Identifying factors associated with treatment delay in leptospirosis : a retrospective study of patients admitted to hospital in Reunion (Indian Ocean) between 2014 and 2015

Background. - Leptospirosis is a life-threatening zoonotic disease for which delayed treatment onset has been associated to poor prognosis. The purpose of the study was to identify the determinants of therapeutic delay in hospitalized leptospirosis cases. Patients and methods. - We carried out a retrospective multicenter study in the 4 public hospitals of Reunion Island, South Western Indian Ocean. Medical records of confirmed leptospirosis cases occurring in 2014-2015 were reviewed for socio-economic, demographic, geographic and medical data. The primary outcome measure was the therapeutic delay, defined as the time elapsed between the onset of symptoms and initiation of antibiotics. Results. - Of the 117 patients included, 107 were men, with an average age of 44.9 +/- 15 years. The median therapeutic delay was 4 days (interquartile: 2-5 days) and this delay was not found to be associated with severity. The following were found to be at increased risk of having a longer therapeutic delay: cases occurring outside the epidemic period, or rainy season (OR 2.8 [1.08-7.3], P = 0.04) and cases with first medical evaluation in primary health care (OR 4.63 [1.43-14.93]; P = 0.01) instead of emergency unit. Nosocio-economic or geographic characteristics were found to be linked to a longer therapeutic delay. Conclusion. - Although delayed treatment was not associated to disease severity, our results indicate that leptospirosis awareness is needed all year in the subtropical area of Reunion Island and particularly in primary care

Observar a Terra para analisar a distribuição espacial das desigualdades da saúde: um olhar histórico e prospectivo sobre o uso do sensoriamento remoto no campo da saúde

International audienceBy providing a wide view of territories, satellite images and aerial photographs allow to capture the environmental factors that can affect the health of populations. Since the development of satellite remote sensing in the 1970s, its use in the health field has had moderate success. Although its potential was widely mentioned in the literature until the 2000s, its operational contribution was not obvious. It is only recently that health applications have been enriched and multiplied by the development of interdisciplinary approaches. This article aims to question the uses of remote sensing applied to health issues according to technical, historical, and thematic aspects in order to identify the bottlenecks. First, it offers a didactic view of theoretical principles, available data and possible uses. Through a bibliographic study, it offers a retrospective look at the evolution of its implementation in the field of health, which allows synthesizing current contributions: for operational mapping, for surveillance and analysis of the dynamics of infectious diseases or, to a lesser extent, to apprehend the vulnerabilities of populations such as difficulties in accessing healthcare. Finally, the article concludes on the limits, recommendations and perspectives for optimizing these uses, which are often constrained by technical and structural issues and for which methodologies still need to be developed.En prenant de la hauteur et en offrant une vue élargie des territoires, les images satellite et les photographies aériennes permettent d'appréhender les facteurs environnementaux qui peuvent conditionner la santé des populations. Depuis l'essor de la télédétection satellite à partir des années 1970, son usage dans le domaine de la santé a connu des succès modérés. Si son potentiel a été largement évoqué dans la littérature jusqu'aux années 2000, son apport opérationnel ne s'est pas imposé. Ce n'est que récemment que les applications en santé se sont enrichies et multipliées par le développement d'approches interdisciplinaires. Cet article vise à questionner les usages de la télédétection appliquée aux questions de santé selon les aspects techniques, historiques, et thématiques afin d'identifier les verrous. Il propose tout d'abord une vue didactique des principes théoriques, des données disponibles et des usages possibles. A travers une étude bibliographique, il offre un regard rétrospectif sur l'évolution de sa mise en ½uvre dans le domaine la santé, qui permet de synthétiser les contributions actuelles : pour la cartographie opérationnelle, pour la surveillance et l'analyse des dynamiques des maladies infectieuses ou, dans une moindre de mesure, pour appréhender les vulnérabilités des populations comme les difficultés d'accès aux soins. Enfin, l'article conclut sur les limites, les recommandations et les perspectives pour optimiser ces usages dont les verrous sont souvent techniques et structurels mais pour lesquels des méthodologies doivent encore être développées.Ao fornecer uma visão ampla dos territórios, as imagens de sensoriamento remoto orbital e fotografias aéreas permitem analisar os fatores ambientais que podem condicionar a saúde das populações. Desde o surgimento do sensoriamento remoto orbital na década de 1970, seu uso no campo da saúde teve um sucesso moderado. Embora seu potencial tenha sido amplamente mencionado na literatura até a década de 2000, sua contribuição operacional era óbvia. Apenas recentemente as aplicações em saúde foram enriquecidas e multiplicadas pelo desenvolvimento de abordagens interdisciplinares. Este artigo tem como objetivo questionar os usos do sensoriamento remoto aplicados às questões de saúde, de acordo com os aspectos técnicos, históricos e temáticos, a fim de identificar os seus gargalos. Primeiramente propõe uma visão didática dos princípios teóricos, dados disponíveis e possíveis usos. Através de um estudo bibliográfico, oferece uma retrospectiva da evolução de sua implementação no campo da saúde, permitindo sintetizar as contribuições atuais: para o mapeamento operacional, para a vigilância e a análise da dinâmica de doenças infecciosas ou, em menor grau, para compreender as vulnerabilidades das populações, tais como as dificuldades de acesso aos serviços de saúde. Por fim, o artigo conclui sobre os limites, as recomendações e as perspectivas para otimizar esses usos, que muitas vezes são limitados por questões técnicas e estruturais e para as quais as metodologias ainda precisam ser desenvolvidas

Improving geographical accessibility modeling for operational use by local health actors

Background Geographical accessibility to health facilities remains one of the main barriers to access care in rural areas of the developing world. Although methods and tools exist to model geographic accessibility, the lack of basic geographic information prevents their widespread use at the local level for targeted program implementation. The aim of this study was to develop very precise, context-specific estimates of geographic accessibility to care in a rural district of Madagascar to help with the design and implementation of interventions that improve access for remote populations. Methods We used a participatory approach to map all the paths, residential areas, buildings and rice fields on OpenStreetMap (OSM). We estimated shortest routes from every household in the District to the nearest primary health care center (PHC) and community health site (CHS) with the Open Source Routing Machine (OSMR) tool. Then, we used remote sensing methods to obtain a high resolution land cover map, a digital elevation model and rainfall data to model travel speed. Travel speed models were calibrated with field data obtained by GPS tracking in a sample of 168 walking routes. Model results were used to predict travel time to seek care at PHCs and CHSs for all the shortest routes estimated earlier. Finally, we integrated geographical accessibility results into an e-health platform developed with R Shiny. Results We mapped over 100,000 buildings, 23,000 km of footpaths, and 4925 residential areas throughout Ifanadiana district; these data are freely available on OSM. We found that over three quarters of the population lived more than one hour away from a PHC, and 10-15% lived more than 1 h away from a CHS. Moreover, we identified areas in the North and East of the district where the nearest PHC was further than 5 h away, and vulnerable populations across the district with poor geographical access (> 1 h) to both PHCs and CHSs. Conclusion Our study demonstrates how to improve geographical accessibility modeling so that results can be context-specific and operationally actionable by local health actors. The importance of such approaches is paramount for achieving universal health coverage (UHC) in rural areas throughout the world