La santé comme sport de combat

Écrit dans le sillage d’une « médecine inhospitalière », ce nouveau livre poursuit l’œuvre de Yannick Jaffré en faveur d’une lecture socio-anthropologique des problèmes de santé. Cet auteur montre une fois de plus sa parfaite maîtrise d’une discipline qu’il pratique depuis plus de 35 ans, dont plus des deux tiers en Afrique subsaharienne, et la place qui lui revient parmi les sciences fondamentales de la santé publique. Le titre de ce livre est déjà éloquent. Ce rapprochement entre le combat..

Giving birth at a maternity hospital: the key strategic option to be adopted in order to combat maternal and neonatal mortality in Mali

The end result of the past 40 years of experience in combating maternal mortality in Mali suggests that the emphasis should be changed, and that giving birth at a maternity hospital should be the basic strategic option chosen. This means creating “compounds set aside for mothers-to-be”, where women approaching the end of their pregnancy will be invited to come and await the onset of labour, and at the same time enjoy the rest they need. However, the prerequisites for such an initiative will be first to guarantee the necessary quality of care in maternity hospitals, by virtue of an accreditation system, and second to ensure that the system is fully operational in terms of referring obstetric emergencies. Giving birth in the woman’s home village will then no longer be regarded as a clearly expressed strategic choice, but as an unintended course of events. The introduction of a subsidised system of fixed-charge obstetric care will remove any financial obstacles, and is a necessary step to ensure the feasibility of such a programme.Le bilan des 40 ans d’expérience du Mali en matière de lutte contre la mortalité maternelle plaide pour un recentrage faisant de l’accouchement en maternité l’option stratégique fondamentale. Pour cela, doivent être créées des « concessions des mamans » où les femmes en fin de grossesse seront invitées à se rendre pour y attendre le début du travail en bénéficiant notamment du repos qui doit s’imposer à elles. Le préalable à cette initiative sera cependant de garantir d’une part la qualité des soins dans les maternités grâce à un mécanisme d’accréditation, d’autre part la pleine fonctionnalité du système de référence des urgences obstétricales. Ainsi, l’accouchement au village ne devra-t-il être plus considéré comme un choix stratégique affirmé, mais comme un incident de parcours. La mise en place d’un forfait obstétrical subventionné permettra de lever l’obstacle financier nécessaire pour assurer la faisabilité d’un tel programme.El resultado final arrojado por los últimos 40 años de experiencia en la lucha contra la mortalidad materna en Malí sugiere que hay que cambiar el énfasis y que dar a luz en un hospital maternal debería ser la opción estratégica básica a escoger. Esto supone la creación de “residencias reservadas para futuras madres”, a las que se invitará a acudir a las madres que están el tramo final del embarazo para esperar el inicio del parto, mientras disfrutan del descanso que necesitan. Sin embargo, los requisitos previos para dicha iniciativa serán, en primer lugar, garantizar la calidad necesaria de los cuidados en los hospitales maternales, a través de un sistema de acreditación, y, en segundo lugar, asegurar que el sistema de derivación de emergencias obstétricas funcione correctamente. El parto en la propia aldea de la mujer ya no se contemplará como una opción estratégica claramente expresada, sino como un desarrollo imprevisto de los acontecimientos. La introducción de un sistema subvencionado de atención obstétrica de coste fijo eliminará los obstáculos económicos, y es un paso necesario para asegurar la viabilidad de un programa de este tipo

Giving birth at a maternity hospital: the key strategic option to be adopted in order to combat maternal and neonatal mortality in Mali

The end result of the past 40 years of experience in combating maternal mortality in Mali suggests that the emphasis should be changed, and that giving birth at a maternity hospital should be the basic strategic option chosen. This means creating “compounds set aside for mothers-to-be”, where women approaching the end of their pregnancy will be invited to come and await the onset of labour, and at the same time enjoy the rest they need. However, the prerequisites for such an initiative will be first to guarantee the necessary quality of care in maternity hospitals, by virtue of an accreditation system, and second to ensure that the system is fully operational in terms of referring obstetric emergencies. Giving birth in the woman’s home village will then no longer be regarded as a clearly expressed strategic choice, but as an unintended course of events. The introduction of a subsidised system of fixed-charge obstetric care will remove any financial obstacles, and is a necessary step to ensure the feasibility of such a programme.Le bilan des 40 ans d’expérience du Mali en matière de lutte contre la mortalité maternelle plaide pour un recentrage faisant de l’accouchement en maternité l’option stratégique fondamentale. Pour cela, doivent être créées des « concessions des mamans » où les femmes en fin de grossesse seront invitées à se rendre pour y attendre le début du travail en bénéficiant notamment du repos qui doit s’imposer à elles. Le préalable à cette initiative sera cependant de garantir d’une part la qualité des soins dans les maternités grâce à un mécanisme d’accréditation, d’autre part la pleine fonctionnalité du système de référence des urgences obstétricales. Ainsi, l’accouchement au village ne devra-t-il être plus considéré comme un choix stratégique affirmé, mais comme un incident de parcours. La mise en place d’un forfait obstétrical subventionné permettra de lever l’obstacle financier nécessaire pour assurer la faisabilité d’un tel programme.El resultado final arrojado por los últimos 40 años de experiencia en la lucha contra la mortalidad materna en Malí sugiere que hay que cambiar el énfasis y que dar a luz en un hospital maternal debería ser la opción estratégica básica a escoger. Esto supone la creación de “residencias reservadas para futuras madres”, a las que se invitará a acudir a las madres que están el tramo final del embarazo para esperar el inicio del parto, mientras disfrutan del descanso que necesitan. Sin embargo, los requisitos previos para dicha iniciativa serán, en primer lugar, garantizar la calidad necesaria de los cuidados en los hospitales maternales, a través de un sistema de acreditación, y, en segundo lugar, asegurar que el sistema de derivación de emergencias obstétricas funcione correctamente. El parto en la propia aldea de la mujer ya no se contemplará como una opción estratégica claramente expresada, sino como un desarrollo imprevisto de los acontecimientos. La introducción de un sistema subvencionado de atención obstétrica de coste fijo eliminará los obstáculos económicos, y es un paso necesario para asegurar la viabilidad de un programa de este tipo

BMJ Open

In low-income settings with limited access to diagnosis, COVID-19 information is scarce. In September 2020, after the first COVID-19 wave, Mali reported 3086 confirmed cases and 130 deaths. Most reports originated from Bamako, with 1532 cases and 81 deaths (2.42 million inhabitants). This observed prevalence of 0.06% appeared very low. Our objective was to estimate SARS-CoV-2 infection among inhabitants of Bamako, after the first epidemic wave. We assessed demographic, social and living conditions, health behaviours and knowledges associated with SARS-CoV-2 seropositivity. We conducted a cross-sectional multistage household survey during September 2020, in three neighbourhoods of the commune VI (Bamako), where 30% of the cases were reported. We recruited 1526 inhabitants in 3 areas, that is, 306 households, and 1327 serological results (≥1 years), 220 household questionnaires and collected answers for 962 participants (≥12 years). We measured serological status, detecting SARS-CoV-2 spike protein antibodies in blood sampled. We documented housing conditions and individual health behaviours through questionnaires among participants. We estimated the number of SARS-CoV-2 infections and deaths in the population of Bamako using the age and sex distributions. The prevalence of SARS-CoV-2 seropositivity was 16.4% (95% CI 15.1% to 19.1%) after adjusting on the population structure. This suggested that ~400 000 cases and ~2000 deaths could have occurred of which only 0.4% of cases and 5% of deaths were officially reported. Questionnaires analyses suggested strong agreement with washing hands but lower acceptability of movement restrictions (lockdown/curfew), and mask wearing. The first wave of SARS-CoV-2 spread broadly in Bamako. Expected fatalities remained limited largely due to the population age structure and the low prevalence of comorbidities. Improving diagnostic capacities to encourage testing and preventive behaviours, and avoiding the spread of false information remain key pillars, regardless of the developed or developing setting. This study was registered in the registry of the ethics committee of the Faculty of Medicine and Odonto-Stomatology and the Faculty of Pharmacy, Bamako, Mali, under the number: 2020/162/CA/FMOS/FAPH

Chapitre 19. Les composantes de la stratégie CHANCE peuvent-elles être intégrées dans le système de santé ?

Même s’il ne figure pas en tête de liste, le trachome constitue une des priorités du ministère de la santé malien. Moins dramatique que le sida, moins grave que le paludisme ou la tuberculose, il est néanmoins la cause d’un nombre important de cécités, de souffrances intenses et continues et de pertes économiques non négligeables. Au cours des années 1970, la lutte contre le trachome a reposé sur les méthodes préconisées à l’époque : l’application systématique de pommade ophtalmique 6 jours p..

annex 1 -interview guides and questionnaire

Interview guides for qualitative phases (phase 1 and 3 of the study); questionnaire passed during quantitative phase (phase 2

Data from: Improving access and continuity of care for homeless people: how could general practitioners effectively contribute? results from a mixed study.

Objectives: To analyze the views of general practitioners (GPs) about how they can provide care to homeless people (HP) and to explore which measures could influence their views. Design: Mixed-methods design (qualitative –> quantitative (cross-sectional observational) qualitative). Qualitative data were collected through semi-structured interviews; quantitative data were collected through questionnaires with closed questions. Quantitative data were analyzed with descriptive statistical analyses on SPPS; a content analysis was applied on qualitative data. Setting: primary care; views of urban GPs working in deprived area in Marseille were explored by questionnaires and/or semi-structured interview. Participants: 19 GPs involved in HP’s healthcare were recruited for phase 1 (qualitative); for phase 2 (quantitative), 150 GPs who provide routine health care (“standard” GPs) were randomized, 144 met the inclusion criteria and 105 responded the questionnaire; for phase 3 (qualitative), data were explored on 14 “standard” GPs. Results: In quantitative phase, 79% of the 105 GPs already treated HP. Most of the difficulties they encountered treating HP concerned social matters (mean level of perceived difficulties = 3.95/5, IC95 [3.74-4.17]), lack of medical information (mn=3.78/5, IC95 [3.55-4.01]patient’s compliance (mn=3.67/5, IC95 [3.45-3.89]), loneliness in practice (mn=3.45/5, IC95 [3.18-3.72]) and time required for doctor (mn=3.25, IC95 [3-3.5]. From qualitative analysis we understood that maintaining a stable follow-up was a major condition for GPs to contribute effectively to the care of HP. Acting on health system organization, developing a medical and psychosocial approach with closer relation with social workers and enhancing the collaboration between tailored and non-tailored programs were also other key answers. Conclusion: If we adapt the conditions of GPs practice, they could contribute to the improvement of HP’s health. These results will enable the construction of a new model of primary care organization aiming to improve access to health care for HP

Improving access and continuity of care for homeless people: how could ă general practitioners effectively contribute? Results from a mixed study

International audienceObjectives: To analyse the views of general practitioners (GPs) about ă how they can provide care to homeless people (HP) and to explore which ă measures could influence their views. ă Design: Mixed-methods design (qualitative -> quantitative ă (cross-sectional observational) -> qualitative). Qualitative data were ă collected through semistructured interviews and through questionnaires ă with closed questions. Quantitative data were analysed with descriptive ă statistical analyses on SPPS; a content analysis was applied on ă qualitative data. ă Setting: Primary care; views of urban GPs working in a deprived area in ă Marseille were explored by questionnaires and/or semistructured ă interview. ă Participants: 19 GPs involved in HP's healthcare were recruited for ă phase 1 (qualitative); for phase 2 (quantitative), 150 GPs who provide ă routine healthcare ('standard' GPs) were randomised, 144 met the ă inclusion criteria and 105 responded to the questionnaire; for phase 3 ă (qualitative), data were explored on 14 `standard' GPs. ă Results: In the quantitative phase, 79% of the 105 GPs already treated ă HP. Most of the difficulties they encountered while treating HP ă concerned social matters (mean level of perceived difficulties=3.95/5, ă IC 95 (3.74 to 4.17)), lack of medical information (mn=3.78/5, IC 95 ă (3.55 to 4.01)) patient's compliance (mn=3.67/5, IC 95 (3.45 to 3.89)), ă loneliness in practice (mn=3.45/5, IC 95 (3.18 to 3.72)) and time ă required for the doctor (mn=3.25, IC 95 (3 to 3.5)). From qualitative ă analysis we understood that maintaining a stable follow-up was a major ă condition for GPs to contribute effectively to the care of HP. Acting on ă health system organisation, developing a medical and psychosocial ă approach with closer relation with social workers and enhancing the ă collaboration between tailored and non-tailored programmes were also ă other key answers. ă Conclusions: If we adapt the conditions of GPs practice, they could ă contribute to the improvement of HP's health. These results will enable ă the construction of a new model of primary care organisation aiming to ă improve access to healthcare for HP