Déterminants clés de la pratique optimale de l’allaitement exclusif au niveau de la communauté urbaine de Niamey, Niger

L’allaitement maternel exclusif (AME), mode d’alimentation de prédilection pour les nourrissons, demeure insuffisamment pratiqué. ’objectif général de cette étude était de contribuer à la pratique optimale de l’AME au niveau de la communauté urbaine de Niamey. Cette étude transversale, d’une durée de 3 mois a porté sur un échantillon de 400 mères d’enfants de 0-6 mois choisi, par commodité au cours de leurs consultations nourrisson au niveau des centres de santé. Les résultats ont montré que l’initiation précoce à l’allaitement maternel a concerné 48% d’enfants ayant été mis au sein dans l’heure qui suit la naissance, et que seulement 33, 5% des mères ont pratiqué l’AME. Cependant, l’analyse statistique traduit une association entre l’allaitement maternel exclusif et certains des facteurs testés. Ces facteurs clés permettant d’optimiser la pratique de l’AME demeurent: la connaissance de la durée et de la définition de l’AME, la connaissance des avantages de l’AME pour la mère tels que : retarde la fertilité et renforce le lien mère/enfant ; la connaissance des avantages pour l’enfant notamment: enfant grossit bien ou l’enfant est toujours en bonne santé et enfin le caractère économique de l’AME. Ces données permettent une meilleure orientation des interventions axées sur la pratique optimale de l’allaitement maternel à Niamey. English title: Key determinants of exclusive breastfeeding optimal practice in the urban community of Niamey, Niger Exclusive breastfeeding, the preferred feeding mode for infants, remains insufficiently practised. The overall objective of this study was to contribute to the optimal practice of exclusive breastfeeding in Niamey urban community. This cross-sectional study included a sample of 400 mothers of children aged 0-6 months chosen for convenience during their infant consultations at the health centre level. The results showed that 48% of children who were breast-fed within one hour of birth were introduced early to breastfeeding, and only 33.5% of mothers practiced exclusive breastfeeding. However, the statistical analysis shows an association between exclusive breastfeeding and some of the factors tested. These key factors for optimizing the practice of exclusive breastfeeding remain: knowledge of the duration and definition of breastfeeding, knowledge of the benefits of breastfeeding for the mother such as: delays fertility and strengthens the mother/child bond; knowledge of the benefits for the child in particular: child grows well or the child is always healthy and finally the economic character of the breastfeeding. These data allow a better orientation of interventions focused on the optimal practice of breastfeeding in Niamey.

Can direct smear results that are routinely collected at health centre level be used for monitoring the impact of mass drug administration with praziquantel on schistosomiasis in Burundi? A preliminary assessment.

Background : Intestinal schistosomiasis is still a public health problem in Burundi. Since 2008, annual mass drug administration with praziquantel have been rolled out in 11 endemic districts. The national programme relies on school-based surveys with Kato-Katz to monitor the impact of mass drug administration. We explored whether routine data on intestinal schistosomiasis as determined by direct fecal smears at health centre level could be used. Methods : From the Burundian National Health Information System, we collected routine incidence data on intestinal schistosomiasis as determined by direct smear examination in all 45 sanitary districts between 2011 and 2015. A temporal trends analysis was performed using a mixed negative binomial regression. Sanitary districts with mass drug administration campaigns with praziquantel (n=11) were compared with those without (n=34). In addition, prevalence data on intestinal schistosomiasis based on Kato-Katz results from a school-based national mapping in 2014 were compared with the incidence data in health centres based on direct smear results, in the same 45 sanitary districts. Findings : In the 11 sanitary districts applying mass drug administration with praziquantel, the incidence rate decreased significantly for the years 2014 (β 2014 = -0.826, p = 0.010) and 2015 (β 2015 = -1.294, p < 0.001) and for the five-year period (β = -0.286, p < 0.001), whereas in the 34 districts where mass drug administration was not delivered, there was no significant decrease over time (β = -0.087, p = 0.219). In most of the 45 sanitary districts, the low prevalences based on Kato-Katz in schoolchildren were confirmed by low incidence rates based on direct smear in the health centres. Conclusions : National Health Information System surveillance data, based on routinely collected direct smear results at health centre level, may be able to monitor the impact of mass drug administration with praziquantel on intestinal schistosomiasis in Burundi. Control and elimination of intestinal schistosomiasis call for integration of adequate diagnosis and treatment into routine activities of primary health care facilities, as recommended by the World Health Organization since more than 20 years. When moving towards elimination, more sensitive tests, such as the Point-of-care Circulating Cathodic Antigen assay are desirable. Keywords : Burundi; direct smear; health centre; mass drug administration; monitoring; routine data; praziquantel; schistosomiasis

Can direct smear results that are routinely collected at health centre level be used for monitoring the impact of mass drug administration with praziquantel on schistosomiasis in Burundi? A preliminary assessment.

Background : Intestinal schistosomiasis is still a public health problem in Burundi. Since 2008, annual mass drug administration with praziquantel have been rolled out in 11 endemic districts. The national programme relies on school-based surveys with Kato-Katz to monitor the impact of mass drug administration. We explored whether routine data on intestinal schistosomiasis as determined by direct fecal smears at health centre level could be used. Methods : From the Burundian National Health Information System, we collected routine incidence data on intestinal schistosomiasis as determined by direct smear examination in all 45 sanitary districts between 2011 and 2015. A temporal trends analysis was performed using a mixed negative binomial regression. Sanitary districts with mass drug administration campaigns with praziquantel (n=11) were compared with those without (n=34). In addition, prevalence data on intestinal schistosomiasis based on Kato-Katz results from a school-based national mapping in 2014 were compared with the incidence data in health centres based on direct smear results, in the same 45 sanitary districts. Findings : In the 11 sanitary districts applying mass drug administration with praziquantel, the incidence rate decreased significantly for the years 2014 (β 2014 =-0.826, p=0.010) and 2015 (β 2015 =-1.294, p<0.001) and for the five-year period (β=-0.286, p<0.001), whereas in the 34 districts where mass drug administration was not delivered, there was no significant decrease over time (β=-0.087, p=0.219). In most of the 45 sanitary districts, the low prevalences based on Kato-Katz in schoolchildren were confirmed by low incidence rates based on direct smear in the health centres. Conclusions : National Health Information System surveillance data, based on routinely collected direct smear results at health centre level, may be able to monitor the impact of mass drug administration with praziquantel on intestinal schistosomiasis in Burundi. Control and elimination of intestinal schistosomiasis call for integration of adequate diagnosis and treatment into routine activities of primary health care facilities, as recommended by the World Health Organization since more than 20 years. When moving towards elimination, more sensitive tests, such as the Point-of-care Circulating Cathodic Antigen assay are desirable. Keywords : Direct smear, Health centre, Mass drug administration, Monitoring, Praziquantel, Routine data, Schistosomiasis, Burundi