An epidemiological study of under-five children consulting in health facilities in Brazzaville

In most of the large cities in developing countries, geographic accessibili ty to health care is not a major problem. Thus, indifference to public serv ices and a preference for home treatment, recourse to traditional medicine or to the private sector may be related to problems in the quality of servi ces. A cross-sectional epidemiological study of hospital visits by under-5 children was carried out in health centres and hospital out-patient service s in Brazzaville (Congo). Sampling in these health facilities was done usin g a systematic random sample with a proportion of 25%, during 4 periods cho sen according to seasonal factors. An exhaustive investigation of the entir e public sector sewing children was done in the study. At the same time, th e same data were gathered in a sample of private facilities (doctors' and n urses' offices, traditional healers, religious healing centres), chosen as a function of their permanence and the numbers of their clientele. This art icle analyses services offered during 2215 visits by children, who were und er 1 year of age in more than 50% of cases. In the public sector, 75% of vi sits were to first-line health centres. Public services show marked dysfunc tions: the complexity of internal referrals, clinical examinations which ar e inadequate in relation to symptoms, and poor communication (explanations as to cause of illness in less than 2% of cases, and on treatments in less than 50% of cases). Communication seems well developed among private physic ians and traditional healers, the latter engaging in both preventive and cu rative! activities. Communication during well-child visits and consultation s at health centres is especially disappointing, in light of the very young age of the parents (1/4 are high-school or college students). There is a t wo-fold risk in this situation: flight towards non-conventional medicine on the one hand, and access to private medicine based on socio-economic statu s on the other. It thus appears necessary to standardise procedures and act s in first line public health services and to promote training of personnel in communication skills with families (training using social science persp ectives and participative pedagogical techniques).