RESUMEN
In Mali since the adoption of community health center (CSCOM) politics, their number knew a progression remarkable: 370 in 1998 and 660 in the end of 2003. Concerning the health staff, the ratio always remained per capita weak in relation to the international norms. In 2001 for the first level of health center, the quantum was: 1 physician for 14,612 inhabitants (norm being of 1/10,000); 1 nurse for 13,989 inhabitants (WHO norm being of 1/10,000). In spite of the well stocked efforts, the foreseen objectives are far from being reached. For example, the used rate of curative consultation was of 0.19 new contact/year/inhabitant. The foreseen objective is of 0.50. Our survey had as objectives to study the reasons of CSCOM's under frequenting, to identify the reasons and to propose some recommendations to improve the situation. We conducted a cross-sectional study that had taken place in Banamba and Dioïla in the Koulikoro's region in April 19 to May 8, 2004. Interview have been performed with the head of CSCOM, the CSCOM's staff, the persons responsible of community health association (ASACO), the mothers residing in the areas at least six months and having a child less than 5 years and the community leaders. We found that women in Banamba (89%) frequented the CSCOM more that those of Dioïla (60%). The reasons of the CSCOM's under frequenting are especially bound to the staff's instability, the geographical accessibility, to poverty and to the insufficiency of information. We recommend to the different actors to inform and to sensitize the population on the importance of the CSCOM's activities, to the state to take the staff's part in charge to improve their stability, in the ASACO to establish the contracts of work with the staff.
Asunto(s)
Centros Comunitarios de Salud/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Masculino , MalíRESUMEN
Most newborn deaths are associated with birth asphyxia (40%), low birth weigt and prematurity (25%) and infections (20%). In Mali, in the Community Health Centers (CSCOM) exercises a staff composed of the nurse chief of health centers (ICPM) assuring the supervision of the matrons that is charged in pregnancy and the newborn. An investigation KAP (Knowledge, Attitudes and Practises) initiated in order to assess the knowledge and the practices of the community health centers agents on birth asphyxia. The survey was cross-sectional and that took place in September 2004. Have been included in the study the matrons, the nurse chief available at the time of the survey. The multiplicity of the names mentioned among which Ninakili dégou (27,3%) and Niominè (15,2%) are the most frequent and show the necessity of a qualitative investigation to find a name. Prolonged labor more than 12 hours (73,3%) and the stained amniotic liquid (63,3%) are the most recognized signs during labor making fear the birth asphyxia. In our survey the prolonged labor (63,7%), the infection/malaria of mother (60,7%) and the Dystocic delivery (45,5%) were the mostly reported causes of birth asphyxia. The pale or bluish coloration (69,7%), the irregular or lack of breath (69,7%), the lack of cry (63,6%) were known as the main signs of birth asphyxia. We noted some good practices as aspirating with a bulb (69,7%) and clearing upper ways with a finger covered with gauze (30,3% ); doing the mouth to mouth (51,5%); stimulating the newborn (66,7%). The improvement of the neontatal mortality requires the training of the staff and the equipment of the centers in small simple materials of resuscitation.
Asunto(s)
Asfixia Neonatal/terapia , Competencia Clínica , Centros Comunitarios de Salud , Conocimientos, Actitudes y Práctica en Salud , Personal de Enfermería , Asfixia Neonatal/diagnóstico , Estudios Transversales , Femenino , Humanos , Recién Nacido , Malí , Enfermeras Administradoras , Complicaciones del Trabajo de Parto/diagnóstico , Embarazo , Factores de RiesgoRESUMEN
Au Mali depuis l'adoption de la politique de creation des centres de sante communautaires (CSCOM) a nos jours; leur nombre a connu une progression remarquable : 370 en 1998 et 660 en fin 2003. Concernant le personnel sanitaire; le ratio par habitant reste toujours faible par rapport aux normes internationales. En 2001 pour le premier niveau de contact; les ratio etaient de : 1 medecin pour 14612 habitants (norme etant de 1/10 000) ; 1 infirmier pour 13989 habitants (norme OMS etant de 1/10 000). Malgre les efforts fournis; les objectifs prevus sont loin d'etre atteints. Par exemple; le taux d'utilisation de la consultation curative etait de 0;19 nouveau contact (Nc)/an/habitant 0;19 en 2003. L'objectif prevu est de 0;50 Nc/an/Habitant. Notre etude avait comme objectif d'identifier les determinants qui pourraient expliquer cette sous frequentation afin de proposer des strategies pour amener les populations a mieux frequenter les centres. Il s'agissait d'une etude transversale qui s'est deroulee a Banamba et a Dioila dans la region de Koulikoro du 19 avril au 8 mai 2004. Les resultats obtenus ont ete collectes aupres des chefs de postes medicaux; du personnel des CSCOM; des responsables des associations de sante communautaires (ASACO); des meres residant dans les aires de sante depuis au moins six mois et ayant un enfant de moins de 5 ans et des leaders communautaires. L'analyse des resultats a montre que les femmes a Banamba (89) frequentaient plus les CSCOM que celles de Dioila (60). Les causes de la sous frequentation des CSCOM sont surtout liees a l'instabilite du personnel; l'accessibilite geographique; a la pauvrete et a l'insuffisance d'information. Nous recommandons aux differents acteurs d'informer et de sensibiliser la population sur l'importance des activites des CSCOM; a l'Etat de prendre en charge une partie du personnel pour ameliorer leur stabilite; au ASACO d'etablir les contrats de travail avec le personnel