Suchergebnisse

Background: The Integrated Management of Childhood Illness (IMCI) strategy was adopted in Burundi in 2003. Our aim was to evaluate to what extent the malnutrition component of the IMCI guidelines is implemented at health facilities level. Methods: We carried out direct observations of curative outpatient consultations for children aged 6–59 months in 90 health centres selected randomly. We considered both the child and the health worker (HW) as units of analysis and used bivariate analysis to explore characteristics of HWs associated with tasks systematically or never performed. Results: A total of 514 consultations carried out by 145 HWs were observed. Among the 250 children under two years, less than 30% were asked questions on breastfeeding. None of them had all seven nutrition-related questions asked to their caregivers and none of the 200 children over the age of two years had all five nutrition-related questions asked to their caregivers. Only 13 cases (3%) had all of the six examinations/tasks (weight, height/length, mid-upper arm circumference, oedema, filling in and discussing the growth curve and calculating the weight for height z-score) performed as part of their care. 393 cases (76%) reported that they had not being given any nutrition advice. With regards to HWs, among 99 of them who had received children under two, only 21 (21.2%)[14.2–30.5%) systematically asked the question regarding 'ongoing breastfeeding'. Only 56 (38.6%)[31–46.9%] weighed or discussed the weight taken prior the consultation for each child they reviewed, only 38 (26.2%)[19.6–34.1%] measured the height/length or discussed it for each child reviewed and 23 (15.9%)[10.7–22.8%] performed (systematically?) the WHZ-score. More than 50% never gave nutrition advices to any child reviewed. HWs who daily manage severe acute malnutrition were the most likely to systematically ask the question regarding 'ongoing breastfeeding' and to perform a 'weight examination'. Those who had not received supervision visit on the topic of malnutrition predominantly never performed a 'weight examination'. The 'height/length' examination' was predominantly performed by female HWs and those who have 'contract with the government. Conclusion: This study has found poor compliance by HWs to IMCI in Burundi. This indicates that a substantial proportion of children do not receive early and appropriate care, especially that pertaining to malnutrition. This alarming situation calls for strong action by actors committed to child health in the country.

Background: The Integrated Management of Childhood Illness (IMCI) strategy was adopted in Burundi in 2003. Our aim was to evaluate to what extent the malnutrition component of the IMCI guidelines is implemented at health facilities level. Methods: We carried out direct observations of curative outpatient consultations for children aged 6–59 months in 90 health centres selected randomly. We considered both the child and the health worker (HW) as units of analysis and used bivariate analysis to explore characteristics of HWs associated with tasks systematically or never performed. Results: A total of 514 consultations carried out by 145 HWs were observed. Among the 250 children under two years, less than 30% were asked questions on breastfeeding. None of them had all seven nutrition-related questions asked to their caregivers and none of the 200 children over the age of two years had all five nutrition-related questions asked to their caregivers. Only 13 cases (3%) had all of the six examinations/tasks (weight, height/length, mid-upper arm circumference, oedema, filling in and discussing the growth curve and calculating the weight for height z-score) performed as part of their care. 393 cases (76%) reported that they had not being given any nutrition advice. With regards to HWs, among 99 of them who had received children under two, only 21 (21.2%)[14.2–30.5%) systematically asked the question regarding 'ongoing breastfeeding'. Only 56 (38.6%)[31–46.9%] weighed or discussed the weight taken prior the consultation for each child they reviewed, only 38 (26.2%)[19.6–34.1%] measured the height/length or discussed it for each child reviewed and 23 (15.9%)[10.7–22.8%] performed (systematically?) the WHZ-score. More than 50% never gave nutrition advices to any child reviewed. HWs who daily manage severe acute malnutrition were the most likely to systematically ask the question regarding 'ongoing breastfeeding' and to perform a 'weight examination'. Those who had not received supervision visit on the topic of malnutrition predominantly never performed a 'weight examination'. The 'height/length' examination' was predominantly performed by female HWs and those who have 'contract with the government. Conclusion: This study has found poor compliance by HWs to IMCI in Burundi. This indicates that a substantial proportion of children do not receive early and appropriate care, especially that pertaining to malnutrition. This alarming situation calls for strong action by actors committed to child health in the country.

Background: Increased availability of maternal health services alone does not lead to better outcomes for maternal health.The services need to be utilized first.One way to increase service utilization is to plan responsive health care services by taking into account the community's views or expressed needs. Burundi has a high maternal mortality ratio, and despite improvements in health infrastructure, skilled staff and the abolition of user fees for pregnant women,utilization of maternal health services remains low. Possible reasons for this include a lack of responsive healthcare services. An exploratory study was conducted in 2013 in two provinces of Burundi (Makamba and Kayanza), with the aim to collect the experiences of women and men with the maternal health services,their views regarding those services, channels used to express these experiences, and the providers' reaction. Methods: Semi-structured interviews were used to collect data from men and women and key informants, including community health workers, health committee members, health providers, local authorities, religious leaders and managers of non-governmental organizations. Data analysis was facilitated by MAXQDA 11 software. Results: Negative experiences with maternal health services were reported and included poor staff behavior towards women and a lack of medicine. Health committees and suggestion boxes were introduced by the government to channel the community's views. However, they are not used by the community members, who prefer to use community health workers as intermediaries. Fear of expressing oneself linked to the post-war context of Burundi, social and gender norms, and religious norms limit the expression of community members' views, especially those of women. The limited appreciation of community health workers by the providers further hampers communication and acceptance of the community's views by health providers. Conclusion: In Burundi, the community voice to express views on maternal health services is encountering obstacles and needs to be strengthened,especially the women's voice. Community mobilization in the form of a mass immunization campaign day organized by women fora, and community empowerment using participatory approaches could contribute towards community voice strengthening.