[Outcomes of improved care on health center activity in a rural area of Senegal].
BACKGROUND
This study aimed at analyzing the short-term effects of an improvement in care offer on dispensary activity in a rural area of Senegal.


METHODS
The Niakhar health center, situated 150 km east of Dakar, underwent significant changes during the years 1998 and 1999: a hospital unit was built, the maternity ward was extended and the patient reception facilities were refurbished and reorganized. We examined dispensary registers before (1997) and after (2000) this period of time. We focused on data reporting activity and utilization of the health center. We also studied the users'perception of these improvements. Interviews were conducted with 39 families to measure the consequences of this change on their attitudes towards treatment.


RESULTS
The number of consultants increased by 49.8% from 1997 to 2000. Activity peaked during the rainy season, during which consultations were twice as numerous in 2000 as in 1997. However a similar increase was noticed in another health center close to Niakhar and could be attributed to the high precipitation rate observed in this area in the year 2000. For children, there was no difference in center utilization between the two study years as each child went to the dispensary 1.18 and 1.21 times a year in 1997 and 2000 respectively. The maternity activity exhibited a 68% increase in deliveries. Families interviewed said the dispensary was significantly improved, but they were not able to change their practice, due to lack of financial resources and poor drug supply.


CONCLUSIONS
The changes in care offer did not seem to have yielded the expected effect on care activity. The appointment of a midwife as well as improvements in both technical facilities and awareness contributed to the increase in maternity use.
Souares
A
A
IRD, UR 10, Dakar, Sénégal.
Chippaux
J-P
JP
Le Hesran
J-Y
JY
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005160:Facility Design and Construction; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010820:Physicians / Q000600:supply & distribution; D012042:Registries; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D012675:Senegal; D014611:Vaccination / Q000706:statistics & numerical data