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千葉大学教育学部研究紀要. 第一部

Attitudes et comportements des femmes enceintes face au dépistage du VIH à Abidjan (Côte d'Ivoire), en 1995 et 1996 : raisons du refus du test et indifférence face aux résultats

La proposition de test de dépistage du VIH chez les femmes enceintes est faite à la Formation sanitaire urbaine (FSU) et au Centre hospitalier universitaire (CHU) de Yopougon, par le biais du projet DITRAME, au cours d'un entretien destiné à obtenir leur consentement. Le taux d'acceptation a été de 61% au CHU et de 77% à la FSU en 1995, mais seulement 73% des femmes du CHU et 48% de la FSU sont revenues chercher le résultat de leur test. Ceci nous a conduits à nous poser les questions suivantes : pour quelles raisons les femmes refusent-elles le test de dépistage du VIH ? Pourquoi celles qui l'ont accepté ne viennent-elles pas chercher les résultats ? Une enquête qualitative à l'aide d'entretiens approfondis a été menée. Cinquante femmes vues en consultation prénatale ayant refusé le test de dépistage VIH ont été interrogées individuellement dans le centre de santé où le test leur a été proposé. Pour connaître les raisons de l'indifférence vis-à-vis des résultats du test, 50 autres femmes l'ont été également, soit à domicile, soit dans le centre de santé, huit jours au moins après la date prévue pour l'annonce des résultats. Les principales raisons du refus du test et de l'indifférence aux résultats semblent essentiellement la crainte de voir sa mort s'accélérer, la peur du rejet par l'entourage, notamment par le mari, celle de la rupture possible du secret médical et de la révélation du statut sérologique alors que ces femmes, enceintes, se considèrent comme vulnérables. Le test de dépistage du VIH reste une pratique peu courante en Afrique subsaharienne. Il est actuellement l'apanage de projets de recherches ou d'essais thérapeutiques. Pour le rendre moins contraignant et mieux accepté, des campagnes de sensibilisation semblent ici indispensables. En effet, beaucoup de femmes en Afrique sont dépendantes économiquement et socialement de leur partenaire, ce qui entrave la décision de réaliser un tel test... (D'après résumé d'auteur

Being hospitalized with a newly diagnosed chronic illness—A phenomenological study of children's lifeworld in the hospital

The impact of a hospital environment on children has rarely been investigated. Recently, however, the perspective of hospitalized children has been taken into account. Being hospitalized and facing an illness represent a dramatic change in a child's daily life, and the quality of the environment may influence the child's experiences. The aim of this study was to investigate the experiences of children being hospitalized with newly diagnosed type 1 diabetes and to obtain an increased understanding of the environmental influences on the children's lifeworld. The study used a hermeneutic phenomenological approach. The design is a combination of observation of the participant, interviews, and photographs. Nine children, aged between 7 and 12 years, participated in the study. The data were collected between October 2008 and February 2010 and analysed in accordance with thematic analysis as described by van Manen. The children experienced change through recognition and adaptation. They perceived the environment as strange but still comfortable because of the “child-friendly” atmosphere, close contact with their relatives, and access to private space. The children were gradually able to adapt to their new life; they perceived their illness through bodily changes and developed practical skills and understanding. The findings underscored the necessity for an emphasis on the mutual relationship between the body and its environment. Bodily changes that occur during illness may lead to changes in one's perception of the environment. Children seem to be particularly affected when the body appears alien and the hospital environment is unfamiliar. A well-adapted environment, active involvement, and the incorporation of new habits are significant elements of gradually returning to a more familiar life. However, the child's new life requires alertness to the body's signals and acclimation to a demanding diabetes treatment regime. All these factors remind children of their body's needs and experiences and influence their lifeworld

Haematological characteristics and HIV status of pregnant women in Abidjan, Côte d'Ivoire, 1995-96

To describe the haematological profile of pregnant women and to compare these characteristics according to HIV serostatus in Abidjan, Côte d'Ivoire, a cross-sectional study was made in the context of a research intervention programme to reduce mother-to-child transmission (MTCT) of HIV (ANRS 049 trial). HIV testing was systematically proposed to pregnant women attending the mother and child health clinic of a community health centre. Blood samples were tested for HIV antibodies using Genelavia(TM) and Peptilav(TM). The haematological parameters were measured with a Coulter counter. From May 1995 to March 1996, 1646 pregnant women accepted HIV testing and had a full blood count available. The prevalence of HIV infection was 12.0% (n = 197). The prevalence of anaemia (haemoglobin (Hb) is less than 11 g/dL) was 70.1%, n = 1155 (95% confidence interval 68-72%) and significantly higher in HIV+ (81.7%, n = 161) than in women (n = 31), 4.6% (n = 9) in HIV+ and 1.5% (n = 22) in HIV+ women (P is less than 0.001). HIV infection, primigravidae and secundigravidae were factors independently associated with anaemia. Anaemia was highly prevalent in this population while severe anaemia was rare. HIV infection was a contributor to anaemia in pregnancy. As zidovudine, with its known haematological toxicity, has recently been introduced to prevent MTCT of HIV in developing countries, screening HIV+ women for severe anemia is necessary. (Résumé d'auteur