Peace-building and reconciliation dividends of integrated health services delivery in post-conflict Burundi: qualitative assessments of providers and community members.

While demonstrating causality remains challenging, several 'health-peace' mechanisms have been proposed to describe how health systems contribute to peace-building and stability in post-conflict settings. A qualitative study was undertaken in southern Burundi to identify drivers of social tension and reconciliation in the catchment area of Village Health Works, a health services organisation. Key informant interviews and focus group discussions were conducted in early 2014 with a total of one hundred and twenty community members and staff representing a range of conflict and recovery experience. Themes emerging from these interviews indicated mechanisms at the individual, household, community, and regional levels through which health provision mitigates tensions and promotes social cohesion. This peace dividend was amplified by the clinic's integrated model, which facilitates further community interaction through economic, agricultural and education programmes. Land pressure and the marginalisation of repatriated refugees were cited as drivers of local tension.

2030 Countdown to combating malnutrition in Burundi: comparison of proactive approaches for case detection and enrolment into treatment.

BACKGROUND: Burundi has one of the highest rates of malnutrition in the world, particularly chronic malnutrition, which affects 55% of all children <5 y of age. Although it rolled out a national treatment programme to combat all forms of malnutrition, enrolment of children remains difficult. In this study, we use observational data from two screening approaches to assess the effectiveness in detection and enrolment into treatment. METHODS: Individual data from each screening approach was classified as either acutely malnourished or normal and either chronically malnourished or normal using a cut-off z-score between -2 and 2. RESULTS: While the Global Acute Malnutrition rate for the community-based mass screening was 8.3% (95% CI 5.6 to 11), with 8% enrolled in treatment, that of clinic-based systematic screening was 14.1% (95% CI 12.2 to 16.1), 98% of which were enrolled in treatment. Clinic systematic screening was 1.82 times (OR, 95% CI 1.26 to 2.62, p<0.001) and 1.35 times (95% CI 1.09 to 1.68, p=0.06) more likely to detect acute and chronic malnutrition, respectively, than community-based mass screening. CONCLUSIONS: Although different mechanisms are relevant to proactively detect cases, strengthening the health system to systematically screen children could yield the best results, as it remains the primary contact for the sicker population, who may be at risk of increased infection as a result of underlying malnutrition.