Circumstances of child deaths in Mali and Uganda: a community-based confidential enquiry

Willcox, Merlin; Kumbakumba, Elias; Diallo, Drissa; Mubangizi, Vincent; Kirabira, Peter; Nakaggwa, Florence; Mutahunga, Birungi; Diakité, Chiaka; Dembélé, Eugène; Traoré, Mamadou; Daou, Pierre; Bamba, Drissa; Traoré, Amadou S; Berthé, Diafara; Wooding, Nick; Dinwoodie, Kieran; Capewell, S; Foster, Hamish; Rowena, Neville; Ngonzi, Joseph; Kabakyenga, Jerome; Mant, David; Harnden, Anthony

doi:10.1016/s2214-109x(18)30215-8

Cited by 41 publications

(47 citation statements)

References 36 publications

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“…According to recent assessments in a rural region of Mali, malnutrition is the main avoidable factor related to child mortality [21]. This study shows that children receiving SAM treatment from CHWs generally exhibited a less severe stage at admission, with lower rates of edema and better anthropometric condition compared to children treated at HFs.…”

Section: Discussionmentioning

confidence: 63%

Bringing severe acute malnutrition treatment close to households through community health workers can lead to early admissions and improved discharge outcomes

López‐Ejeda

Charle-Cuéllar²,

Alé

et al. 2020

PLoS ONE

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Severe acute malnutrition (SAM) affects over 16.6 million children worldwide. The integrated Community Case Management (iCCM) strategy seeks to improve essential health by means of nonmedical community health workers (CHWs) who treat the deadliest infectious diseases in remote rural areas where there is no nearby health center. The objective of this study was to assess whether SAM treatment delivered by CHWs close to families' locations may improve the early identification of cases compared to outpatient treatment at health facilities (HFs), with a decreased number complicated cases referred to stabilization centers, increased anthropometric measurements at admission (closer to the admission threshold) and similarity in clinical outcomes (cure, death, and default). The study included 930 children aged 6 to 59 months suffering from SAM in the Kita district of the Kayes Region in Mali; 552 children were treated by trained CHWs. Anthropometric measurements, the presence of edema, and other medical signs were recorded at admission, and the length of stay and clinical outcomes were recorded at discharge. The results showed fewer children with edema at admission in the CHW group than in the HF group (0.4% vs. 3.7%; OR = 10.585 [2.222-50.416], p = 0.003). Anthropometric measurements at admission were higher in the CHW group, with fewer children falling into the lowest quartiles of both weight-for-height z-scores (20.2% vs. 31.5%; p = 0.002) and mid-upper arm circumference (18.0% vs. 32.4%; p<0.001), than in the HF group. There was no difference in the length of stay. More children in the CHW group were cured (95.9% vs. 88.7%; RR = 3.311 [1.772-6.185]; p<0.001), and there were fewer defaulters (3.7% vs. 9.8%; RR = 3.345 [1.702-6.577]; p<0.001) than in the HF group. Regression analyses demonstrated that less severe anthropometric measurements at admission resulted in an increased probability of cure at discharge. The study results also showed that CHWs provided more integrated care, as they diagnosed and treated significantly more cases of infectious diseases than HFs (diarrhea: 36.

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Section: Discussionmentioning

confidence: 63%

Bringing severe acute malnutrition treatment close to households through community health workers can lead to early admissions and improved discharge outcomes

López‐Ejeda

Charle-Cuéllar²,

Alé

et al. 2020

PLoS ONE

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“…While our data do not allow for evaluation of mortality rates that robust death audits do,35 36 patterns and avoidable deaths can be identified, which may in turn point to gaps in the local healthcare system. The majority of deaths were either rapid on-scene trauma deaths or chronic conditions (eg, hypertension and diabetes) already being attended to by the healthcare system.…”

Section: Discussionmentioning

confidence: 95%

Emergency healthcare needs in the Lavender Hill suburb of Cape Town, South Africa: a cross-sectional, community-based household survey

2020

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ObjectiveEmergency care is a key component of healthcare systems, but little is known about its real impact on communities. This study evaluated access, utilisation and barriers to healthcare, and specifically emergency care, in the low socioeconomic Cape Town suburb of Lavender Hill.DesignA cross-sectional, community-based household survey.SettingLavender Hill suburb in the Cape Flats of Cape Town, South Africa.ParticipantsTwo-stage cluster sampling was used to identify approximately 13 households in each of 46 clusters, for a total of 608 households. A senior householder responded on behalf of each household surveyed.Primary outcome measuresAccess to, utilisation of and unmet needs related to healthcare at large and emergency care.ResultsIn August 2018, 608 households were surveyed, encompassing 2754 individuals, with a response rate of 96.4%. Almost a quarter of respondents (n=663, 24.1%) used the healthcare system within the last year. Female gender, advancing age, lower levels of education, recipients of disability grants, smaller household sizes and living in formal dwellings were factors associated with increased risk of unmet healthcare and emergency care needs. Only a small proportion of respondents (n=39, 1.4%) reported having unmet emergency healthcare needs, with wait times at facilities (n=9, 23.1%), emergency medical service delays (n=7, 17.9%) and personal safety (n=6, 15.4%) being prominent. There was a high prevalence of chronic medical conditions (hypertension, diabetes and dyslipidaemias) and recent deaths predominantly from trauma and malignancy.ConclusionThe emergency healthcare needs of the community appear to be well catered for, although community expectations may not be high and many barriers exist, particularly in accessing emergency care—be it via ambulance services or at healthcare facilities—and caring for chronic diseases in the ageing population. The Lavender Hill community could benefit from programmes addressing chronic disease management and emergency care delivery within the community.

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“…Unmet need is an avoidable factor in many child deaths that result from unwanted pregnancies and inadequate spacing between births (Willcox et al. ). In Uganda, under‐five mortality is 64 per 1,000 and infant mortality is 43 per 1,000 live births.…”

Section: Context Of the Studymentioning

confidence: 99%

Barriers to Uptake of Postpartum Long‐Acting Reversible Contraception: Qualitative Study of the Perspectives of Ugandan Health Workers and Potential Clients

Willcox¹,

King²,

Fall³

et al. 2019

Studies in Family Planning

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Health workers have received training on delivering postpartum long-acting reversible contraceptives (LARCs) through several projects in Uganda, yet uptake still remains poor. To understand the reasons, and to gather suggestions for improving uptake, we conducted individual semi-structured interviews with a total of 80 postpartum parents, antenatal parents, health workers, and village health teams in rural south-west Uganda. Interviews were recorded, transcribed, translated, and analyzed using qualitative thematic analysis. Specific barriers to uptake of immediate postpartum contraception for women included: the need to discuss this option with their husband, the belief that time is needed to recover before insertion of a LARC, and fear that the baby might not survive. Furthermore, social consequences of side-effects are more serious in low-income settings. Suggestions for improving uptake of postpartum contraception included health education by "expert users," couples counseling during antenatal care, and improved management of side-effects.

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Circumstances of child deaths in Mali and Uganda: a community-based confidential enquiry

Abstract: European Union's 7th Framework Programme for research and technological development.

Cited by 41 publications

References 36 publications

Bringing severe acute malnutrition treatment close to households through community health workers can lead to early admissions and improved discharge outcomes

Bringing severe acute malnutrition treatment close to households through community health workers can lead to early admissions and improved discharge outcomes

Emergency healthcare needs in the Lavender Hill suburb of Cape Town, South Africa: a cross-sectional, community-based household survey

Barriers to Uptake of Postpartum Long‐Acting Reversible Contraception: Qualitative Study of the Perspectives of Ugandan Health Workers and Potential Clients

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