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To assess the adherence to option B + antiretroviral therapy (ART) and associated factors in pregnant and breastfeeding women in Sub-Saharan Africa (SSA)., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives: The study aimed to assess the determinants of modern contraceptive method use among young women in Benin. Design: A mixed-methods design. Setting and participants: We used the Benin 2017–2018 Demographic and Health Survey datasets for quantitative analysis. Data collection was conducted using multiple-cluster sampling method and through household survey. Qualitative part was conducted in the city of Allada, one of the Fon cultural capitals in Benin. The participants were purposively selected. Outcomes: Contraceptive prevalence rate, unmet need for modern method and percentage of demand satisfied by a modern method for currently married and sexually active unmarried women were measured in the quantitative part. Access barriers and utilisation of modern methods were assessed in the qualitative part. Results: Overall, 8.5% (95% CI 7.7% to 9.5%) among young women ages 15–24 were using modern contraceptives and 13% (12.1% to 14.0%) among women ages 25 or more. Women 15–24 had a higher unmet need, and a lower demand satisfied by modern contraceptive methods compared with women ages 25 or more. 60.8% (56.9% to 64.7%) of all unmarried young women had unmet need for modern contraceptives. Young women were more likely to use male condoms which they obtain mainly from for-profit outlets, pharmacies and relatives. The factors associated with demand satisfied by a modern method were literacy, being unmarried, knowing a greater number of modern contraceptive methods and experiencing barriers in access to health services. On the other hand, the qualitative study found that barriers to using modern methods include community norms about pre-marital sexual intercourse, perceptions about young women’s fertility, spousal consent and the use of non-modern contraceptives. Conclusion: Contraceptive use is low among young women in Benin. The use of modern contraceptives is influenced by sociodemographic factors and social norms. Appropriate interventions might promote comprehen, BMJ Open, 12, art. no. e054188; 2022

Following publication of the original article [1] two errors have been identified in the abstract and the plain English summary. The incorrect and correct information is listed below; the changes are shown in bold. Incorrect Abstract The implementation of PAC strategy in Kinshasa referral hospitals has resulted in the utilization of WHO recommended uterine evacuation method MVA (29.3% more in the experimental structures, p = 0.025), a significant decline in sharp-curettage (19.3% less, p = 0.132), and a decline in the duration of hospitalization of patients admitted for PAC (1 day less, p = 0.020). Plain English summary The implementation of PAC strategy in Kinshasa referral hospitals has resulted in the utilization of WHO recommended uterine evacuation method MVA (29.3% more in the experimental structures, p = 0.025), a significant decline in sharp-curettage (19.3% less, p = 0.132), and a decline in the duration of hospitalization of patients admitted for PAC (1 day less, p = 0.020). Correct Abstract The implementation of PAC strategy in Kinshasa referral hospitals has resulted in the utilization of WHO recommended uterine evacuation method MVA (29.3% more in the experimental structures, p = 0.025), a nonsignificant decline in sharp-curettage (19.3% less, p = 0.132), and a decline in the duration of hospitalization of patients admitted for PAC (1 day less, p = 0.020). Plain English summary The implementation of PAC strategy in Kinshasa referral hospitals has resulted in the utilization of WHO recommended uterine evacuation method MVA (29.3% more in the experimental structures, p = 0.025), a nonsignificant decline in sharp-curettage (19.3% less, p = 0.132), and a decline in the duration of hospitalization of patients admitted for PAC (1 day less, p = 0.020)., SCOPUS: er.j, info:eu-repo/semantics/published

RésuméContexte :Les avortements provoqués sont un problème de santé publique, et cela de par leur fréquence, la survenue de complication, et la mortalité et morbidité qui en découlent. Les décès peuvent ainsi représenter jusqu’à 18% de décès maternels. Très peu des données y relatives sont disponibles pour la RDC, alors que ce pays montre une mortalité maternelle très élevée avec un ratio qui est passé de 546 à 1188 décès maternels pour 100.000 naissances vivantes de 2007 à 2016 malgré l’amélioration de l’accessibilité et de l’utilisation des services de santé maternelle de 2001 à 2014. Objectif :Analyser les complications des avortements provoqués et les effets de l’intégration de la stratégie standard des soins après avortement dans les structures sanitaires de référence de la ville de Kinshasa, capitale de la RDC.Méthodes :L'analyse des complications des avortements provoqués incluait trois études transversales. La première étude a déterminé la prévalence des avortements provoqués et les complications y relatives. La deuxième et la troisième ont analysé les cas de complications des avortements provoqués admis dans les structures sanitaires de référence de Kinshasa du niveau secondaire et tertiaire successivement. Ensuite, l’analyse des effets de l’intégration de la stratégie standard des soins après avortement dans les structures sanitaires de référence de la ville de Kinshasa incluait une étude quasi expérimentale avec un design avant-après-comparatif. En outre, une étude qualitative avait été menée afin de contribuer à produire un modèle des soins après avortement adapté à la ville de Kinshasa.Résultats :Il ressort de nos études que le taux des avortements provoqués en 2015 était de 55 pour 1000 femmes en âge de procréer à Kinshasa, capitale de la RDC, et que la pratique de ces avortements était significativement plus souvent observée chez les femmes célibataires, séparées, ou divorcées, chez celles n’ayant pas étudié ou n’ayant fait que l’école primaire, et ch, Doctorat en Sciences de la santé Publique, info:eu-repo/semantics/nonPublished

To evaluate the effects of the implementation of a postabortion care (PAC) strategy in Kinshasa referral hospitals, this study analyzed the quality of postabortion care services, including postabortion contraception, and the duration of hospitalization., SCOPUS: ar.j, info:eu-repo/semantics/published

Due to a lack of relevant data on induced abortions in the Democratic Republic of the Congo (DRC) as well as the persistence of maternal deaths in the country, this study aims to analyse the extent of induced abortions and occurrence of complications in Kinshasa., SCOPUS: ar.j, info:eu-repo/semantics/published

BACKGROUND: Obstetric fistula (OF) is described as a health and human rights tragedy due to its devastating consequences and debilitating sequelae. In sub-Saharan Africa, the lifetime prevalence of OF symptoms is estimated at 3.0 cases (95% CI 1.3-5.5) per 1000 women of reproductive age. In Guinea, this prevalence is 6·0 (95% CI 3·9–7·4) per 1000 women of reproductive age, a double that of sub-Saharan Africa. As maternal mortality reduction is accelerating in many countries due to better access to cesarean section and more women are benefiting treatment for OF worldwide, women who have a successful fistula repair need more attention to prevent fistula recurrence and adverse maternal and neonatal outcomes.AIM: To analyze the long-term reproductive health outcomes in women who undergo fistula surgery in Guinea and contribute to closing the knowledge gap on the reproductive health of women after fistula surgery.METHODS: The situational analysis of fistula management programs in Guinea included three retrospective cohort studies. Study I analyzed the clinical outcomes of fistula care programs in Guinea. Study II analyzed the trends and factors associated with loss to follow-up after surgical repair of obstetric fistula in Guinea. Study III estimated the overall proportions of surgical failure of fistula closure and incontinence among women undergoing repair for obstetric fistula in Guinea and identified factors associated with these outcomes. To analyze the health and reproductive outcomes in women after female genital fistula surgery in Guinea, two studies (IV and V) were conducted. Study IV critically reviewed the existing literature on pregnancy and childbirth post repair of obstetric fistula and Study V analyzed the incidence of fistula recurrence and pregnancy post repair along with the associated maternal and neonatal outcomes. RESULTS: Routine programmatic repair of OF was found to achieve satisfactory short-term clinical outcomes with 85% of women having their f, Doctorat en Sciences de la santé Publique, info:eu-repo/semantics/nonPublished

Background The 2014 west African epidemic of Ebola virus disease posed a major threat to the health systems of the countries affected. We sought to quantify the consequences of Ebola virus disease on maternal and child health services in the highly-affected Forest region of Guinea. Methods We did a retrospective, observational cohort study of women and children attending public health facilities for antenatal care, institutional delivery, and immunisation services in six of seven health districts in the Forest region (Beyla, Guéckédou, Kissidougou, Lola, Macenta, and N'Zérékoré). We examined monthly service use data for eight maternal and child health services indicators: antenatal care (≥1 antenatal care visit and ≥3 antenatal care visits), institutional delivery, and receipt of five infant vaccines: polio, pentavalent (diphtheria, tetanus, pertussis, hepatitis B virus, and Haemophilus influenzae type b), yellow fever, measles, and tuberculosis. We used interrupted time series models to estimate trends in each indicator across three time periods: pre-Ebola virus disease epidemic (January, 2013, to February, 2014), during-epidemic (March, 2014, to February, 2015) and post-epidemic (March, 2015, to Feb, 2016). We used segmented ordinary least-squares (OLS) regression using Newey-West standard errors to accommodate for serial autocorrelation, and adjusted for any potential effect of birth seasonality on our outcomes. Findings In the months before the Ebola virus disease outbreak, all three maternal indicators showed a significantly positive change in trend, ranging from a monthly average increase of 61 (95% CI 38–84) institutional deliveries to 119 (95% CI 79–158) women achieving at least three antenatal care visits. These increasing trends were reversed during the epidemic: fewer institutional deliveries occurred (–240, 95% CI −293 to −187), and fewer women achieved at least one antenatal care visit (–418, 95% CI −535 to −300) or at least three antenatal care visits, SCOPUS: ar.j, info:eu-repo/semantics/published

Background Female genital fistula is a devastating maternal complication of delivery in developing countries. We sought to analyse the incidence and proportion of fistula recurrence, residual urinary incontinence, and pregnancy after successful fistula closure in Guinea, and describe the delivery-associated maternal and child health outcomes. Methods We did a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by EngenderHealth in Guinea. We recruited women retrospectively (via medical record review) and prospectively at hospital discharge. We used Kaplan-Meier methods to analyse the cumulative incidence, incidence proportion, and incidence ratio of fistula recurrence, associated outcomes, and pregnancy after successful fistula closure. The primary outcome was recurrence of fistula following discharge from repair hospital in all eligible women who consented to inclusion and could provide follow-up data. Findings 481 women eligible for analysis were identified retrospectively (from Jan 1, 2012, to Dec 31, 2014; 348 women) or prospectively (Jan 1 to June 20, 2015; 133 women), and followed up until June 30, 2016. Median follow-up was 28·0 months (IQR 14·6–36·6). 73 recurrent fistulas occurred, corresponding to a cumulative incidence of 71 per 1000 person-years (95% CI 56·5–89·3) and an incidence proportion of 18·4% (14·8–22·8). In 447 women who were continent at hospital discharge, we recorded 24 cases of post-repair residual urinary incontinence, equivalent to a cumulative incidence of 23·1 per 1000 person-years (14·0–36·2), and corresponding to 10·3% (5·2–19·6). In 305 women at risk of pregnancy, the cumulative incidence of pregnancy was 106·0 per 1000 person-years, corresponding to 28·4% (22·8–35·0) of these women. Of 50 women who had delivered by the time of follow-up, only nine delivered by elective caesarean section. There were 12 stillbirths, seven delivery-related fistula recurrences, and one maternal death. Interp, SCOPUS: ar.j, info:eu-repo/semantics/published

Background: Obstetric fistula is a serious medical condition which affects women in low income countries. Despite the progress of research on fistula, there is little data on long term follow-up after surgical repair. The objective of this study is to analyse the factors associated with the recurrence of fistula and the outcomes of pregnancy following fistula repair in Guinea. Methods: A descriptive longitudinal study design will be used. The study will include women who underwent fistula repair between 2012 and 2015 at 3 fistula repair sites supported by the Fistula Care Project in Guinea (Kissidougou Prefectoral Hospital, Labé Regional Hospital and Jean Paul II Hospital of Conakry). Participants giving an informed consent after a home visit by the Fistula Counsellors will be interviewed for enrolment at least 3 months after hospital discharge The study enrolment period is January 1, 2012 - June 30, 2015. Participants will be followed-up until June 30, 2016 for a maximum follow up period of 48 months. The sample size is estimated at 364 women. The cumulative incidence rates of fistula recurrence and pregnancy post-repair will be calculated using Kaplan-Meier methods and the risk factor analyses will be performed using adjusted Cox regression. The outcomes of pregnancy will be analysed using proportions, the Pearson's Chi Square (χ2) and a logistic regression with associations reported as risk ratios with 95 % confidence intervals. All analyses will be done using STATA version 13 (STATA Corporation, College Station, TX, USA) with a level of significance set at P<0.05. Discussion: This study will contribute to improving the prevention and management of obstetric fistula within the community and support advocacy efforts for the social reintegration of fistula patients into their communities. It will also guide policy makers and strategic planning for fistula programs. Trial registration: ClinicalTrials.gov Identifier: NCT02686957. Registered 12 February 2016 (Retrospe, SCOPUS: ar.j, info:eu-repo/semantics/published

Objective: To synthesise the evidence on pregnancy and childbirth after repair of obstetric fistula in sub-Saharan Africa and to identify the existing knowledge gaps. Methods: A scoping review of studies reporting on pregnancy and childbirth in women who underwent repair for obstetric fistula in sub-Saharan Africa was conducted. We searched relevant articles published between 1 January 1970 and 31 March 2016, without methodological or language restrictions, in electronic databases, general Internet sources and grey literature. Results: A total of 16 studies were included in the narrative synthesis. The findings indicate that many women in sub-Saharan Africa still desire to become pregnant after the repair of their obstetric fistula. The overall proportion of pregnancies after repair estimated in 11 studies was 17.4% (ranging from 2.5% to 40%). Among the 459 deliveries for which the mode of delivery was reported, 208 women (45.3%) delivered by elective caesarean section (CS), 176 women (38.4%) by emergency CS and 75 women (16.3%) by vaginal delivery. Recurrence of fistula was a common maternal complication in included studies while abortions/miscarriage, stillbirths and neonatal deaths were frequent foetal consequences. Vaginal delivery and emergency C-section were associated with increased risk of stillbirth, recurrence of the fistula or even maternal death. Conclusion: Women who get pregnant after repair of obstetric fistula carry a high risk for pregnancy complications. However, the current evidence does not provide precise estimates of the incidence of pregnancy and pregnancy outcomes post-repair. Therefore, studies clearly assessing these outcomes with the appropriate study designs are needed., SCOPUS: re.j, FLWIN, info:eu-repo/semantics/published

Background: The prevention and treatment of obstetric fistula still remains a concern and a challenge in low income countries. The objective of this study was to estimate the overall proportions of failure of fistula closure and incontinence among women undergoing repair for obstetric fistula in Guinea and identify its associated factors. Methods: This was a retrospective cohort study using data extracted from medical records of fistula repairs between 1 January 2012 and 30 September 2013. The outcome was the failure of fistula closure and incontinence at hospital discharge evaluated by a dye test. A sub-sample of women with vesicovaginal fistula was used to identify the factors associated with these outcomes. Results: Overall, 109 women out of 754 (14.5 %; 95 % CI:11.9-17.0) unsuccessful repaired fistula at discharge and 132 (17.5 %; 95 % CI:14.8-20.2) were not continent. Failure of fistula closure was associated with vaginal delivery (AOR: 1.9; 95 % CI: 1.0-3.6), partially (AOR: 2.0; 95 % CI: 1.1-5.6) or totally damaged urethra (AOR: 5.9; 95 % CI: 2.9-12.3) and surgical repair at Jean Paul II Hospital (AOR: 2.5; 95 % CI: 1.2-4.9). Women who had a partially damaged urethra (AOR: 2.5; 95 % CI: 1.5-4.4) or a totally damaged urethra (AOR: 6.3; 95 % CI: 3.0-13.0) were more likely to experience post-repair urinary incontinence than women who had their urethra intact. Conclusion: At programmatic level in Guinea, caution should be paid to the repair of women who present with a damaged urethra and those who delivered vaginally as they carry greater risks of experiencing a failure of fistula closure and incontinence., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction: In 2010, the Ministry of Health (MoH) of Guinea introduced a free emergency obstetric care policy in all the public health facilities of the country. This included antenatal checks, normal delivery and Caesarean section. Objective: This study aims at assessing the changes in coverage of obstetric care according to the Unmet Obstetric Need concept before (2008) and after (2012) the implementation of the free emergency obstetric care policy in a rural health district in Guinea. Methods: We carried out a descriptive cross-sectional study involving the retrospective review of routine programme data during the period April to June 2014. Results: No statistical difference was observed in women's sociodemographic characteristics and indications (absolute maternal indications versus non-absolute maternal indications) before and after the implementation of the policy. Compared to referrals from health centers of patients, direct admissions at hospital significantly increased from 49% to 66% between 2008 and 2012 (p = 0.001). In rural areas, this increase concerned all maternal complications regardless of their severity, while in urban areas it mainly affected very severe complications. Compared to 2008, there were significantly more Major Obstetric Interventions for Maternal Absolute Indications in 2012 (p<0.001). Maternal deaths decreased between 2008 and 2012 from 1.5% to 1.1% while neonatal death increased from 12% in 2008 to 15% in 2012. Conclusion: The implementation of the free obstetric care policy led to a significant decrease in unmet obstetric need between 2008 and 2012 in the health district of Kissidougou. However, more research is needed to allow comparisons with other health districts in the country and to analyse the trends., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives: Female genital fistula remains a public health concern in developing countries. From January 2007 to September 2013, the Fistula Care project, managed by EngenderHealth in partnership with the Ministry of Health and supported by USAID, integrated fistula repair services in the maternity wards of general hospitals in Guinea. The objective of this article was to present and discuss the clinical outcomes of 7 years of work involving 2116 women repaired in three hospitals across the country. Methods: This was a retrospective cohort study using data abstracted from medical records for fistula repairs conducted from 2007 to 2013. The study data were reviewed during the period April to August 2014. Results: The majority of the 2116 women who underwent surgical repair had vesicovaginal fistula (n = 2045, 97%) and 3% had rectovaginal fistula or a combination of both. Overall 1748 (83%) had a closed fistula and were continent of urine immediately after surgery. At discharge, 1795 women (85%) had a closed fistula and 1680 (79%) were dry, meaning they no longer leaked urine and/or faeces. One hundred and fifteen (5%) remained with residual incontinence despite fistula closure. Follow-up at 3 months was completed by 1663 (79%) women of whom 1405 (84.5%) had their fistula closed and 80% were continent. Twenty-one per cent were lost to follow-up. Conclusion: Routine programmatic repair for obstetric fistula in low resources settings can yield good outcomes. However, more efforts are needed to address loss to follow-up, sustain the results and prevent the occurrence and/or recurrence of fistula., SCOPUS: ar.j, FLWIN, info:eu-repo/semantics/published

Objective: To understand the health-seeking behaviour of adolescent women in Bangladesh with respect to the use of maternal health services. Methods: Literature review of seven electronic databases: PubMed, ISI Web of Knowledge, PsycINFO, Embase, CINAHL, POPLINE and Global Health. Studies published in English between 1990 and 2013 which describe Bangladeshi adolescent women's healthcare-seeking behaviour during pregnancy, delivery and post-partum were included. Results: Twelve studies were included in this review. 11 used quantitative methods and one used a mixed-methods approach. All studies included married adolescent women only. Women with lower educational levels are less likely to seek skilled maternal health services than those with higher levels of education. Use of maternal health services is also less common among rural married adolescent women than women in urban areas. Being part of the richest bands of wealth, having had previous experiences of childbirth and higher women's autonomy positively influence the use of skilled maternal health services among married adolescent women in Bangladesh. Antenatal care is a key predictor of the use of skilled birth attendants for delivery and post-natal care. Conclusion: Maternal health-related programmes should be designed targeting rural and uneducated married adolescent women in Bangladesh. More qualitative investigations are required to broaden our understanding on maternal health-seeking behaviour of both married and unmarried adolescent women., SCOPUS: re.j, FLWIN, info:eu-repo/semantics/published

Objective: To understand the health-seeking behaviour of adolescent women in Bangladesh with respect to the use of maternal health services. Methods: Literature review of seven electronic databases: PubMed, ISI Web of Knowledge, PsycINFO, Embase, CINAHL, POPLINE and Global Health. Studies published in English between 1990 and 2013 which describe Bangladeshi adolescent women's healthcare-seeking behaviour during pregnancy, delivery and post-partum were included. Results: Twelve studies were included in this review. 11 used quantitative methods and one used a mixed-methods approach. All studies included married adolescent women only. Women with lower educational levels are less likely to seek skilled maternal health services than those with higher levels of education. Use of maternal health services is also less common among rural married adolescent women than women in urban areas. Being part of the richest bands of wealth, having had previous experiences of childbirth and higher women's autonomy positively influence the use of skilled maternal health services among married adolescent women in Bangladesh. Antenatal care is a key predictor of the use of skilled birth attendants for delivery and post-natal care. Conclusion: Maternal health-related programmes should be designed targeting rural and uneducated married adolescent women in Bangladesh. More qualitative investigations are required to broaden our understanding on maternal health-seeking behaviour of both married and unmarried adolescent women., SCOPUS: re.j, FLWIN, info:eu-repo/semantics/published

Objectives: Female genital fistula remains a public health concern in developing countries. From January 2007 to September 2013, the Fistula Care project, managed by EngenderHealth in partnership with the Ministry of Health and supported by USAID, integrated fistula repair services in the maternity wards of general hospitals in Guinea. The objective of this article was to present and discuss the clinical outcomes of 7 years of work involving 2116 women repaired in three hospitals across the country. Methods: This was a retrospective cohort study using data abstracted from medical records for fistula repairs conducted from 2007 to 2013. The study data were reviewed during the period April to August 2014. Results: The majority of the 2116 women who underwent surgical repair had vesicovaginal fistula (n = 2045, 97%) and 3% had rectovaginal fistula or a combination of both. Overall 1748 (83%) had a closed fistula and were continent of urine immediately after surgery. At discharge, 1795 women (85%) had a closed fistula and 1680 (79%) were dry, meaning they no longer leaked urine and/or faeces. One hundred and fifteen (5%) remained with residual incontinence despite fistula closure. Follow-up at 3 months was completed by 1663 (79%) women of whom 1405 (84.5%) had their fistula closed and 80% were continent. Twenty-one per cent were lost to follow-up. Conclusion: Routine programmatic repair for obstetric fistula in low resources settings can yield good outcomes. However, more efforts are needed to address loss to follow-up, sustain the results and prevent the occurrence and/or recurrence of fistula., SCOPUS: ar.j, FLWIN, info:eu-repo/semantics/published

Introduction: In 2010, the Ministry of Health (MoH) of Guinea introduced a free emergency obstetric care policy in all the public health facilities of the country. This included antenatal checks, normal delivery and Caesarean section. Objective: This study aims at assessing the changes in coverage of obstetric care according to the Unmet Obstetric Need concept before (2008) and after (2012) the implementation of the free emergency obstetric care policy in a rural health district in Guinea. Methods: We carried out a descriptive cross-sectional study involving the retrospective review of routine programme data during the period April to June 2014. Results: No statistical difference was observed in women's sociodemographic characteristics and indications (absolute maternal indications versus non-absolute maternal indications) before and after the implementation of the policy. Compared to referrals from health centers of patients, direct admissions at hospital significantly increased from 49% to 66% between 2008 and 2012 (p = 0.001). In rural areas, this increase concerned all maternal complications regardless of their severity, while in urban areas it mainly affected very severe complications. Compared to 2008, there were significantly more Major Obstetric Interventions for Maternal Absolute Indications in 2012 (p<0.001). Maternal deaths decreased between 2008 and 2012 from 1.5% to 1.1% while neonatal death increased from 12% in 2008 to 15% in 2012. Conclusion: The implementation of the free obstetric care policy led to a significant decrease in unmet obstetric need between 2008 and 2012 in the health district of Kissidougou. However, more research is needed to allow comparisons with other health districts in the country and to analyse the trends., SCOPUS: ar.j, info:eu-repo/semantics/published

To analyse the trend of loss to follow-up over time and identify factors associated with women being lost to follow-up after discharge in three fistula repair hospitals in Guinea., FLWOA, SCOPUS: ar.j, info:eu-repo/semantics/published

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La césarienne est une intervention obstétricale majeure qui peut sauver la vie de la mère et de l’enfant. En Afrique sub-saharienne, il persiste une grande inégalité d’accès à la césarienne et une grande variation des pratiques autour des indications d’intervention. D’un côté, des barrières financières, géographiques, culturelles privent des femmes d’une intervention qui peut sauver leur vie. De l’autre, la pratique grandissante de césariennes sans indication médicale, dans un contexte de mauvaise qualité de soins, entraine une sur-morbidité et mortalité iatrogènes et évitables. L’objectif de notre thèse est de contribuer à une meilleure connaissance des déterminants d’une césarienne de qualité et de montrer comment en situation réelle (cas d’un district urbain au Burkina Faso) on peut agir sur ces déterminants pour améliorer la qualité des césariennes.Dans le cadre d’un projet multidisciplinaire (santé publique, mobilisation politique et sociale, anthropologie) d’Amélioration de la QUalité et de l’Accès aux Soins Obstétricaux d’Urgence - le projet AQUASOU (2003-2006) - nous avons pu mettre en œuvre des activités visant à améliorer l’accès à une césarienne de qualité dans le district du Secteur 30) à Ouagadougou, Burkina Faso. Nous avons mené une étude Avant-Après et utilisé des méthodes d’évaluation mixtes quantitatives et qualitatives pour comprendre dans quelle mesure et comment ce type d’approche globale améliore la qualité de la césarienne. Nous avons utilisé le cadre d’analyse de Dujardin et Delvaux (1998) qui présente les différents déterminants de la césarienne pour organiser et structurer nos résultats. Cette expérience s’étant déroulée dans le cadre d’un projet pilote nous avons également évalué le degré de pérennité du projet AQUASOU quatre ans après sa clôture officielle et analysé sa diffusion au niveau région et national.Le cadre d’analyse de la césarienne de qualité avec ses quatre piliers (Accès, Diagnostic, Procédure, Soins postopératoires), Doctorat en Sciences de la santé publique, info:eu-repo/semantics/nonPublished

La césarienne est une intervention obstétricale majeure qui peut sauver la vie de la mère et de l’enfant. En Afrique sub-saharienne, il persiste une grande inégalité d’accès à la césarienne et une grande variation des pratiques autour des indications d’intervention. D’un côté, des barrières financières, géographiques, culturelles privent des femmes d’une intervention qui peut sauver leur vie. De l’autre, la pratique grandissante de césariennes sans indication médicale, dans un contexte de mauvaise qualité de soins, entraine une sur-morbidité et mortalité iatrogènes et évitables. L’objectif de notre thèse est de contribuer à une meilleure connaissance des déterminants d’une césarienne de qualité et de montrer comment en situation réelle (cas d’un district urbain au Burkina Faso) on peut agir sur ces déterminants pour améliorer la qualité des césariennes.Dans le cadre d’un projet multidisciplinaire (santé publique, mobilisation politique et sociale, anthropologie) d’Amélioration de la QUalité et de l’Accès aux Soins Obstétricaux d’Urgence - le projet AQUASOU (2003-2006) - nous avons pu mettre en œuvre des activités visant à améliorer l’accès à une césarienne de qualité dans le district du Secteur 30) à Ouagadougou, Burkina Faso. Nous avons mené une étude Avant-Après et utilisé des méthodes d’évaluation mixtes quantitatives et qualitatives pour comprendre dans quelle mesure et comment ce type d’approche globale améliore la qualité de la césarienne. Nous avons utilisé le cadre d’analyse de Dujardin et Delvaux (1998) qui présente les différents déterminants de la césarienne pour organiser et structurer nos résultats. Cette expérience s’étant déroulée dans le cadre d’un projet pilote nous avons également évalué le degré de pérennité du projet AQUASOU quatre ans après sa clôture officielle et analysé sa diffusion au niveau région et national.Le cadre d’analyse de la césarienne de qualité avec ses quatre piliers (Accès, Diagnostic, Procédure, Soins postopératoires), Doctorat en Sciences de la santé publique, info:eu-repo/semantics/nonPublished

Background: Infants of North African immigrants are reported to have higher birthweights than their Belgian counterparts. It is unclear what mechanism contributes to this difference. Methods: Analyses were based on a hospital-based cohort of 1,162 women. Results: Infants of North African immigrants were less likely to be born preterm, compared to infants of Belgian women. After adjusting for sociodemographic and maternal factors, the estimated difference in mean birthweight was 74 g (p=0.05). When limited to term births, this difference was 28 g (p=0.42). Conclusion: The difference in mean birthweight between North African and Belgian infants was explained by differences in preterm birth and other risk factors., SCOPUS: ar.j, info:eu-repo/semantics/published

OBJECTIVE: Despite their low socioeconomic status, infants of North African immigrants have been reported to have high birth weights in Belgium. The aim of the study was to further explore potential mechanisms explaining this high birth weight. STUDY DESIGN: Venous umbilical cord blood samples and perinatal characteristics of live-bom infants from mothers of North African and Belgian nationality were collected in 1997 through 1998 at the University Hospital La Citadelle, Liège, Belgium. RESULTS: The median connecting peptide (C-peptide) concentration was significantly higher among North African than Belgian neonates (0.125 vs 0.110 pmol/mL, P = .04). However, the median insulin-like growth factor-I concentrations among North African and Belgian newborn infants were, respectively, 74.0 and 69.6 ng/ mL (P = .45). Nationality remained significantly associated with C-peptide after adjusting for age and parity. C-peptide, insulin-like growth factor-I correlated positively with birth weight and remained significant factors for birth weight after adjusting for confounders in multiple regression. CONCLUSION: These results suggest a link between higher C-peptide levels and birth weights among North African neonates in Belgium., SCOPUS: ar.j, info:eu-repo/semantics/published

OBJECTIVE: Despite their low socioeconomic status, infants of North African immigrants have been reported to have high birth weights in Belgium. The aim of the study was to further explore potential mechanisms explaining this high birth weight. STUDY DESIGN: Venous umbilical cord blood samples and perinatal characteristics of live-bom infants from mothers of North African and Belgian nationality were collected in 1997 through 1998 at the University Hospital La Citadelle, Liège, Belgium. RESULTS: The median connecting peptide (C-peptide) concentration was significantly higher among North African than Belgian neonates (0.125 vs 0.110 pmol/mL, P = .04). However, the median insulin-like growth factor-I concentrations among North African and Belgian newborn infants were, respectively, 74.0 and 69.6 ng/ mL (P = .45). Nationality remained significantly associated with C-peptide after adjusting for age and parity. C-peptide, insulin-like growth factor-I correlated positively with birth weight and remained significant factors for birth weight after adjusting for confounders in multiple regression. CONCLUSION: These results suggest a link between higher C-peptide levels and birth weights among North African neonates in Belgium., SCOPUS: ar.j, info:eu-repo/semantics/published

In Europe, it is sometimes assumed that few barriers to prenatal care exist because extensive programs of health insurance and initiatives to promote participation in prenatal care have been established for many decades., Journal Article, Research Support, Non-U.S. Gov't, SCOPUS: ar.j, info:eu-repo/semantics/published

In Europe, it is sometimes assumed that few barriers to prenatal care exist because extensive programs of health insurance and initiatives to promote participation in prenatal care have been established for many decades., Journal Article, Research Support, Non-U.S. Gov't, SCOPUS: ar.j, info:eu-repo/semantics/published

Objective: The purpose of the study was to compare prenatal care attendance in European Union countries, Hungary and Norway.Study Design: We analysed live births or deliveries from national registers in five countries, national surveys in five countries, and regional register or surveys in three countries.Results: The frequency of no prenatal care was lower than 0.5% in 10 countries, 0.9% in Hungary, 2.1% in Greece and 2.6% in Portugal. Late prenatal care varied from 3.1% in Finland to 29.2% in Ireland. Late care among women with parity 4 and more varied from 7.7% in Finland to 41.5% in Hungary. Among women under 20 years old, late care varied from 11.8% in Finland to 39.5% in Portugal. The median number of prenatal visits varied from seven in Greece to 14 in Finland.Conclusion: Prenatal care attendance varies widely among European countries. Late attendance is frequent in many countries. Copyright (C) 1999 Elsevier Science Ireland Ltd., SCOPUS: ar.j, info:eu-repo/semantics/published

Objective: The purpose of the study was to compare prenatal care attendance in European Union countries, Hungary and Norway.Study Design: We analysed live births or deliveries from national registers in five countries, national surveys in five countries, and regional register or surveys in three countries.Results: The frequency of no prenatal care was lower than 0.5% in 10 countries, 0.9% in Hungary, 2.1% in Greece and 2.6% in Portugal. Late prenatal care varied from 3.1% in Finland to 29.2% in Ireland. Late care among women with parity 4 and more varied from 7.7% in Finland to 41.5% in Hungary. Among women under 20 years old, late care varied from 11.8% in Finland to 39.5% in Portugal. The median number of prenatal visits varied from seven in Greece to 14 in Finland.Conclusion: Prenatal care attendance varies widely among European countries. Late attendance is frequent in many countries. Copyright (C) 1999 Elsevier Science Ireland Ltd., SCOPUS: ar.j, info:eu-repo/semantics/published

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The purpose of the study was to identify prenatal care incentives and benefits in 17 European countries. All participating countries completed a questionnaire on their prenatal care delivery system, incentives and benefits. Results were analyzed according to their direct or indirect relationship with prenatal care attendance. Direct incentives require a prenatal care visit to be eligible for the benefit. Indirect incentives support the pregnant woman but do not require a prenatal care visit to be eligible for the benefit. All 17 countries offer direct incentives, such as paid maternity leave. In 9 countries, pregnant women receive direct financial incentives. Eleven countries offer indirect incentives, such as transportation benefits. Prenatal care incentives such as financial benefits and social supports are widespread in Europe. The combination of incentives superimposed upon an inclusive health care system create a supportive environment which encourages prenatal care attendance. © 1998 by the Journal of Public Health Policy, Inc., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives. This study was examined birthweights of North African immigrants in Belgium. Methods. Analyses focused on Belgian single live birth certificates from 1981 to 1988. Results. Low-birthweight (<2500 g) rates were 3.1% among 34 686 newborns of North African origin and 4.8% among 804 286 newborns of Belgian origin. The entire North African birthweight distribution was shifted toward higher birthweights than the Belgian distribution. Low frequencies of low birthweights among North Africans were still observed after marital status, occupation of the father, and parity had been taken into account. Conclusions. Despite their low socioeconomic status, North African immigrants have high birthweights., SCOPUS: ar.j, info:eu-repo/semantics/published

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Introduction Referral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the COVID-19 pandemic. Methods Mixed-methods design using three data sources: (1) qualitative data from repeated rounds of semi-structured interviews conducted between July 2020 and February 2021 with 22 maternity skilled heath personnel (SHP) on perceptions of care provision; (2) quantitative monthly routine data on caesarean section and labour induction from March 2019 to February 2021; and (3) timeline data of COVID-19 epidemiology, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on timeline analysis, and triangulated during reporting. Results We identified three periods: first wave, slow period and second wave. The first wave was challenging for SHP given little knowledge about COVID-19, lack of infection prevention and control training, and difficulties reaching workplace. Challenges that persisted beyond the first wave were shortage of personal protective equipment and no rapid testing for women suspected with COVID-19. We noted no change in the proportion of caesarean sections during the pandemic, and a small increase in the proportion of labour inductions. All hospitals arranged isolation areas for women suspected/confirmed with COVID-19 and three hospitals provided care to women with suspected/confirmed COVID-19. Breastfeeding was not discouraged and newborns were not separated from mothers confirmed with COVID-19. Care provision was maintained through dedication of SHP, support from hospital management and remote communication between SHP. Conclusion Routine maternal care provision was maintained in referral hospitals, despite first wave challenges. Referral hospitals and SHP contributed to guide