The at risk child clinic (ARCC): 3 years of health activities in support of the most vulnerable children in Beira, Mozambique

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Study Justification:
The aim of this study was to analyze the activities of fifteen At Risk Child Clinics (ARCCs) in Beira, Mozambique over a 3-year period in order to define the health profile of children accessing these services. The study focused on understanding the main reasons children accessed the clinics and the prevalence of HIV among them. This information is important for policymakers and healthcare providers to better understand the health needs of vulnerable children in the area and improve the quality of care provided.
Study Highlights:
– The main motivation for children accessing the ARCCs was HIV exposure, accounting for 69.7% of the cases.
– Other risk conditions, Moderate Acute Malnutrition (MAM), Severe Acute Malnutrition (SAM), and TB exposure were also significant reasons for seeking care.
– During the first consultations, 95.5% of the children were screened for HIV, and 7.89% tested positive.
– The study highlights the importance of ARCCs in providing care for vulnerable children and suggests that they can serve as a strategic point for understanding health demands and monitoring the quality of care.
Study Recommendations:
– Efforts should be made to improve the quality of data collection in ARCCs to ensure accurate and complete information.
– More resources and support should be provided to address the high prevalence of HIV among children accessing the clinics.
– The findings of this study can be used to inform policy decisions and resource allocation to better meet the health needs of vulnerable children in Beira.
Key Role Players:
– Ministry of Health (MoH): Responsible for managing the Maternal and Child Health Services and coordinating healthcare facilities.
– Doctors with Africa CUAMM: Provides support to most of the ARCCs in Beira.
– Clinical officers and nurses: Provide care to children in the ARCCs.
– Beira referral hospital: Provides more complex care and admission for children who require it.
– District Health Authority: Approves the use of data for publication and plays a role in overseeing healthcare activities.
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare professionals to improve data collection.
– HIV testing kits and related supplies.
– Additional healthcare staff to address the high demand for services.
– Infrastructure improvements in ARCCs to enhance the quality of care.
– Resources for HIV prevention and treatment programs.
– Monitoring and evaluation systems to track the impact of interventions.
Please note that the cost items provided are for planning purposes and do not reflect actual costs.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides data from a 3-year period and includes a large number of first consultations. The motivations for accessing the services are clearly described. However, the abstract does not mention any specific methodology or statistical analysis used to analyze the data. To improve the strength of the evidence, the authors could provide more details on the data collection process, including any quality control measures taken. Additionally, they could describe the statistical methods used to analyze the data, such as any tests of significance or confidence intervals calculated. This would provide more transparency and allow for better evaluation of the study’s findings.

The concept of “children at risk” changes worldwide according to each specific context. Africa has a large burden of overall risk factors related to childhood health and development, most of which are of an infective or social origin. The aim of this study was to report and analyze the volumes of activities of fifteen At Risk Child Clinics (ARCCs) within the Beira District (Mozambique) over a 3 year-period in order to define the health profile of children accessing such health services. We retrospectively analyzed the data from all of the children accessing one of the 15 Beira ARCCs from January 2015 to December 2017. From this, 17,657 first consultations were registered. The motivations for accessing the services were in order of relevance: HIV exposure (n. 12,300; 69.7%), other risk conditions (n. 2542; 14.4%), Moderate Acute Malnutrition (MAM) (n. 1664; 9.4%), Severe Acute Malnutrition (SAM) (n. 772; 4.4%), and TB exposure (n. 542; 3.1%). During the first consultations, 16,865 children were screened for HIV (95.5%), and 7.89% tested HIV-positive. In our three years of experience, HIV exposure was the main indication for children to access the ARCCs in Mozambique. ARCCs could represent a strategic point to better understand health demands and to monitor the quality of care provided to this vulnerable population group, however significant effort is needed to improve the quality of the data collection.

The Beira District is one of the 13 districts of the Sofala Province, laying on the eastern coast of Mozambique, and it is the third largest district in the country. The health system of the Sofala Province is articulated in 146 health facilities (1 per every 12,000 inhabitants) [21] and it is organized into four basic levels of care, including (1) one quaternary-level hospital in Beira, (2) four secondary-level rural hospitals, (3) 114 urban and rural health centers, including Maternal and Child Health Services specific to mothers and children, which are managed by the Ministry of Health (MoH), and (4) 27 health posts [22]. The ARCCs are configured as specific clinics within the Maternal and Child Health Services, and since 2012, most of the 15 ARCCs of the Beira district are supported by Doctors with Africa CUAMM. Each ARCC provides free out-patient consultations dedicated to new-borns and children under five with specific health risks, such as HIV exposed infants (HEI), preterm, malnourished, TB exposed, referred to Maternal and Child Health Services from maternity, health posts, neonatology, or directly accessing the MCH services. Children that are presented in centers are taken charge of by clinical officers and nurses who provide care in an out-patient setting. The ones requiring more complex care and/or admission are addressed to the Beira referral hospital or to chronic disease out-patient services, except for HEI. In fact, since 2013, after a positive screening test with a PCR or Rapid test, a confirmation test with Western Blot [23] has been performed and, if positive again, the HEI remains in charge of ARCCS until 5 years old, together with his mother, in order to guarantee a better continuum of care [24]. We retrospectively analyzed all children accessing one of the 15 Beira ARCCs for a first consultation over a 3-year period, from January 2015 to December 2017. Routine service data were accessed. Data collection in Health Centers (HC) goes through several processes, from registration to assignment to the higher levels (Provincial and National). Firstly, data is recorded in each health section of HC during the consultation using a national format in a daily logbook. Health professionals have to ensure consistency and completeness (filling in all fields) of the registration in order to obtain high quality data. The daily logbook is filled exclusively by the health care professional who delivers the service. At the end of the activities, the daily summary is elaborated on. In this case, the person in charge of this activity verifies the agreement of the data. After the last day of the period under analysis (following the statistical calendar), a monthly summary is made, aggregating the daily summaries corresponding to the period in question. The direction of the HC is responsible for issuing and approving the summaries. Thus, the data analysis is done at the HC level and, subsequently, is reported to the district level and is then sent to higher levels. We accessed the data at the district level, obtaining aggregate information on a number of consultations at each ARCCs. Information about the motives of the first consultation, the type and the timing of the first HIV test that was administered and it’s result, and the type and duration of breastfeeding were also extracted. Motivations were grouped into 5 categories: TB exposure, Moderate Acute Malnutrition (MAM), Severe Acute Malnutrition (SAM), HIV exposure, and other risk conditions (e.g., malaria, preterm). Moderate Acute Malnutrition and Severe Acute Malnutrition were defined according to the z-scores of weight-for-height [25,26]. A database was created on Microsoft Excel software and was analyzed using the STATA 13.0 statistics software. The frequencies for the categorical variables were calculated as descriptive statistics. Data use for publication was approved by the District Health Authority in Beira, the Health District Direction (protocol reference: 293 /15), Mozambique.

Based on the provided information, here are some potential innovations that could be used to improve access to maternal health:

1. Mobile Clinics: Implementing mobile clinics that can travel to remote areas within the Beira District to provide maternal health services. This would ensure that pregnant women and new mothers who live in hard-to-reach areas have access to essential healthcare services.

2. Telemedicine: Introducing telemedicine services that allow pregnant women and new mothers to consult with healthcare professionals remotely. This would be particularly beneficial for women who are unable to travel to healthcare facilities due to distance or other constraints.

3. Community Health Workers: Expanding the role of community health workers to provide maternal health education, screenings, and basic healthcare services within their communities. This would help bridge the gap between healthcare facilities and the community, ensuring that women receive the necessary care and support.

4. Health Information Systems: Implementing a robust health information system that collects and analyzes data on maternal health services. This would help identify gaps in service delivery, monitor the quality of care provided, and inform decision-making for improving maternal health outcomes.

5. Public-Private Partnerships: Collaborating with private healthcare providers to increase the availability and accessibility of maternal health services. This could involve subsidizing services or establishing referral systems between public and private healthcare facilities.

6. Maternal Health Vouchers: Introducing a voucher system that provides pregnant women and new mothers with access to essential maternal health services. This would help reduce financial barriers and ensure that women can receive the care they need.

7. Maternal Health Education Programs: Developing and implementing comprehensive maternal health education programs that target women, families, and communities. These programs would focus on raising awareness about the importance of maternal health, promoting healthy behaviors, and addressing cultural and social barriers to accessing care.

8. Transportation Support: Providing transportation support for pregnant women and new mothers who face challenges in reaching healthcare facilities. This could involve organizing community transportation services or partnering with existing transportation providers to ensure women can access care in a timely manner.

These innovations have the potential to improve access to maternal health services and contribute to better health outcomes for women and children in the Beira District of Mozambique.
AI Innovations Description
The recommendation to improve access to maternal health based on the provided information is to strengthen and expand the At Risk Child Clinics (ARCCs) in the Beira District of Mozambique. These clinics have shown to be effective in providing health services to vulnerable children, particularly those exposed to HIV. By investing in the ARCCs, the quality of care can be improved, and more children can be reached.

To implement this recommendation, the following steps can be taken:

1. Increase funding and resources: Allocate additional funding and resources to the ARCCs to enhance their capacity to provide comprehensive maternal and child health services. This includes ensuring a sufficient number of trained healthcare professionals, medical supplies, and equipment.

2. Improve data collection and monitoring: Address the need for better data collection and monitoring systems to accurately track the health profile of children accessing the ARCCs. This will help identify trends, gaps, and areas for improvement in maternal health services.

3. Strengthen collaboration and coordination: Foster collaboration between the ARCCs, the Ministry of Health, and other relevant stakeholders to ensure a coordinated approach to maternal health. This includes sharing best practices, coordinating referrals, and leveraging resources effectively.

4. Expand outreach and awareness programs: Conduct targeted outreach and awareness programs to reach vulnerable populations and inform them about the services provided by the ARCCs. This can be done through community engagement, health education campaigns, and partnerships with local organizations.

5. Enhance training and capacity building: Provide ongoing training and capacity building opportunities for healthcare professionals working in the ARCCs. This will ensure they have the necessary skills and knowledge to deliver high-quality maternal health services.

By implementing these recommendations, access to maternal health can be improved, and the ARCCs can serve as a strategic point for understanding health demands and monitoring the quality of care provided to vulnerable populations in the Beira District of Mozambique.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Strengthening ARCCs: Enhance the capacity and resources of the At Risk Child Clinics (ARCCs) in Beira District to provide comprehensive maternal health services. This can include training healthcare professionals, improving infrastructure, and ensuring the availability of necessary medical supplies and equipment.

2. Community outreach programs: Implement community-based programs to raise awareness about maternal health and the services provided by ARCCs. This can involve conducting health education sessions, organizing mobile clinics in remote areas, and engaging community leaders to promote the importance of accessing maternal health services.

3. Integration of services: Foster collaboration between ARCCs and other healthcare facilities, such as maternity wards, health centers, and referral hospitals. This can ensure a seamless continuum of care for pregnant women and mothers, allowing for early detection and management of maternal health issues.

4. Mobile health technology: Utilize mobile health technology, such as telemedicine and mobile applications, to improve access to maternal health services. This can enable remote consultations, appointment reminders, and access to educational resources, particularly for women in rural or underserved areas.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define indicators: Identify key indicators to measure the impact of the recommendations, such as the number of pregnant women accessing ARCCs, the percentage of women receiving antenatal care, the rate of maternal mortality, and the rate of successful referrals to higher-level healthcare facilities.

2. Data collection: Collect baseline data on the identified indicators before implementing the recommendations. This can involve reviewing existing health records, conducting surveys or interviews with healthcare providers and community members, and analyzing relevant demographic and health data.

3. Implement interventions: Implement the recommended interventions, such as strengthening ARCCs, conducting community outreach programs, integrating services, and utilizing mobile health technology. Ensure proper monitoring and evaluation mechanisms are in place to track the implementation process.

4. Data analysis: After a sufficient period of time, collect post-intervention data on the identified indicators. Compare the post-intervention data with the baseline data to assess the impact of the recommendations on improving access to maternal health.

5. Evaluate outcomes: Analyze the data to evaluate the outcomes of the interventions. This can involve calculating changes in the indicators, assessing the reach and effectiveness of the interventions, and identifying any challenges or barriers encountered during the implementation process.

6. Adjust and refine: Based on the evaluation outcomes, make necessary adjustments and refinements to the interventions to further improve access to maternal health. This can involve scaling up successful interventions, addressing identified challenges, and incorporating feedback from healthcare providers and community members.

By following this methodology, it will be possible to simulate the impact of the recommendations on improving access to maternal health and make informed decisions for further improvements.

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