sampling. A standardized questionnaire was administered to collect vaccination histories, demographic information, and reasons for under-vaccination of children aged 12-23 months. A child who received the eight recommended routine vaccinations was considered fully vaccinated. The routine vaccination schedule was used to define valid doses and estimate the percentage of children vaccinated on time. RESULTS: Among 1345 children surveyed, 40.4% (95% CI: 36.6-44.2) of the 840 children with vaccination cards had received all eight recommended vaccinations. Coverage was highest for the Bacille Calmette-Guérin vaccine (87.3%), the first doses of the diphtheria-tetanus-pertussis vaccine (92.0%), and oral poliovirus vaccine (93.4%) and lowest for measles vaccine (46.9%). Timely vaccination rates were lower. Assuming similar coverage for the 505 children without cards, coverage with the complete vaccination series among all surveyed children 31.9%. Reasons for under-vaccination included not having enough time to reach the vaccination location (24.8%), having a child who was ill (13.8%), and not knowing when, or forgetting, to go for vaccination (12.8%). CONCLUSIONS AND RECOMMENDATIONS: Coverage for early-infant vaccines was high; however, most children did not complete the full vaccination series, and many children received vaccinations later than recommended. Efforts to improve the immunization program should include increasing the frequency of outreach services, training for vaccination staff to minimize missed opportunities, and better communicating the timing of vaccinations to encourage caregivers to bring their children for vaccinations at the recommended age. Efforts to promote the benefits of vaccination and card retention are also needed.

Haiti 2007-2008 national measles-rubella vaccination campaign: implications for rubella elimination.

BACKGROUND: A national campaign was conducted in Haiti in 2007-2008 to vaccinate all children and adolescents aged 1-19 years with measles-rubella vaccine in support of achieving the Region of the Americas' 2010 goal of eliminating rubella and congenital rubella syndrome (CRS). Measles-rubella vaccine was introduced into the country's routine childhood immunization schedule after the campaign. METHODS: A nationwide, stratified, multistage cluster sample survey of 20859 children was conducted to assess coverage using house-to-house interviews. RESULTS: Estimated national coverage with measles-rubella vaccine was 79.2% (95% confidence interval, 77.6%-80.7%), ranging from 90.2% in Nord-Ouest Department to 70.0% in Cite Soleil Metropolitan Area. National coverage was lower for children aged 1-5 years (76.7%) than for those aged 6-19 years (80.3%) (P< .001) but similar in rural departments (79.4%) and metropolitan areas (78.6%; P = .61). The reasons most frequently cited for nonparticipation in the campaign were that the child was ill or unavailable (18.6%), did not know vaccinations were important (13.8%), did not know when to go or forgot to go (13.3%), and did not have enough time (12.3%). CONCLUSIONS: The measles-rubella vaccination campaign was critical for raising rubella immunity levels in children and adolescents in Haiti. To remain free of rubella transmission and CRS, Haiti must also achieve and sustain high routine measles-rubella vaccination coverage and maintain high-quality integrated measles-rubella and CRS surveillance, including laboratory-based confirmation for reported rash illnesses. If routine measles-rubella vaccination coverage is suboptimal or if gaps in coverage are identified, additional mass campaigns with measles-rubella vaccine will be necessary.