Suchergebnisse

Die zehn Artikel kreisen um das Gesundheitssystem, Gesundheit und Krankheit in Afrika. Van Lerberghe/Brouwere zeichnen die Entstehung der afrikanischen Gesundheitssysteme während der Kolonialzeit und in der postkolonialen Periode nach. Brunet-Jailly beleuchtet die staatliche Gesundheitspolitik in den frankophonen Staaten Westafrikas. Vigouroux/Okalla beschreiben am Beispiel Kameruns die Reorganisation des Gesundheitssystems und die Rolle konfessioneller Einrichtungen. Die Franc-Abwertung von 1994 hatte in den frankophonen Ländern dramatische Auswirkungen auf die Verfügbarkeit von Arzneimittel. Maritoux et al. machen eine Bestandsaufnahme. Letourmy beschreibt Entstehung und Funktionserfüllung der afrikanischen Krankenversicherungen. Am Beispiel Kenya erläutert Njue den Beitrag von Nicht-Regierungsorganisationen bei der Gesundheitsversorgung. Am Beispiel Bamako (Mali) erläutern Jaffre/Dicko die mit einer Gesundheitserziehung in der Schule verbundenen Probleme. Seit 1984 wurden in Kongo (Brazzaville) überall im Lande, teilweise im Rahmen von Entwicklungshilfeprojekten, "centres de sante integres" geschaffen. Yila-Boumpoto beschreibt die Lage der Zentren nach dem Ausbruch der gewaltsamen innenpolitischen Konflikte 1994. Tonda/Gruenais berichten am Beispiel Kongo (Brazzaville) über die Rolle der traditionellen Medizin. (DÜI-Sbd)

BACKGROUND: The World Health Organization's Global Strategy on Human Resources for Health (HRH) emphasizes the importance of dynamic and effective health worker regulation for achieving the health-related Sustainable Development Goals, with the establishment of education standards and quality assurance of education programs being critical. Governments in West Africa have struggled to address the problems within their higher education systems for health professionals, and it is now generally acknowledged that private institutions can play a crucial role in revitalizing the region's outdated universities. However, the rapid expansion of private schools raises concerns about the quality of education and adequacy of regulatory mechanisms. The USAID-funded Mali HRH Strengthening Activity, led by IntraHealth International, assisted Mali's Ministry of Health and Social Development to deliver targeted HRH interventions to improve the quality of education in private universities, better manage available health workers, and initiate a decentralized strategy for health worker recruitment and motivation. CASE PRESENTATION: In 2018, the HRH activity leveraged the West African Health Organization (WAHO)'s accreditation system to support 10 private nursing schools to introduce WAHO's regionally accepted, competency-based curriculum in reproductive, maternal, newborn, and child health. The project undertook a 10-step process to work alongside private nursing and midwifery schools to assess their current status against WAHO regional standards, implement action plans to address identified gaps, and support the institutions toward accreditation. As a result, eight schools in Mali are now accredited compared to only three at project inception. CONCLUSIONS: This case study underscores the importance of private school accreditation in Mali to improve the quality of health worker training through a standardized local curriculum. By supporting existing regulatory bodies that oversee accreditation, local capacity for initial ...

Family medicine has not received appropriate attention in the sub-Saharan African context. In particular, family medicine is rarely recognised as a medical speciality and most African countries are silent on the role of family medicine in their health systems. There is, however, an emerging interest in developing family medicine as a key component of primary healthcare. Postgraduate training in family medicine is progressing and many countries have already established specific training programmes. In addition, there have been attempts to define the importance of family medicine, which, we expect, this short report contributes to. Interviews were conducted with physicians, partners and beneficiaries of two international development projects funded by the Canadian government. The one project supports training of health professionals and the other education of healthy women and girls in the community. The objective was to document the strengthening of primary healthcare through the creation and adaptation of a new family and community medicine postgraduate medical programme (which includes both family and community medicine) emphasising field training, immersion in local communities and interdisciplinary collaboration. This article underlines the importance of family medicine in Mali by documenting how what is now termed family and community medicine can promote community-orientated health services. To do so, we use the examples of initiatives and actions done through two international health development projects.

Ce rapport présente les résultats de la deuxième Enquête Démographique et de Santé (EDSM-II) réalisée au Mali de novembre 1995 à mai 1996. L'EDSM-II fournit des informations sur la fécondité, la planification familiale, la nuptialité, les préferences en matière de fécondité, la santé de la mère et de l'enfant, l'état nutritionnel des enfants et des femmes, la mortalité des enfants, la mortalité maternelle, l'excision, les infections sexuellement transmissibles, le sida et la disponibilité des services communautaires. (DÜI-Hff)

IntroductionThere is a risk of anaemia among HIV‐infected children on antiretroviral therapy (ART) containing zidovudine (ZDV) recommended in first‐line regimens in the WHO guidelines. We estimated the risk of severe anaemia after initiation of a ZDV‐containing regimen in HIV‐infected children included in the IeDEA West African database.MethodsStandardized collection of data from HIV‐infected children (positive PCR<18 months or positive serology ≥18 months) followed up in HIV programmes was included in the regional IeDEA West Africa collaboration. Ten clinical centres from seven countries contributed (Benin, Burkina Faso, Côte d'Ivoire, Gambia, Ghana, Mali and Senegal) to this collection. Inclusion criteria were age <16 years and starting ART. We explored the data quality of haemoglobin documentation over time and the incidence and predictors of severe anaemia (Hb<7g/dL) per 100 child‐years of follow‐up over the duration of first‐line antiretroviral therapy.ResultsAs of December 2009, among the 2933 children included in the collaboration, 45% were girls, median age was five years; median CD4 cell percentage was 13%; median weight‐for‐age z‐score was −2.7; and 1772 (60.4%) had a first‐line ZDV‐containing regimen. At baseline, 70% of the children with a first‐line ZDV‐containing regimen had a haemoglobin measure available versus 76% in those not on ZDV (p≤0.01): the prevalence of severe anaemia was 3.0% (n=38) in the ZDV group versus 10.2% (n=89) in those without (p<0. 01). Over the first‐line follow‐up, 58.9% of the children had ≥1 measure of haemoglobin available in those exposed to ZDV versus 60.4% of those not (p=0.45). Severe anaemia occurred in 92 children with an incidence of 2.47 per 100 child‐years of follow‐up in those on a ZDV‐containing regimen versus 4.25 in those not (p≤0.01). Adjusted for age at ART initiation and first‐line regimen, a weight‐for‐age z‐score ≤−3 was a strong predictor associated with a 5.59 times risk of severe anaemia (p<0.01).ConclusionsSevere anaemia is frequent at baseline and guides the first‐line ART prescription, but its incidence seems rare among children on ART. Severe malnutrition at baseline is a strong predictor for development of severe anaemia, and interventions to address this should form an integral component of clinical care.

IntroductionCurrent knowledge on morbidity and mortality in HIV‐infected children comes from data collected in specific research programmes, which may offer a different standard of care compared to routine care. We described hospitalization data within a large observational cohort of HIV‐infected children in West Africa (IeDEA West Africa collaboration).MethodsWe performed a six‐month prospective multicentre survey from April to October 2010 in five HIV‐specialized paediatric hospital wards in Ouagadougou, Accra, Cotonou, Dakar and Bamako. Baseline and follow‐up data during hospitalization were recorded using a standardized clinical form, and extracted from hospitalization files and local databases. Event validation committees reviewed diagnoses within each centre. HIV‐related events were defined according to the WHO definitions.ResultsFrom April to October 2010, 155 HIV‐infected children were hospitalized; median age was 3 years [1–8]. Among them, 90 (58%) were confirmed for HIV infection during their stay; 138 (89%) were already receiving cotrimoxazole prophylaxis and 64 children (40%) had initiated antiretroviral therapy (ART). The median length of stay was 13 days (IQR: 7–23); 25 children (16%) died during hospitalization and four (3%) were transferred out. The leading causes of hospitalization were WHO stage 3 opportunistic infections (37%), non‐AIDS‐defining events (28%), cachexia and other WHO stage 4 events (25%).ConclusionsOverall, most causes of hospitalizations were HIV related but one hospitalization in three was caused by a non‐AIDS‐defining event, mostly in children on ART. HIV‐related fatality is also high despite the scaling‐up of access to ART in resource‐limited settings.

IntroductionWe assessed the rate of treatment failure of HIV‐infected children after 12 months on antiretroviral treatment (ART) in the Paediatric IeDEA West African Collaboration according to their perinatal exposure to antiretroviral drugs for preventing mother‐to‐child transmission (PMTCT).MethodsA retrospective cohort study in children younger than five years at ART initiation between 2004 and 2009 was nested within the pWADA cohort, in Bamako‐Mali and Abidjan‐Côte d'Ivoire. Data on PMTCT exposure were collected through a direct review of children's medical records. The 12‐month Kaplan‐Meier survival without treatment failure (clinical or immunological) was estimated and their baseline factors studied using a Cox model analysis. Clinical failure was defined as the appearance or reappearance of WHO clinical stage 3 or 4 events or any death occurring within the first 12 months of ART. Immunological failure was defined according to the 2006 World Health Organization age‐related immunological thresholds for severe immunodeficiency.ResultsAmong the 1035 eligible children, PMTCT exposure was only documented for 353 children (34.1%) and remained unknown for 682 (65.9%). Among children with a documented PMTCT exposure, 73 (20.7%) were PMTCT exposed, of whom 61.0% were initiated on a protease inhibitor‐based regimen, and 280 (79.3%) were PMTCT unexposed. At 12 months on ART, the survival without treatment failure was 40.6% in the PMTCT‐exposed group, 25.2% in the unexposed group and 18.5% in the children with unknown exposure status (p=0.002). In univariate analysis, treatment failure was significantly higher in children unexposed (HR 1.4; 95% CI: 1.0–1.9) and with unknown PMTCT exposure (HR 1.5; 95% CI: 1.2–2.1) rather than children PMTCT‐exposed (p=0.01). In the adjusted analysis, treatment failure was not significantly associated with PMTCT exposure (p=0.15) but was associated with immunodeficiency (aHR 1.6; 95% CI: 1.4–1.9; p=0.001), AIDS clinical events (aHR 1.4; 95% CI: 1.0–1.9; p=0.02) at ART initiation and receiving care in Mali compared to Côte d'Ivoire (aHR 1.2; 95% CI: 1.0–1.4; p=0.04).ConclusionsDespite a low data quality, PMTCT‐exposed West African children did not have a poorer 12‐month response to ART than others. Immunodeficiency and AIDS events at ART initiation remain the main predictors associated with treatment failure in this operational context.