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Objective To estimate the prevalence of awareness and use of evidence-based reproductive health interventions and to describe the barriers associated with the use of evidence-based interventions among health providers in north-west Cameroon. Methods In February 2004, a population-based descriptive study of the awareness and use of 13 evidence-based interventions targeted health workers providing reproductive health care. Their awareness and use of a composite of four vital interventions was also evaluated. These were peripartum use of antiretrovirals to prevent transmission of HIV, antenatal corticosteroid administration, magnesium sulfate prophylaxis and active management of placental delivery with uterotonics, tn-depth interviews with key informants were conducted as part of a qualitative substudy to discover the barriers to the use of evidence-based interventions. Findings Overall, 91.4% (328/359) of reproductive health workers were surveyed. Their awareness of evidence-based interventions varied from 29% for the use of antenatal corticosteroids to 97% for the use of iron and folic acid supplementation during pregnancy. Their use of these interventions ranged from 10.2% for antenatal corticosteroids to 94.8% for iron and folic acid supplementation. Only 50/322 (15.5%; 95% confidence interval (Cl) = 11.8-20.0) of health workers were aware of all four vital interventions, and only 12/312 (3.8%; 95% Cl = 2.0-6.6) reported using all of them regularly. A total of 26 key informants participated in the qualitative substudy. A deficiency in the education and training of health workers, especially a lack of continuing education, was commonly identified as the most important barrier to their awareness of evidence-based practices. A lack of awareness and a lack of supplies and materials were the main barriers to practice. Conclusion The awareness and practice of important evidence-based reproductive health interventions were less than optimal. To improve maternal and perinatal outcomes both remedial programmes to enhance awareness, including continuing education for health workers, and the provision of necessary supplies are needed. Keywords Reproductive health services; Evidence-based medicine; Health personnel/education; Health knowledge, attitudes, practice; Pregnancy complications/drug therapy;Adrenal cortex hormones/therapeutic use;Anti-retroviral agents/therapeutic use; Magnesium sulfate/therapeutic use; Tocolytic agents/therapeutic use; Population surveillance; Cameroon (source: MeSH, NLM). Soins de sante genesique fondes sur l'experience au Cameroun : etudes en population de la connaissance et de la mise en oeuvre de ces soins, ainsi que des obstacle rencontres dans cette mise en oeuvre Objectif Estimer la frequence de la connaissance et de l'utilisation d'interventions de sante genesique reposant sur l'experience et decrire les obstacles s'opposant a la mise en oeuvre de ces interventions par les soignants au nord-ouest du Cameroun. Methodes En fevrier 2004, une etude descriptive en population de la connaissance et de l'utilisation de 13 interventions reposant sur l'experience a ete menee chez des agents de sante dispensant des soins de sante genesique. On a egalement evalue la connaissance et l'utilisation d'un ensemble de quatre interventions vitales a savoir, l'utilisation pendant le peripartum d'antiretroviraux pour prevenir la transmission du VIH, l'administration prenatale de corticosteroides, la prophylaxie par le sulfate de magnesium et la prise en charge active de la delivrance placentaire au moyen d'uterotoniques. Des entretiens approfondis avec des informateurs cles se sont deroules dans le cadre d'une etude subsidiaire qualitative, visant a determiner les obstacles a l'utilisation d'interventions reposant sur l'experience. Resultats Au total, 91,4 % (328/359) des soignants en sante genesique ont participe a l'enquete. Leur connaissance des interventions reposant sur l'experience se situait entre 29% pour l'utilisation prenatale de corticosteroides et 97% pour l'utilisation de la supplementation en fer et en acide folique au cours de la grossesse. La mise en oeuvre de ces interventions se situait entre 10,2 % pour l'administration prenatale de corticosteroides et 94,8 % pour la supplementation en fer et en acide folique. Seuls 50 agents de sante sur 322 (15,5%; intervalle de confiance [IC a 95% = 11,8-20,0) connaissaient les quatre interventions vitales et seuls 12/312 (3,8% ; IC 95% = 2,0-6,6) ont indique qu'ils les utilisaient tous regulierement. Au total 26 informateurs cles ont participe a l'etude subsidiaire qualitative. Des lacunes au niveau de l'education et de la formation des agents de sante, notamment l'absence d'une formation continue, ont ete frequemment identifiees comme l'obstacle le plus important a la connaissance des pratiques reposant sur l'experience. Les connaissances insuffisantes et le manque de fournitures et de materiel etaient les principaux obstacles a leur mise en oeuvre. Conclusion La connaissance et la mise en oeuvre d'interventions importantes en sante genesique et reposant sur l'experience n'etaient pas optimales. Pour ameliorer les resultats obtenus au niveau maternel et perinatal, il faut a la fois offrir des programmes pour renforcer les connaissances des agents de sante, notamment une formation continue, et apporter les fournitures necessaires. Mots cles Services de medecine de la reproduction; Personnel sanitaire/enseignement; Medecine factuelle; Connaissance, attitude, pratique; Grossesse compliquee/chimiotherapie; Hormones corticosurrenaliennes/usage therapeutique; Agents antiretroviraux/usage therapeutique; Sulfate magnesium/usage therapeutique; Agents tocolytiques/usage therapeutique; Surveillance population; Cameroun (source: MeSH, INSERM). Atencion de salud reproductiva basada en la evidencia en el Camerun: estudio poblacional sobre los conocimientos, la aplicacion y las barreras. Objetivo Estimar la prevalencia de los conocimientos y la aplicacion de las intervenciones de salud reproductiva basadas en la evidencia, y describir las barreras que se oponen al uso de esas intervenciones entre los proveedores de asistencia sanitaria en el noroeste del Camerun. Metodos En febrero de 2004 se realizo un estudio descriptivo poblacional sobre el conocimiento y uso de 13 intervenciones basadas en la evidencia, centrado en personal sanitario que dispensaba atencion de salud reproductiva. Se evaluaron tambien sus conocimientos y aplicacion de un conjunto de cuatro intervenciones fundamentales: el uso de antirretrovirales durante el parto para prevenir la transmision del VIH, la administracion prenatal de cortiocosteroides, la profilaxis con sulfato de magnesio y el fomento activo de la expulsion de la placenta con uterotonicos. Ademas, se llevaron a cabo entrevistas detalladas con informantes clave como parte de un subestudio cualitativo destinado a identificar las barreras a la aplicacion de esas intervenciones basadas en la evidencia. Resultados Se estudio en total al 91,4% (328/359) de los trabajadores de salud reproductiva. Su conocimiento de las intervenciones basadas en la evidencia variaba entre el 29% para la utilizacion prenatal de corticosteroides y el 97% para la administracion de suplementos de hierro y acido folico durante el embarazo. Su utilizacion de esas intervenciones variaba desde el 10,2% en el caso de los corticosteroides prenatales hasta el 94,8% en el caso de los suplementos de hierro y acido folico. Solo 50 de 322 (15,5%; intervalo de confianza [IC] del 95% = 11,8-20,0) trabajadores sanitarios conocian las cuatro intervenciones esenciales analizadas, y solo 12 de 312 (3,8%; IC95% = 2,0-6,6) senalaron que aplicaban todas ellas regularmente. Un total de 26 informantes clave participaron en el subestudio cualitativo. La barrera mas importante en cuanto al conocimiento de las practicas basadas en la evidencia resulto ser una deficiente formacion teorica y practica del personal sanitario, especialmente la falta de ensenanza continua. La falta de conocimientos y la falta de suministros y material eran las barreras principales a la aplicacion de esas practicas. Conclusion El conocimiento y la aplicacion de importantes intervenciones de salud reproductiva basadas en la evidencia eran suboptimos. Para mejorar los resultados matemos y perinatales se necesitan tanto programas correctivos que aumenten los conocimientos, en particular ensenanza continua para los agentes de salud, como suministros suficientes. Palabras clave Servicios de salud reproductiva; Personal de salud/educacion; Medicina basada en evidencia; Conocimientos, actitudes y practica sanitarias; Complicaciones del embarazo/quimioterapia; Corticosteroides/uso terapeutico; Agentes antirretrovirales/uso terapeutico; Sulfato de magnesio/uso terapeutico; Agentes tocoliticos/uso terapeutico; Vigilancia de la poblacion; Camerun (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction More than 500 000 women die annually from pregnancy-related complications and millions become ill from these complications (1). Altogether, 99% of these deaths occur in the developing world, especially [...]

Background: This article describes the setting-up process for nurse-led pilot clinics for the management of four chronic diseases: asthma, type 2 diabetes mellitus, epilepsy and hypertension at the primary health care level in urban and rural Cameroon. Methods: The Biyem-Assi urban and the Bafut rural health districts in Cameroon served as settings for this study. International and local guidelines were identified and adapted to the country's circumstances. Training and follow-up tools were developed and nurses trained by experienced physicians in the management of the four conditions. Basic diagnostic and follow-up materials were provided and relevant essential drugs made available. Results: Forty six nurses attended six training courses. By the second year of activity, three and four clinics were operational in the urban and the rural areas respectively. By then, 925 patients had been registered in the clinics. This represented a 68.5% increase from the first year. While the rural clinics relied mainly on essential drugs for their prescriptions, a prescription pattern combining generic and proprietary drugs was observed in the urban clinics. Conclusion: In the quest for cost-effective health care for NCD in sub-Saharan Africa, rethinking health workforce and service delivery has relevance. Nurse-led clinics, algorithm driven service delivery stands as alternatives to overcome the shortage of trained physicians and other issues relating to access to care. [ABSTRACT FROM AUTHOR]

Background and purpose. Asthma is an important health condition in sub-Saharan Africa, with major gaps in clinical care. The aim of this project was to implement nurse-led care for asthma in rural Cameroon. Methods: We set-up a nurse-led structured management program for asthma in Bafut rural health district in Cameroon from 1998 to 2000. After an initial phase of intensive medical supervision, nurses were offered to run the clinics independently. Patients were monitored for all-cause mortality, hospitalizations, and control of asthma attacks. Results. At the final evaluation, 87 (73.4% women) were registered in the two pilot clinics. They were 4 to 92 years of age (median 51) and had been diagnosed with asthma for 0 to 40 years. The median duration of follow-up was 5 months (range 1-20) and patients attended on average 3 visits (range 1 to 14). During follow-up, a 66-year-old participant died and 170 emergency hospital admissions/consultations were recorded in 34 participants, 82.3% of them being women. Overall there was a significant downward trend in the number of days/month with attacks with the duration of follow-up, and at the last visit most patients had improved compared with the initial visit. This trend was apparent in most subgroups of participants. Hospital admission before baseline visit was a predictor of hospital admission during follow-up, hazard ratio (95% confidence interval) 3.20 (1.30-7.91), p = 0.012. Conclusions. The program was well received by the community at large. A marked improvement was observed for most patients as substantiated by the reduction in the number of asthma attacks. Trained nurses are a good alternative for the management of asthma in a resource-limited context. [ABSTRACT FROM AUTHOR]