The project will focus on the causes and risk factors of Pneumonia to reduce the morbidity and mortality of girls and boys under five years old.
The main actions of the project will be:
Management of Pneumonia: At the community level, in support of the health district, the goal is to integrate the treatment of community-acquired pneumonia by CHWs (community health workers) and to strengthen its management at rural health centers and the reference hospital. An increased awareness and education on vaccination, exclusive breastfeeding, good child nutrition practices, hand-washing and reduction of pollution of interior air will accompany this process put in place by CHW and the health staff supported by CRCI (Red Cross Cote d’Ivoire).
In short, this will aim to :
protect children from pneumonia through vaccination, exclusive breastfeeding, child nutrition, hand-washing and reduction of indoor air pollution in homes;
treat pneumonia by ensuring that each sick child has access to adequate care – provided by a CHW or in severe cases, in a health facility – and that he/she should take antibiotics and should put on oxygen if his/her condition requires it.
Hygiene, sanitation and access to drinking water.
According to the initial needs assessment (October 2016), Pneumonia among girls and boys under 5 years of age is a real public health problem in the health district of Dimbokro (424.34 ‰ against 202.35 ‰ on the National plan, RASS 2015). This needs assessment highlighted the explanatory reasons for this impact:
– The poor knowledge of the real causes of the disease by the communities
At the level of this health district, the pneumonia is not unknown by the communities and it bears the name of “djêkin” in local language. However, they may attribute its causes to the consumption of a fish, called “djêkin” in the local language, by a pregnant woman. As it is, she may transmit the disease to her baby at the time of delivery. This belief leads communities not to use health services because they are convinced that modern medicine is not capable of diagnosing this disease and therefore administering adequate treatment. The communities mainly use traditional medicine (an application of decoction of leaves on the body of the child, especially on his coasts, this decoction is also introduced in his nostrils) to treat this disease. Pneumonia is therefore discovered at the health center in the aftermath of another pathology that prompted the consultation.
– Non-attendance of health centers
The communities of the sanitary areas visited do not practice the systematic use of health centers. Indeed, practice in these localities means that it is first and foremost traditional medicine that is the first resort in case of illness among both adults and children. This situation can partly be explained by the low economic power of the inhabitants of the area, hence financial inability to afford health care and services.
– The low purchasing power of the communities
The health district of Dimbokro is a locality where the main source of income of the populations is the sale of products from the farm. As a result, the populations have seasonal incomes linked to the sale of their crops. However, with climate change, these communities suffer from a loss of production because of the disruption of the seasonal schedule. Also, frequent bush fires due to high heat during dry seasons causes destruction of crops. Dimbokro is a department with the highest temperatures in Côte d’Ivoire. This situation of destruction of crops reduces the economic power of these populations and submits them at risk of food insecurity and malnutrition.
The weakness of economic power is a reason for not attending health centers, especially for villages that are far away from them. Thus, according to the Nurses’ CSR Djangokro and Langba (during the initial needs assessment), it was notified again that cases of home births with the risk of inhalation of amniotic fluid by the child, hence the occurrence of pneumonia in the first weeks of life of the child.
This weak economic power of the population does not allow them to access another type of habitat and adopt new culinary practices. Indeed, despite the comfort of the houses made of adobe (reduction of heat), they are used in addition to bedroom, to store all the goods and equipment of households (bicycles, kitchen utensils, work tools…), thus reducing usable space and therefore source of atmospheric pollution. Also, for cooking, the use of firewood is a common practice in unimproved homes exposing the household (adults and children) to fumes from wood which sometimes prove toxic source of illness such as pneumonia.
– Low level of hygiene and sanitation
In the locality of Dimbokro, the practice of defecation in the open-air is a cultural norm. It is not common to find latrines in households. This standard is valid for both children and adults. In addition, there is a lack of animal parking and the existence of wild garbage deposits. In addition, the almost non-existence of improved water points (the backwaters are the main points of supply of drinking water in several villages), expose the inhabitants to water-borne diseases such as diarrhea and malaria. These infections therefore become factors that can cause pneumonia.
– The low technical equipment of rural health centers
In Côte d’Ivoire, there is a targeted gratuity policy for pregnant women and children aged 0 to 5 years. This gives rise to free consultations and access to medicines. However, despite the free medicines, there are frequent breaks in the stock of medicines free of charge. Therefore, patients are obliged to pay the drugs of their treatment in pharmacies that are only in the city of Dimbokro. Moreover, the technical equipment of rural health centers does not allow them to offer a number of services, notably biological examinations and even quality neonatal services (no modern vacuum cleaner). This situation obliges the patients to go to the Regional Hospital Center (CHR) in Dimbokro. The distance of the town from the various villages (between 27 and 70 km depending on the health center CSR), the cost of transport and the lack of a permanent transport service linking the villages and the city. There is only one departure in the morning and one return in the evening) and the low purchasing power of populations, unfortunately contributes to the non-use of the services offered by these rural health centers. The project will be implemented in 3 rural health areas covering 29 villages, with a population of 12 645 inhabitants, ie 13.20% of the total population of the health district of Dimbokro and almost half (45.92%) of the population of all rural health areas (excluding the town of Dimbokro). The health areas to be covered by the project are Djangokro, Nofou and Langba. These 3 health areas were selected under guidance of the Dimbokro Departmental Health Director and the focal point of Ministry of Health (National Maternal and Child Health Program), taking into account their high incidence of low IRA / Pneumonia, infant mortality rate, CSR attendance rate, distance from the health center to the health district. Indeed, health centers in these health areas are the furthest from the reference hospital. According to the head nurse of these health areas, when patients are referred to the reference center in Dimbokro, very few of them go there. The choice of this health district is justified by:
1- According to the 2015 RASS data, the health district of Dimbokro is one of the health districts with the highest incidence of pneumonia (3rd highest national rate). Indeed, the health district of Dimbokro has an incidence of 424,34 ‰ against 202,35 ‰ at the national level.
2- Relatively low coverage of health services at village level in the health district. There are 15 first contact establishments for a population estimated at 91 056 inhabitants, of which 5 are in the city of Dimbokro.
3- a low rate of attendance of these centers and of the use of the services offered, especially at the community level.
4- Dimbokro is the hottest area of the country, which means that the population is often confronted with dust with poor road conditions with no tar.
5- Lack of humanitarian structures working on the topic of pneumonia and childhood diseases in the area. The few structures working in the area are local NGOs, working exclusively in the field of HIV / AIDS.
6- The Red Cross of Côte d’Ivoire has a local branch in Dimbokro and has no activity outside Dimbokro, either in the target villages of the project.
The project will be implemented in 3 rural health areas covering 29 villages, with a population of 12 645 inhabitants, ie 13.20% of the total population of the health district of Dimbokro and almost half (45.92%) of the population of all rural health areas (excluding the town of Dimbokro). The health areas to be covered by the project are Djangokro, Nofou and Langba. These 3 health areas were selected under guidance of the Dimbokro Departmental Health Director and the focal point of Ministry of Health (National Maternal and Child Health Program), taking into account their high incidence of low IRA / Pneumonia, infant mortality rate, CSR attendance rate, distance from the health center to the health district. Indeed, health centers in these health areas are the furthest from the reference hospital. According to the head nurse of these health areas, when patients are referred to the reference center in Dimbokro, very few of them go there.
Implementation of the project will ensure the participation and involvement of the different stakeholders, namely, the communities in the implementation areas, the Ministry of Health and Public Hygiene through the National Mother Program and The health district of Dimbokro, the local administrative authorities (prefecture, sub-prefectures, municipality, regional councils).
To achieve this goal, different approaches will be used. At the community level, the CBHFA for community mobilization, BenCom, for communication aspects, CLTS, PHAST / CHAST and San-market for water, sanitation and hygiene issues. At the level of the health district, integration of community treatment of pneumonia and strengthening of its advanced strategies. At the local branch of Dimbokro, the BOCA approach will be used to improve the structural organization with a view to the sustainability of the project.
Ensuring the involvement of all stakeholders in a project is to ensure ownership of interventions and the sustainability of achievements.
Red Cross Côte d’Ivoire (HQ, Local Branch, volunteers), mothers clubs, husband clubs, local authorities (Prefet, Sub-Prefet), Ministry of Health (central and local level), Territorial Directorate of hydraulic, Regional council