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Ag Ahmed MA, Ravinetto R, Diop K, Trasancos Buitrago V, Dujardin C. Evaluation of Rational Medicines Use Based on World Health Organization Core Indicators: A Cross-Sectional Study in Five Health Districts in Mauritania. Integr Pharm Res Pract 2024; 13:17-29. [PMID: 38566890 PMCID: PMC10984847 DOI: 10.2147/iprp.s447664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The rational use of medicines is essential for preventing adverse medicine reactions, achieving therapeutic outcomes, and optimizing treatment costs. While the irrational use of medicines is frequently reported in sub-Saharan Africa, to the best of our knowledge no formal studies have taken place in Mauritania thus far. The main objective of this study was therefore to analyze the rational use of medicines in public and private not-for-profit health facilities, in five health districts in Mauritania. Methods We conducted a cross-sectional study to assess the rational use of medicines. We used the standard indicators derived from the methodologies of the World Health Organization (WHO) and International Network for Rational Use of Drugs (INRUD). Data were prospectively collected from 1050 prescriptions/patients, in thirty-one public and private not-for-profit health posts/centers in 5 health districts. The data were analyzed using the Statistical Package for the Social Sciences. P value less than 0.05 at 95% confidence interval considered for significance of relationships for associations in statistical test. Results The average number of medicines per prescription was 2.21; 83.1% (1931/2325) of medicines were prescribed by generic name, but only 54% (1253/2325) were on the National Essential Medicine List (NEML). Antibiotics were prescribed in 62.4% (655/1050) of the consultations, and injectable medicines were prescribed in 15.6% (164/1050) of the consultations. The average consultation time was 16.32 minutes, and the average dispensing time was 97 seconds. Dispensed medicines were correctly labeled, and 83% (871/1050) of patients met the correct administration schedule. The NEML, and the "restricted NEML" for 76 commonly-used medicines, were available in all surveyed health facilities, but the National Therapeutic Guidelines were available in only 60.26% of them. Conclusion Our findings indicate a possible excess of antibiotics prescriptions, and a likely lack of knowledge of the National Therapeutic Guidelines. There is a need to investigate in more detail the prescription patterns versus disease-specific therapeutic guidelines, and to qualitatively investigate the factors that contribute to the observed irrational prescribing. Moreover, training local staff in the rational use of medicines seems important.
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Affiliation(s)
- Mohamed Ali Ag Ahmed
- Sherpa University Institute, Montreal, Québec, Canada
- Management, Evaluation and Health Policy Department. University of Montreal, Montreal, Québec, Canada
| | - Raffaella Ravinetto
- Department of Public Health. Institute of Tropical Medicine, Antwerp, Belgium
- University of the Western Cape, Cape Town, South Africa
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Kadio K, Ly A, Ouédraogo A, Ahmed MAA, Yaya S, Gagnon MP. Implementation of lockdown, quarantine, and isolation measures in the context of COVID-19 among internally displaced persons in Burkina Faso: a qualitative study. Confl Health 2024; 18:17. [PMID: 38429753 PMCID: PMC10908079 DOI: 10.1186/s13031-024-00579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/25/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The triple political, security, and health crisis in Burkina Faso has impacted the lives of Burkinabè people, resulting in massive internal displacement. These internally displaced persons (IDPs) are very vulnerable to epidemic diseases, which was exacerbated by the recent COVID-19 pandemic., The implementation of public health measures to curb the spread of COVID-19 represented a major concern among IDPs. The objective of this study was to document knowledge, difficulties, adjustments, and challenges faced by IDPs and humanitarian authorities/actors during implementation of lockdown, quarantine, and isolation measures in response to COVID-19. METHODS The study was conducted in Burkina Faso, in the north-central region Kaya, a commune which hosts the largest number of IDPs in the country. Qualitative research using semi-structured interviews collected discursive data from 18 authorities and/or humanitarian actors and 29 IDPs in June 2021. The transcribed interviews were coded with N'vivo 11 software and analyzed thematically. RESULTS Although respondents had a good knowledge of lockdown, isolation, and quarantine measures, the difference between these three concepts was not easily understood by either authorities/humanitarian actors or IDPs. Communication was one of the biggest challenges for humanitarian actors. The difficulties encountered by IDPs were economic (lack of financial resources), infrastructural (limited housing), and socio-cultural in the application of lockdown, isolation, and quarantine measures. As for adjustment measures, the health authorities developed a strategy for isolation and quarantine for the management of positive and suspected cases. The IDPs mentioned their commitment to compliance and awareness of lockdown measures as the main adjustment. CONCLUSION Although there were no known cases of COVID-19 among the IDPs at the time of the study, tailored response plans were developed to facilitate the application of these measures in emergencies. The involvement of IDPs in the communication and sensitization process was necessary to facilitate their adherence to these different measures.
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Affiliation(s)
- Kadidiatou Kadio
- Centre national de la recherche scientifique et technologique (CNRST)/Institut de recherche en sciences de la santé (IRSS), 03 BP 7047, Ouagadougou, Burkina Faso.
- Fellow Pilote African Postdoctrorat Academy - PAPA, Université Goethe de Francfort, Francfort, Hesse, Allemagne.
| | - Antarou Ly
- Centre national de la recherche scientifique et technologique (CNRST)/Institut de recherche en sciences de la santé (IRSS), 03 BP 7047, Ouagadougou, Burkina Faso
- Département de médecine sociale et préventive, Université Laval, Québec, QC, G1V 0A6, Canada
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, G1S 4L8, Canada
| | - Adidjata Ouédraogo
- Centre national de la recherche scientifique et technologique (CNRST)/Institut de recherche en sciences de la santé (IRSS), 03 BP 7047, Ouagadougou, Burkina Faso
| | - Mohamed Ali Ag Ahmed
- Institut de médecine tropicale d'Anvers, Kronenburgstraat 43, Antwerpen, 2000, Belgique
| | - Sanni Yaya
- Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 9A7, Canada
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Traoré FB, Sidibé CS, Diallo EHM, Camara BS, Sidibé S, Diallo A, Diarra NH, Ly BA, Ag Ahmed MA, Kayentao K, Touré A, Camara A, Delamou A, Sangho H, Terera I. Prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis. Front Public Health 2024; 12:1272193. [PMID: 38327574 PMCID: PMC10847291 DOI: 10.3389/fpubh.2024.1272193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024] Open
Abstract
Objectives This study aimed to determine the prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa. Methods This systematic review and meta-analysis used the PRISMA guideline on sepsis data in sub-Saharan Africa. The bibliographic search was carried out on the following databases: Medline/PubMed, Cochrane Library, African Index Medicus, and Google Scholar. Additionally, the reference lists of the included studies were screened for potentially relevant studies. The last search was conducted on 15 October 2022. The Joanna Briggs Institute quality assessment checklist was applied for critical appraisal. Estimates of the prevalence of maternal and neonatal sepsis were pooled using a random-effects meta-analysis model. Heterogeneity between studies was estimated using the Q statistic and the I2 statistic. The funnel plot and Egger's regression test were used to assess the publication bias. Results A total of 39 studies were included in our review: 32 studies on neonatal sepsis and 7 studies on maternal sepsis. The overall pooled prevalence of maternal and neonatal sepsis in Sub-Saharan Africa was 19.21% (95% CI, 11.46-26.97) and 36.02% (CI: 26.68-45.36), respectively. The meta-analyses revealed that Apgar score < 7 (OR: 2.4, 95% CI: 1.6-3.5), meconium in the amniotic fluid (OR: 2.9, 95% CI: 1.8-4.5), prolonged rupture of membranes >12 h (OR: 2.8, 95% CI: 1.9-4.1), male sex (OR: 1.2, 95% CI: 1.1-1.4), intrapartum fever (OR: 2.4, 95% CI: 1.5-3.7), and history of urinary tract infection in the mother (OR: 2.7, 95% CI: 1.4-5.2) are factors associated with neonatal sepsis. Rural residence (OR: 2.3, 95% CI: 1.01-10.9), parity (OR: 0.5, 95% CI: 0.3-0.7), prolonged labor (OR: 3.4, 95% CI: 1.6-6.9), and multiple digital vaginal examinations (OR: 4.4, 95% CI: 1.3-14.3) were significantly associated with maternal sepsis. Conclusion The prevalence of maternal and neonatal sepsis was high in sub-Saharan Africa. Multiple factors associated with neonatal and maternal sepsis were identified. These factors could help in the prevention and development of strategies to combat maternal and neonatal sepsis. Given the high risk of bias and high heterogeneity, further high-quality research is needed in the sub-Saharan African context, including a meta-analysis of individual data.Systematic review registration: PROSPERO (ID: CRD42022382050).
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Affiliation(s)
- Fatoumata Bintou Traoré
- National Institute of Public Health, Bamako, Mali
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Cheick Sidya Sidibé
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU Amsterdam, Amsterdam, Netherlands
| | - El Hadj Marouf Diallo
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Bienvenu Salim Camara
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Sidikiba Sidibé
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Alhassane Diallo
- Université de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Nielé Hawa Diarra
- Faculté de Médecine et d'Odontostomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Birama Apho Ly
- Faculté de Pharmacie, Université des Sciences, Techniques et Technologies de Bamako, Bamako, Mali
| | - Mohamed Ali Ag Ahmed
- Faculté de Médecine et d'Odontostomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Kassoum Kayentao
- Malaria Research and Training Center, Mali International Center for Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Abdoulaye Touré
- Center of Research and Training in Infectious Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Alioune Camara
- National Malaria Control Programme Conakry, Conakry, Guinea
| | - Alexandre Delamou
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Hamadoun Sangho
- Faculté de Médecine et d'Odontostomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
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Kadio K, Ly A, Ouédraogo A, Ahmed MAA, Yaya S, Gagnon MP. "if we don't regroup, hunger will kill us…": a qualitative study on measures of physical distancing during covid-19 among internally displaced persons in Burkina Faso. Front Sociol 2023; 8:1189235. [PMID: 38162932 PMCID: PMC10757600 DOI: 10.3389/fsoc.2023.1189235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
This study contributes to the body of knowledge on IDPs in the context of security crisis related to terrorism. Very little research has been done on covid-19 amongst IDPs in Africa and this is one of the first studies in Burkina Faso. Our diversified sample allowed us to consider the discourses of humanitarian actors working with IDPs, but also the discourses of IDPs in a context of aggravated health and security crisis. The challenges encountered by IDPs in implementing physical distancing and the coping strategies have been documented. It showed some possible solutions that decision-makers could use in order to facilitate the appropriation of this measure by IDPs. This is a contribution to the field of applied human and social science research They will help to anticipate solutions in the event of a resurgence of covid-19 cases. In the current context, where the spread of the disease seems to be under control, concerted action should now be taken in the event of the detection of a case of covid-19 in the various IDP sites.
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Affiliation(s)
- Kadidiatou Kadio
- Département Biomédical et de Santé Publique, Institut de recherche en sciences de la santé (IRSS), du Centre National de la Recherche scientifique et Technologique (CNRST), Ouagadougou, Burkina Faso
- Fellow Pilote African Postdoctrorat Academy – PAPA, Goethe University Frankfurt, Frankfurt, Hesse, Germany
| | - Antarou Ly
- Département Biomédical et de Santé Publique, Institut de recherche en sciences de la santé (IRSS), du Centre National de la Recherche scientifique et Technologique (CNRST), Ouagadougou, Burkina Faso
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
- Centre de recherche du CHU de Québec, Laval University, Quebec, QC, Canada
| | - Adidjata Ouédraogo
- Département Biomédical et de Santé Publique, Institut de recherche en sciences de la santé (IRSS), du Centre National de la Recherche scientifique et Technologique (CNRST), Ouagadougou, Burkina Faso
| | | | - Sanni Yaya
- Faculté des sciences sociales, University of Ottawa, Ottawa, ON, Canada
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Accoe K, Criel B, Ag Ahmed MA, Buitrago VT, Marchal B. Conditions for health system resilience in the response to the COVID-19 pandemic in Mauritania. BMJ Glob Health 2023; 8:e013943. [PMID: 38050409 PMCID: PMC10693853 DOI: 10.1136/bmjgh-2023-013943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023] Open
Abstract
INTRODUCTION A country's ability to manage a crisis depends on its level of resilience. Efforts are made to clarify the concept of health system resilience, but its operationalisation remains little studied. In the present research, we described the capacity of the local healthcare system in the Islamic Republic of Mauritania, in West Africa, to cope with the COVID-19 pandemic. METHODS We used a single case study with two health districts as units of analysis. A context analysis, a literature review and 33 semi-structured interviews were conducted. The data were analysed using a resilience conceptual framework. RESULTS The analysis indicates a certain capacity to manage the crisis, but significant gaps and challenges remain. The management of many uncertainties is largely dependent on the quality of the alignment of decision-makers at district level with the national level. Local management of COVID-19 in the context of Mauritania's fragile healthcare system has been skewed to awareness-raising and a surveillance system. Three other elements appear to be particularly important in building a resilient healthcare system: leadership capacity, community dynamics and the existence of a learning culture. CONCLUSION The COVID-19 pandemic has put a great deal of pressure on healthcare systems. Our study has shown the relevance of an in-depth contextual analysis to better identify the enabling environment and the capacities required to develop a certain level of resilience. The translation into practice of the skills required to build a resilient healthcare system remains to be further developed.
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Affiliation(s)
- Kirsten Accoe
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Ag Ahmed MA, Ly BA, Diarra D, Traore FB, Diarra NH, Toure M, Dembele M, Van De Put W, Gagnon MP, Doumbia S. Internally displaced persons in Mali facing the COVID 19 pandemic: A qualitative study. Sante Publique 2023; 35:343-351. [PMID: 37848380 DOI: 10.3917/spub.233.0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Introduction The COVID-19 pandemic has exacerbated an already existing security crisis leading to massive population displacements that have been taking place since 2012. Purpose of research This study aims to explore the representations of internally displaced persons (IDPs) about the existence of COVID-19 and their knowledge about its signs, symptoms, modes of transmission and prevention measures. Methods The study was qualitative and exploratory. Individual and group interviews were used to collect data from 52 IDPs in six sites in Bamako and Segou. All interviews were recorded and transcribed. Thematic content analysis and N-Vivo software were used. Results The majority of IDPs believed in the existence of COVID-19 and had good knowledge of the signs, symptoms, modes of transmission and prevention measures against the disease. However, this was not sufficient for the adoption of public health measures. Among those who believed in its existence, some thought that it was a disease of the white and rich. Finally, a group of participants believed in conspiracy theories and claimed that the government and humanitarian organizations were only trying to make money through these campaigns. Conclusion To our knowledge, this is the first study in Mali to explore IDPs’ beliefs and knowledge about COVID-19. These results could inform policies, strategies, and interventions to combat COVID-19 in IDP sites and in the general population.
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Affiliation(s)
- Mohamed Ali Ag Ahmed
- Faculté de médecine et d’odontostomalogie de Bamako – Université des sciences, des techniques et des technologies de Bamako (USTTB) – Bamako – Mali
- Département de Santé publique – Institut de médecine tropicale d’Anvers – Anvers – Belgique
- Institut universitaire SHERPA – Montréal – Canada
| | - Birama Apho Ly
- Institut universitaire SHERPA – Montréal – Canada
- Faculté de pharmacie – Université des sciences, des techniques et des technologies de Bamako – Bamako – Mali
| | - Djeneba Diarra
- Faculté de médecine et d’odontostomalogie de Bamako – Université des sciences, des techniques et des technologies de Bamako (USTTB) – Bamako – Mali
| | - Fatoumata Bintou Traore
- Faculté de médecine et d’odontostomalogie de Bamako – Université des sciences, des techniques et des technologies de Bamako (USTTB) – Bamako – Mali
| | - Niélé Hawa Diarra
- Faculté de médecine et d’odontostomalogie de Bamako – Université des sciences, des techniques et des technologies de Bamako (USTTB) – Bamako – Mali
| | - Mohamed Toure
- Faculté de médecine et d’odontostomalogie de Bamako – Université des sciences, des techniques et des technologies de Bamako (USTTB) – Bamako – Mali
| | - Mahamadou Dembele
- Faculté de médecine et d’odontostomalogie de Bamako – Université des sciences, des techniques et des technologies de Bamako (USTTB) – Bamako – Mali
| | - Willem Van De Put
- Département de Santé publique – Institut de médecine tropicale d’Anvers – Anvers – Belgique
| | - Marie-Pierre Gagnon
- Centre d’analyse et de recherche de l’espace sahélo-saharien Modibo Goita – École de Maintien de la Paix Alioune Blondin Beye – Bamako – Mali
| | - Seydou Doumbia
- Faculté de médecine et d’odontostomalogie de Bamako – Université des sciences, des techniques et des technologies de Bamako (USTTB) – Bamako – Mali
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Ag Ahmed MA, Ly BA, Diarra NH, Traore FB, Diarra D, Kande IF, Dembele M, Doumbia S, Alami H. Challenges to the implementation and adoption of physical distancing measures against COVID-19 by internally displaced people in Mali: a qualitative study. Confl Health 2021; 15:88. [PMID: 34863236 PMCID: PMC8642860 DOI: 10.1186/s13031-021-00425-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background For almost a decade now, Mali has been facing a security crisis that led to the displacement of thousands of people within the country. Since March 2020, a health crisis linked to the COVID-19 pandemic also surfaced. To overcome this health crisis, the government implemented some physical distancing measures but their adoption proved difficult, particularly among internally displaced people (IDPs). The objective of this study is to identify the challenges relating to the implementation and adoption of physical distancing measures and to determine the main mitigation measures taken by IDPs to adjust to these new policies.
Methods An exploratory qualitative research was conducted in Bamako and Ségou, two of the ten regions of Mali. The study counted 68 participants including 50 IDPs, seven administrative and health authorities, and 11 humanitarian actors. Sampling was guided by the principle of saturation and diversification, and data was collected through semi-structured individual interviews (n = 36) and focus groups (n = eight). Analysis was based on thematic content analysis through NVivo software.
Results The main challenges identified concerning the implementation and adoption of physical distancing measures include the proximity in which IDPs live, their beliefs and values, the lack of toilets and safe water on sites, IDPs habits and economic situation, humanitarian actors’ lack of financial resources and authority, and social pressure from religious leaders. Implemented mitigation measures include the building of new shelters or their compartmentalization, the creation of income-generating activities and food banks, psychosocial support, promoting awareness of IDPs, and nightly police patrols and surveillance to discourage IDPs from going out. Finally, a call for action is suggested for the actors involved in IDPs support and management. Conclusions The study demonstrates the difficulty for IDPs to follow most of the physical distancing measures and informs about the risk of disease spreading among IDPs with its potential consequences. It also shows the inability of mitigation measures to control the outbreak and suggests actions to be considered.
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Affiliation(s)
- Mohamed Ali Ag Ahmed
- Institute of Tropical Medicine, Antwerp, Belgium. .,Faculty of Medicine and Odontostomalogy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
| | - Birama Apho Ly
- Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Niélé Hawa Diarra
- Faculty of Medicine and Odontostomalogy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Djeneba Diarra
- Faculty of Medicine and Odontostomalogy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Mahamadou Dembele
- Faculty of Medicine and Odontostomalogy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Seydou Doumbia
- Faculty of Medicine and Odontostomalogy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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Alami H, Lehoux P, Attieh R, Fortin JP, Fleet R, Niang M, Offredo K, Rouquet R, Ag Ahmed MA, Ly BA. A “Not So Quiet” Revolution: Systemic Benefits and Challenges of Telehealth in the Context of COVID-19 in Quebec (Canada). Front Digit Health 2021. [DOI: 10.3389/fdgth.2021.721898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The COVID-19 pandemic has had a major impact on health and social service systems (HSSS) worldwide. It has put tremendous pressure on these systems, threatening access, continuity, and the quality of patient care and services. In Quebec (Canada), the delivery of care and services has radically changed in a short period of time. During the pandemic, telehealth has been widely deployed and used, notwithstanding the decades-long challenges of integrating this service modality into the Quebec HSSS. Adopting a narrative-integrative approach, this article describes and discusses Quebec's experience with the deployment and utilization of telehealth in the context of COVID-19. Firstly, we introduced the achievements and benefits made with the use of telehealth. Secondly, we discussed the challenges and concerns that were revealed or accentuated by the sanitary crisis, such as: (1) training and information; (2) professional and organizational issues; (3) quality of services and patient satisfaction; (4) cost, remuneration, and funding; (5) technology and infrastructure; (6) the emergence of private telehealth platforms in a public HSSS; (7) digital divide and equity; and (8) legal and regulatory issues. Finally, the article presents recommendations to guide future research, policies and actions for a successful integration of telehealth in the Quebec HSSS as well as in jurisdictions and countries facing comparable challenges.
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Ngangue P, Brown JB, Forgues C, Ag Ahmed MA, Nguyen TN, Sasseville M, Loignon C, Gallagher F, Stewart M, Fortin M. Evaluating the implementation of interdisciplinary patient-centred care intervention for people with multimorbidity in primary care: a qualitative study. BMJ Open 2021; 11:e046914. [PMID: 34561255 PMCID: PMC8475135 DOI: 10.1136/bmjopen-2020-046914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE A patient-centred care interdisciplinary pragmatic intervention to support self-management for patients with multimorbidity was implemented in one region of Quebec, Canada. This embedded study aimed to evaluate the process of implementation. DESIGN A descriptive qualitative study was conducted in 2016-2017 using semistructured individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data coding, analysis and reporting of the findings. SETTING The study took place in seven Family Medicine Groups in one region (Saguenay-Lac-Saint-Jean) of Quebec, Canada. PARTICIPANTS Ten managers (including two family physicians) and 19 healthcare professionals (HCPs), nurses, kinesiologists, nutritionists and a respiratory therapist, were interviewed. RESULTS Many key elements within the five CFIR domains were identified as impacting the implementation of the intervention : (1) intervention characteristics-evidence strength and quality, design quality and packaging, relative advantage and complexity; (2) outer setting-patients' needs and resources, external policies and incentives; (3) inner setting-structural characteristics, networks and communication, culture, compatibility, readiness for implementation and leadership engagement; (4) characteristics of the managers and HCPs-knowledge and belief about the intervention; (5) process-planning, opinion leaders, formally appointed internal implementation leaders, reflecting and evaluating. CONCLUSION This study revealed the organisational and contextual aspects of the implementation based on different and complementary perspectives. With the growing demand for interdisciplinary teams in primary care, we believe that our insights will be helpful for practices, researchers, and policymakers interested in the implementation of disease prevention and management programmes for people with multiple chronic conditions in primary care. TRIAL REGISTRATION NUMBER NCT02789800.
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Affiliation(s)
- Patrice Ngangue
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Catherine Forgues
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mohamed Ali Ag Ahmed
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Tu Ngoc Nguyen
- Westmead Apllied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maxime Sasseville
- Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Christine Loignon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Frances Gallagher
- School of Nursing, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Moira Stewart
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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10
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Alami H, Lehoux P, Fleet R, Fortin JP, Liu J, Attieh R, Cadeddu SBM, Abdoulaye Samri M, Savoldelli M, Ag Ahmed MA. How Can Health Systems Better Prepare for the Next Pandemic? Lessons Learned From the Management of COVID-19 in Quebec (Canada). Front Public Health 2021; 9:671833. [PMID: 34222176 PMCID: PMC8249772 DOI: 10.3389/fpubh.2021.671833] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
The magnitude of the COVID-19 pandemic challenged societies around our globalized world. To contain the spread of the virus, unprecedented and drastic measures and policies were put in place by governments to manage an exceptional health care situation while maintaining other essential services. The responses of many governments showed a lack of preparedness to face this systemic and global health crisis. Drawing on field observations and available data on the first wave of the pandemic (mid-March to mid-May 2020) in Quebec (Canada), this article reviewed and discussed the successes and failures that characterized the management of COVID-19 in this province. Using the framework of Palagyi et al. on system preparedness toward emerging infectious diseases, we described and analyzed in a chronologically and narratively way: (1) how surveillance was structured; (2) how workforce issues were managed; (3) what infrastructures and medical supplies were made available; (4) what communication mechanisms were put in place; (5) what form of governance emerged; and (6) whether trust was established and maintained throughout the crisis. Our findings and observations stress that resilience and ability to adequately respond to a systemic and global crisis depend upon preexisting system-level characteristics and capacities at both the provincial and federal governance levels. By providing recommendations for policy and practice from a learning health system perspective, this paper contributes to the groundwork required for interdisciplinary research and genuine policy discussions to help health systems better prepare for future pandemics.
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Affiliation(s)
- Hassane Alami
- Center for Public Health Research of the University of Montreal, Montreal, QC, Canada
- Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, QC, Canada
| | - Pascale Lehoux
- Center for Public Health Research of the University of Montreal, Montreal, QC, Canada
- Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, QC, Canada
| | - Richard Fleet
- VITAM Research Centre on Sustainable Health, Laval University, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
- Research Chair in Emergency Medicine Université Laval-CHAU Hôtel-Dieu de Lévis, Lévis, QC, Canada
| | - Jean-Paul Fortin
- VITAM Research Centre on Sustainable Health, Laval University, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Joanne Liu
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Randa Attieh
- Research Centre of the University of Montreal Hospital Centre, University of Montreal, Montreal, QC, Canada
| | - Stéphanie Bernadette Mafalda Cadeddu
- Research Centre of the University of Montreal Hospital Centre, University of Montreal, Montreal, QC, Canada
- Faculty of Law, University of Montreal, Montreal, QC, Canada
| | | | | | - Mohamed Ali Ag Ahmed
- Research Chair on Chronic Diseases in Primary Care, Sherbrooke University, Chicoutimi, QC, Canada
- The Institute of Tropical Medicine, Antwerp, Belgium
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11
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Millimouno TM, Ahmed MAA, Ly BA, Delamou A, Sana B, Faye CL, Van Damme W. Evolution of the COVID-19 pandemic over six weeks in four French-speaking countries in West Africa. J Glob Health 2021; 11:03008. [PMID: 33643618 PMCID: PMC7897449 DOI: 10.7189/jogh.11.03008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Tamba Mina Millimouno
- National Training and Research Center in Rural Health of Maferinyah, Forecariah, Guinea
| | - Mohamed Ali Ag Ahmed
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Birama Apho Ly
- Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Alexandre Delamou
- National Training and Research Center in Rural Health of Maferinyah, Forecariah, Guinea
- Africa Center of Excellence for the Prevention and Control of Transmissible Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Boukary Sana
- Management Sciences for Health, Ouagadougou, Burkina Faso
| | - Christophe Laba Faye
- Department of Migration Health, International Organization for Migration, Dakar, Senegal
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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12
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Ahmed MAA, Almirall J, Ngangue P, Poitras ME, Fortin M. A bibliometric analysis of multimorbidity from 2005 to 2019. J Comorb 2020; 10:2235042X20965283. [PMID: 33110764 PMCID: PMC7557650 DOI: 10.1177/2235042x20965283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/15/2022]
Abstract
Context: Multimorbidity is frequently seen in primary care. We aimed to identify and analyze publications on multimorbidity, including those that most influenced this field. Method: A bibliometric analysis of publications from 2005 to 2019 in the PubMed database containing “multimorbidity” or “multi-morbidity” identified with the tool iCite. We analyzed the number of publications, total citations, the article-level metric Relative Citation Ratio (RCR), type of study, and journals with the most cited articles. Results: The number of publications using “multimorbidity” has continuously increased since 2005 (2005–2009: 138; 2010–2014: 823; 2015–2019: 3068). The median number of total citations per article was 3. The median RCR was 1.04. Articles with RCR at or above the 97th percentile (RCR = 7.43) were analyzed in detail (n = 104). In 34 publications of this subgroup (33%), the word multimorbidity was used but was not the subject of study. The remaining top 70 publications included 32 observational studies, 22 reviews, five guideline statements, three analysis papers, two randomized trials, three qualitative studies, two measurement development reports, and one conceptual framework development report. The publications were produced by authors from 32 countries. They were published in 37 different journals, ranging from one to four articles in the same journal. Conclusions: We found a continuous increase in the number of publications about multimorbidity since 2005. However, our study suggests that the numbers should be considered only a general trend because multimorbidity was not the main subject in 33% of publications in a subgroup of 104 analyzed in detail.
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Affiliation(s)
- Mohamed Ali Ag Ahmed
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - José Almirall
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - Patrice Ngangue
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
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13
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Alami H, Fortin JP, Gagnon MP, Lamothe L, Ghandour EK, Ag Ahmed MA, Roy D. [Strategic framework to Support the evaluation of complex and innovative digital health projects]. Sante Publique 2020; 32:221-228. [PMID: 32985838 DOI: 10.3917/spub.202.0221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Digital technologies play a central role in strategies to improve access, quality and efficiency of health care and services. However, many digital health projects have failed to become sustainable and spread across health organizations and systems. This situation is partly due to the fact that these projects are often developed and evaluated by reducing the issues linked mainly to the technological dimension. Such tradition has paid little attention to the fact that technology is introduced into pluralistic and complex sociotechnical systems such as health organizations and systems. The aim of this article is to propose practical and theorical, non-prescriptive, elements of reflection that can serve as a basis for evaluating complex and innovative digital health projects. This reflection builds on the lessons learned from the application of a strategic framework for evaluating three major complex and innovative digital health projects in Quebec over the last 15 years.
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14
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Ag Ahmed MA, Ly BA, Millimouno TM, Alami H, Faye CL, Boukary S, Accoe K, Van Damme W, Put WVD, Criel B, Doumbia S. Willingness to comply with physical distancing measures against COVID-19 in four African countries. BMJ Glob Health 2020; 5:e003632. [PMID: 32972967 PMCID: PMC7517213 DOI: 10.1136/bmjgh-2020-003632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Mohamed Ali Ag Ahmed
- University of Sherbrooke, Sherbrooke, Quebec, Canada
- Faculty of Medicine, Pharmacy and Odonto-Stomatology of bamako, USTTB Mali, Bamako, Mali
| | - Birama Apho Ly
- Faculty of Pharmacy, Université des Sciences des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Tamba Mina Millimouno
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Maferinyah, Guinea
| | | | - Christophe L Faye
- Migration Health Department, International Organization for Migration, Dakar, Senegal
| | - Sana Boukary
- Management Sciences for Health, Ouagadougou, Burkina Faso
| | - Kirsten Accoe
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Willem Van De Put
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bart Criel
- Unit of Equity and Health - Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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15
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Alami H, Rivard L, de Oliveira RR, Lehoux P, Cadeddu SBM, Savoldelli M, Ag Ahmed MA, Fortin JP. Guiding Pay-As-You-Live Health Insurance Models Toward Responsible Innovation in Health. J Particip Med 2020; 12:e19586. [PMID: 33064095 PMCID: PMC7543981 DOI: 10.2196/19586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 11/13/2022] Open
Abstract
While the transition toward digitalized health care and service delivery challenges many publicly and privately funded health systems, patients are already producing a phenomenal amount of data on their health and lifestyle through their personal use of mobile technologies. To extract value from such user-generated data, a new insurance model is emerging called Pay-As-You-Live (PAYL). This model differs from other insurance models by offering to support clients in the management of their health in a more interactive yet directive manner. Despite significant promises for clients, there are critical issues that remain unaddressed, especially as PAYL models can significantly disrupt current collective insurance models and question the social contract in so-called universal and public health systems. In this paper, we discuss the following issues of concern: the quantification of health-related behavior, the burden of proof of compliance, client data privacy, and the potential threat to health insurance models based on risk mutualization. We explore how more responsible health insurance models in the digital health era could be developed, particularly by drawing from the Responsible Innovation in Health framework.
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Affiliation(s)
- Hassane Alami
- Center for Public Health Research, Université de Montréal, Montreal, QC, Canada.,Department of Health Management, Evaluation, and Policy, Université de Montréal, Montreal, QC, Canada
| | - Lysanne Rivard
- Center for Public Health Research, Université de Montréal, Montreal, QC, Canada
| | - Robson Rocha de Oliveira
- Center for Public Health Research, Université de Montréal, Montreal, QC, Canada.,Department of Health Management, Evaluation, and Policy, Université de Montréal, Montreal, QC, Canada
| | - Pascale Lehoux
- Center for Public Health Research, Université de Montréal, Montreal, QC, Canada.,Department of Health Management, Evaluation, and Policy, Université de Montréal, Montreal, QC, Canada
| | | | | | - Mohamed Ali Ag Ahmed
- Research Chair on Chronic Diseases in Primary Care, Université de Sherbrooke, Chicoutimi, QC, Canada
| | - Jean-Paul Fortin
- Research Center on Healthcare and Services in Primary Care, Université Laval, Quebec, QC, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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16
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Ag Ahmed MA, Diakité SL, Sissoko K, Gagnon MP, Charron S. Factors explaining the shortage and poor retention of qualified health workers in rural and remote areas of the Kayes, region of Mali: a qualitative study. Rural Remote Health 2020; 20:5772. [PMID: 32731738 DOI: 10.22605/rrh5772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Shortage of health workers is a worldwide problem but is particularly critical in sub-Saharan Africa. In Mali, the number of health workers is insufficient and their retention is low, particularly in rural and remote areas. Rural postings are unattractive to health workers. Very few studies have examined the factors contributing to the shortage and poor retention of health workers in Mali. The objective of this study is to identify and understand these factors with regards to skilled health workers in two rural health districts (Yélimané and Bafoulabé) in the region of Kayes, Mali. METHODS This qualitative study is based on the conceptual framework of Lehman, Dieleman and Martineau. Data were collected through 46 in-depth interviews with health workers and decision-makers. A thematic content analysis was conducted with the support of QDA Miner software. RESULTS The study identified factors contributing to the insufficient allocation and poor retention of rural health workers in these districts. They are individual-level factors (gender, family situation, age), unattractive living and working conditions, community recognition and participation, quality of leadership, an unfavourable recruitment/assignment process and insufficient financial incentives. It shows that female staff have specific constraints that prevent them from deploying to or staying in rural areas for long periods. In addition, the number of staff recruited at the national level is unpredictable and insufficient, while their recruitment and assignment process is perceived to be inequitable and not very transparent, disadvantaging rural health structures. Some strategies were identified to improve the availability and retention of health workers in these areas. They take into account certain social norms, notably gender roles, and include the improvement of living and working conditions, as well as the strengthening of health workforce management. CONCLUSION This study's findings highlight the multifaceted nature of factors contributing to the availability and retention of health workers in rural and remote areas of sub-Saharan Africa and the challenges associated with them. This study identifies some strategies that can be combined to facilitate the retention and availability of health workers in these areas. Some strategies involve actors outside the health sector, requiring joint efforts for their implementation. This research provides decision-makers with evidence to support informed decision making with regards to the retention of health workers in rural areas.
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Affiliation(s)
- Mohamed Ali Ag Ahmed
- Sherbrooke University, 4-309 Rue Jacques cartier Est, Chicoutimi, Québec, Canada
| | | | - Koman Sissoko
- Project "Evacuation of mothers in five districts of Kayes" MEDIK, Mali
| | - Marie- Pierre Gagnon
- Faculty of Nursing Sciences, Laval University, 1050 Avenue de la Médecine, Québec, Canada
| | - Sylvie Charron
- International Health Unit, School of Public Health, Montreal University, Canada
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17
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Alami H, Lehoux P, Auclair Y, de Guise M, Gagnon MP, Shaw J, Roy D, Fleet R, Ag Ahmed MA, Fortin JP. Artificial Intelligence and Health Technology Assessment: Anticipating a New Level of Complexity. J Med Internet Res 2020; 22:e17707. [PMID: 32406850 PMCID: PMC7380986 DOI: 10.2196/17707] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/25/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Artificial intelligence (AI) is seen as a strategic lever to improve access, quality, and efficiency of care and services and to build learning and value-based health systems. Many studies have examined the technical performance of AI within an experimental context. These studies provide limited insights into the issues that its use in a real-world context of care and services raises. To help decision makers address these issues in a systemic and holistic manner, this viewpoint paper relies on the health technology assessment core model to contrast the expectations of the health sector toward the use of AI with the risks that should be mitigated for its responsible deployment. The analysis adopts the perspective of payers (ie, health system organizations and agencies) because of their central role in regulating, financing, and reimbursing novel technologies. This paper suggests that AI-based systems should be seen as a health system transformation lever, rather than a discrete set of technological devices. Their use could bring significant changes and impacts at several levels: technological, clinical, human and cognitive (patient and clinician), professional and organizational, economic, legal, and ethical. The assessment of AI's value proposition should thus go beyond technical performance and cost logic by performing a holistic analysis of its value in a real-world context of care and services. To guide AI development, generate knowledge, and draw lessons that can be translated into action, the right political, regulatory, organizational, clinical, and technological conditions for innovation should be created as a first step.
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Affiliation(s)
- Hassane Alami
- Public Health Research Center, Université de Montréal, Montreal, QC, Canada
- Department of Health Management, Evaluation and Policy, École de santé publique de l'Université de Montréal, Montreal, QC, Canada
- Institut national d'excellence en santé et services sociaux, Montréal, QC, Canada
| | - Pascale Lehoux
- Public Health Research Center, Université de Montréal, Montreal, QC, Canada
- Department of Health Management, Evaluation and Policy, École de santé publique de l'Université de Montréal, Montreal, QC, Canada
| | - Yannick Auclair
- Institut national d'excellence en santé et services sociaux, Montréal, QC, Canada
| | - Michèle de Guise
- Institut national d'excellence en santé et services sociaux, Montréal, QC, Canada
| | - Marie-Pierre Gagnon
- Research Center on Healthcare and Services in Primary Care, Université Laval, Quebec, QC, Canada
- Faculty of Nursing Science, Université Laval, Quebec, QC, Canada
| | - James Shaw
- Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Denis Roy
- Institut national d'excellence en santé et services sociaux, Montréal, QC, Canada
| | - Richard Fleet
- Research Center on Healthcare and Services in Primary Care, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
- Research Chair in Emergency Medicine, Université Laval - CHAU Hôtel-Dieu de Lévis, Lévis, QC, Canada
| | - Mohamed Ali Ag Ahmed
- Research Chair on Chronic Diseases in Primary Care, Université de Sherbrooke, Chicoutimi, QC, Canada
| | - Jean-Paul Fortin
- Research Center on Healthcare and Services in Primary Care, Université Laval, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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18
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Van Damme W, Dahake R, Delamou A, Ingelbeen B, Wouters E, Vanham G, van de Pas R, Dossou JP, Ir P, Abimbola S, Van der Borght S, Narayanan D, Bloom G, Van Engelgem I, Ag Ahmed MA, Kiendrébéogo JA, Verdonck K, De Brouwere V, Bello K, Kloos H, Aaby P, Kalk A, Al-Awlaqi S, Prashanth NS, Muyembe-Tamfum JJ, Mbala P, Ahuka-Mundeke S, Assefa Y. The COVID-19 pandemic: diverse contexts; different epidemics-how and why? BMJ Glob Health 2020; 5:e003098. [PMID: 32718950 PMCID: PMC7392634 DOI: 10.1136/bmjgh-2020-003098] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
It is very exceptional that a new disease becomes a true pandemic. Since its emergence in Wuhan, China, in late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, has spread to nearly all countries of the world in only a few months. However, in different countries, the COVID-19 epidemic takes variable shapes and forms in how it affects communities. Until now, the insights gained on COVID-19 have been largely dominated by the COVID-19 epidemics and the lockdowns in China, Europe and the USA. But this variety of global trajectories is little described, analysed or understood. In only a few months, an enormous amount of scientific evidence on SARS-CoV-2 and COVID-19 has been uncovered (knowns). But important knowledge gaps remain (unknowns). Learning from the variety of ways the COVID-19 epidemic is unfolding across the globe can potentially contribute to solving the COVID-19 puzzle. This paper tries to make sense of this variability-by exploring the important role that context plays in these different COVID-19 epidemics; by comparing COVID-19 epidemics with other respiratory diseases, including other coronaviruses that circulate continuously; and by highlighting the critical unknowns and uncertainties that remain. These unknowns and uncertainties require a deeper understanding of the variable trajectories of COVID-19. Unravelling them will be important for discerning potential future scenarios, such as the first wave in virgin territories still untouched by COVID-19 and for future waves elsewhere.
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Affiliation(s)
- Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Alexandre Delamou
- Africa Centre of Excellence for Prevention and Control of Transmissible Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Brecht Ingelbeen
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Edwin Wouters
- Department of Sociology and Centre for Population, University of Antwerp, Antwerpen, Belgium
- Centre for Health Systems Research and Development, University of the Free State-Bloemfontein Campus, Bloemfontein, Free State, South Africa
| | - Guido Vanham
- Biomedical Department, Institute of Tropical Medicine, Antwerpen, Belgium
- Biomedical Department, University of Antwerp, Antwerpen, Belgium
| | - Remco van de Pas
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Jean-Paul Dossou
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Public Health, Centre de recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Por Ir
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | | | | | - Gerald Bloom
- Health and Nutrition Cluster, Institute of Development Studies, Brighton, UK
| | - Ian Van Engelgem
- European Commission Directorate General for Civil Protection and Humanitarian Aid Operations, Kinshasa, Democratic Republic of Congo
| | | | - Joël Arthur Kiendrébéogo
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Public Health, University of Ouagadougou Health Sciences Training and Research Unit, Ouagadougou, Burkina Faso
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Vincent De Brouwere
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Kéfilath Bello
- Public Health, Centre de recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Peter Aaby
- INDEPTH Network, Bandim Health Project, Bissau, Guinea-Bissau
| | - Andreas Kalk
- Bureau GIZ à Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Sameh Al-Awlaqi
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - N S Prashanth
- Health Equity Cluster, Institute of Public Health, Bengaluru, India
| | | | - Placide Mbala
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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19
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Alami H, Rivard L, Lehoux P, Hoffman SJ, Cadeddu SBM, Savoldelli M, Samri MA, Ag Ahmed MA, Fleet R, Fortin JP. Artificial intelligence in health care: laying the Foundation for Responsible, sustainable, and inclusive innovation in low- and middle-income countries. Global Health 2020; 16:52. [PMID: 32580741 PMCID: PMC7315549 DOI: 10.1186/s12992-020-00584-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
The World Health Organization and other institutions are considering Artificial Intelligence (AI) as a technology that can potentially address some health system gaps, especially the reduction of global health inequalities in low- and middle-income countries (LMICs). However, because most AI-based health applications are developed and implemented in high-income countries, their use in LMICs contexts is recent and there is a lack of robust local evaluations to guide decision-making in low-resource settings. After discussing the potential benefits as well as the risks and challenges raised by AI-based health care, we propose five building blocks to guide the development and implementation of more responsible, sustainable, and inclusive AI health care technologies in LMICs.
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Affiliation(s)
- Hassane Alami
- Center for Public Health Research, Université de Montréal, Montreal, Quebec Canada
- Department of Health Management, Evaluation and Policy, Université de Montréal, Montreal, Quebec Canada
| | - Lysanne Rivard
- Center for Public Health Research, Université de Montréal, Montreal, Quebec Canada
- Department of Health Management, Evaluation and Policy, Université de Montréal, Montreal, Quebec Canada
| | - Pascale Lehoux
- Center for Public Health Research, Université de Montréal, Montreal, Quebec Canada
- Department of Health Management, Evaluation and Policy, Université de Montréal, Montreal, Quebec Canada
| | - Steven J. Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Ontario Canada
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts USA
| | - Stéphanie Bernadette Mafalda Cadeddu
- Research Centre of the University of Montreal Hospital Centre, Université de Montréal, Montreal, Quebec Canada
- Faculty of Law, Université de Montréal, Montreal, Quebec Canada
| | | | - Mamane Abdoulaye Samri
- Research Center on Healthcare and Services in Primary Care, Université Laval, Quebec, Quebec Canada
| | - Mohamed Ali Ag Ahmed
- Research Chair on Chronic Diseases in Primary Care, Université de Sherbrooke, Chicoutimi, Quebec Canada
| | - Richard Fleet
- Research Center on Healthcare and Services in Primary Care, Université Laval, Quebec, Quebec Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec Canada
- Research Chair in Emergency Medicine Université Laval-CHAU Hôtel-Dieu de Lévis, Lévis, Quebec Canada
| | - Jean-Paul Fortin
- Research Center on Healthcare and Services in Primary Care, Université Laval, Quebec, Quebec Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec Canada
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Alami H, Lehoux P, Gagnon MP, Fortin JP, Fleet R, Ag Ahmed MA. Rethinking the electronic health record through the quadruple aim: time to align its value with the health system. BMC Med Inform Decis Mak 2020; 20:32. [PMID: 32066432 PMCID: PMC7027292 DOI: 10.1186/s12911-020-1048-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 02/11/2020] [Indexed: 11/10/2022] Open
Abstract
Electronic health records (EHRs) are considered as a powerful lever for enabling value-based health systems. However, many challenges to their use persist and some of their unintended negative impacts are increasingly well documented, including the deterioration of work conditions and quality, and increased dissatisfaction of health care providers. The “quadruple aim” consists of improving population health as well as patient and provider experience while reducing costs. Based on this approach, improving the quality of work and well-being of health care providers could help rethinking the implementation of EHRs and also other information technology-based tools and systems, while creating more value for patients, organizations and health systems.
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Affiliation(s)
- Hassane Alami
- Center for Public Health Research (CreSP), Université de Montréal, P.O. Box 6128, Branch Centre-Ville, Montreal, Quebec, H3C 3J7, Canada. .,Institute for Excellence in Health and Social Services (INESSS), Montreal, QC, Canada. .,Department of Health Management, Evaluation and Policy, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada.
| | - Pascale Lehoux
- Center for Public Health Research (CreSP), Université de Montréal, P.O. Box 6128, Branch Centre-Ville, Montreal, Quebec, H3C 3J7, Canada.,Department of Health Management, Evaluation and Policy, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Pierre Gagnon
- Research Center on Healthcare and Services in Primary Care, Institute of Health and Social Services in Primary Care, Université Laval, Quebec City, Quebec, Canada.,Faculty of Nursing Science, Université Laval, Quebec City, Canada
| | - Jean-Paul Fortin
- Research Center on Healthcare and Services in Primary Care, Institute of Health and Social Services in Primary Care, Université Laval, Quebec City, Quebec, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Richard Fleet
- Research Center on Healthcare and Services in Primary Care, Institute of Health and Social Services in Primary Care, Université Laval, Quebec City, Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.,Research Chair in Emergency Medicine Université Laval-CHAU Hôtel-Dieu de Lévis, Lévis, Quebec, Canada
| | - Mohamed Ali Ag Ahmed
- Research Chair on Chronic Diseases in Primary Care, Université de Sherbrooke, Chicoutimi, QC, Canada
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Alami H, Gagnon MP, Ag Ahmed MA, Fortin JP. Digital health: Cybersecurity is a value creation lever, not only a source of expenditure. Health Policy and Technology 2019. [DOI: 10.1016/j.hlpt.2019.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ag Ahmed MA, Hamelin-Brabant L, Gagnon MP. Nomads' perceptions of quality, accessibility, and affordability of health services as determinants of using skilled birth attendants in Gossi, Mali. Midwifery 2019; 79:102556. [PMID: 31634758 DOI: 10.1016/j.midw.2019.102556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 11/20/2022]
Abstract
AIM More than half of all maternal deaths worldwide occur in sub-Saharan Africa (SSA). For nomadic pastoralists (30 to 60 million) in SSA, the risk of maternal death is very high because of the low proportion of assisted deliveries in the areas where they live. The objective of this research was to understand the determinants of using skilled birth attendants in relation to the perceptions of quality, geographic accessibility, and financial affordability of health services by nomadic women. METHODS We used a qualitative research design, inspired by ethnography. Research was conducted in the commune of Gossi (Mali), where 90% of the population is nomadic. The study population consisted of 26 nomadic women living in their camps. Saturation and diversification guided sampling. Semi-structured individual interviews and non-participant observation enabled concomitant data collection. Thematic content analysis was performed using QDA Miner software. RESULTS Our results show that only 10 women used assisted childbirth for their last delivery. These women thought that health workers were competent and well trained, and they liked the fact that these workers were recruited locally. Similarly, these 10 women deemed the health workers' attitude acceptable and appreciated their availability. In contrast, the majority of participants (16 women) were prevented or discouraged from using skill birth attendants. Some of them did not use them because they were afraid of being undressed, of giving birth on a table, and especially of male staff. They also said that they did not have access to information about health services. In addition, respondents considered health services very difficult to access due to distances, unavailable means of transportation, and costs perceived as being expensive. CONCLUSION Our results identify several determinants of the use or non-use of skilled birth attendants by nomadic women in relation to the context and way of life. In addition, our findings call for future research to better understand these determinants and to deepen, refine, and test emerging strategies that seem potentially hopeful with respect to facilitating the use of skilled birth attendance in SSA.
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Affiliation(s)
- Mohamed Ali Ag Ahmed
- Université Laval, 1050 Avenue de la Médecine, room 3696, Québec, Québec G1V 0A6, Canada.
| | - Louise Hamelin-Brabant
- Faculty of Nursing Sciences, Université Laval, 1050 Avenue de la Médecine, room 3447, Québec, Québec G1V 0A6, Canada.
| | - Marie-Pierre Gagnon
- Faculty of Nursing Sciences, Université Laval, 1050 Avenue de la Médecine, room 1426, Québec, Québec G1V 0A6, Canada.
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Ag Ahmed MA, Gagnon MP, Hamelin-Brabant L, Mbemba GIC, Alami H. A mixed methods systematic review of success factors of mhealth and telehealth for maternal health in Sub-Saharan Africa. Mhealth 2017; 3:22. [PMID: 28736731 PMCID: PMC5505928 DOI: 10.21037/mhealth.2017.05.04] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/23/2017] [Indexed: 11/06/2022] Open
Abstract
Access to health care is still limited for many women in sub-Saharan Africa (SSA), while it remains an important determinant of maternal mortality and morbidity. Information and communication technologies (ICTs), such as mhealth and telehealth, can help to facilitate this access by acting on the various obstacles encountered by women, be they socio-cultural, economic, geographical or organizational. However, various factors contribute to the success of mhealth and telehealth implementation and use, and must be considered for these technologies to go beyond the pilot project stage. The objective of this systematic literature review is to synthesize the empirical knowledge on the success factors of the implementation and use of telehealth and mhealth to facilitate access to maternal care in SSA. The methodology used is based on that of the Cochrane Collaboration, including a documentary search using standardized language in six databases, selection of studies corresponding to the inclusion criteria, data extraction, evaluation of study quality, and synthesis of the results. A total of 93 articles were identified, which allowed the inclusion of seven studies, six of which were on mhealth. Based on the framework proposed by Broens et al., we synthesized success factors into five categories: (I) technology, such as technical support to maintain, troubleshoot and train users, good network coverage, existence of a source of energy and user friendliness; (II) user acceptance, which is facilitated by factors such as unrestricted use of the device, perceived usefulness to the worker, adequate literacy, or previous experience of use ; (III) short- and long-term funding; (IV) organizational factors, such as the existence of a well-organized health system and effective coordination of interventions; and (V) political or legislative aspects, in this case strong government support to deploy technology on a large scale. Telehealth and mhealth are promising solutions to reduce maternal morbidity and mortality in SSA, but knowledge on how these interventions can succeed and move to scale is limited. Success factors identified in this review can provide guidance on elements that should be considered in the design and implementation of telehealth and mhealth for maternal health in SSA.
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Affiliation(s)
| | - Marie-Pierre Gagnon
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Faculty of Nursing, Université Laval, Québec, Canada
| | | | | | - Hassane Alami
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
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Abstract
Au Mali, les nomades (des Maures, Touaregs et Peulhs) représentent environ 1,25 million de personnes. Les services de santé leur sont peu accessibles en raison de leur mobilité, liée à leur activité d'élevage. La question que se posent plusieurs intervenants en santé publique des pays où vivent ces nomades est de savoir comment améliorer leur santé. Dans ce commentaire, après un bref exposé des problèmes liés à l'accès aux services de santé, nous proposons une approche innovante et holistique de la santé, qui soutient que des agents de santé communautaires (ASC) pourraient contribuer à améliorer la santé des nomades en offrant conjointement des services de santé aux nomades et à leurs animaux (le concept « One Health » [d'Une Seule Santé]). Des pistes de réflexion sont dégagées, quant aux principaux défis pour leur efficacité et durabilité, qui sont la conception et gestion du programme, leur soutien par les communautés et leur intégration aux services de santé publique et vétérinaire.
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