Couverture vaccinale contre l hépatite B de la population consultant au Centre de Dépistage Anonyme et Gratuit de Grenoble (connaissances, perceptions et attitudes vis-à-vis de l hépatite B et de sa vaccination)

Malgré l existence d un vaccin efficace, la couverture vaccinale (CV) en France contre le virus de l hépatite B reste insuffisante. L objectif de notre étude était d analyser la CV contre l hépatite B de la population consultant au Centre de Dépistage Anonyme et Gratuit (CDAG) de Grenoble ainsi que les connaissances et attitudes vis-à-vis de l hépatite B et de sa vaccination. Cette étude s est déroulée du 1er mars au 13 juin 2013 au CDAG de Grenoble. Tous les patients consultant durant cette période et parlant français ou anglais ont été conviés à répondre à un questionnaire anonyme, et à réaliser une sérologie VHB lors du bilan de dépistage. Parmi les 1136 patients ayant consulté au CDAG durant la période d étude, 735 ont été inclus. La CV déclarée était de 45,2%; la CV certifiée de 56,6%; la CV selon les sérologies de 55,4%. La sérologie de 33 patients témoignait d un contact avec le VHB, avec 7 porteurs d Ag HBs. La CV était plus importante (69,1%) dans la classe d âge des 25-32 ans (concernés par la campagne de vaccination de 1994-1998). L hépatite B était considérée comme une maladie grave, mais la perception du risque de contamination était sous-estimée. La vaccination contre l hépatite B était source de méfiance, la notion de polémique étant encore ancrée dans les esprits. La CV contre le VHB de notre étude reste au-dessous des objectifs de l OMS. La connaissance très superficielle de l hépatite B pourrait expliquer la mauvaise perception du risque et le faible recours à une vaccination qui souffre encore de la méfiance de la population. Un travail de communication auprès du grand public et des professionnels de santé semble essentiel à l amélioration des pratique.Despite the availability of an effective vaccine, French vaccination coverage (VC) against hepatitis B virus (HBV) remains too low. The target of this study was to investigate the VC against HBV among the population attending the sexually transmitted infection screening center (CDAG) in Grenoble. Knowledge and behaviours toward hepatitis B and its vaccination was analyzed secondarily. This transversal study was conducted from March 1st to June 13th 2013, at the Grenoble s CDAG. Every patient attending a consultation during the study period was invited to answer an anonymous questionnaire and to do a HBV serology as part of the screening procedure. From the 1136 patients attending the CDAG during the study period, 735 were included. VC reached 45,2% according to the patients declaration; 56,6% according to the vaccination booklets; and 55,4% according to serologies. 33 patients had a serologic test result indicating a previous contact with HBV, 7 were AgHBs carriers. Vaccination coverage was higher (69,1%) within the group aged from 25 to 32 years old (targeted by the 1994-1998 national vaccination campaign). The population considered hepatitis B as a serious illness but the risk perception was widely under-estimated. Vaccination against hepatitis B was distrusted as the controversy still remained on most patients mind. VC against HBV remains below the threshold recommended by the WHO. The shallow knowledge about hepatitis B may explain the low awareness of individual risk, accounting for low uptake of this vaccination that still suffers from public distrust. A communication effort directed toward both the general public and health care workers seems essential to improve practices.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Evaluation of psychological support for victims of sexual violence in a conflict setting: results from Brazzaville, Congo

ABSTRACT: BACKGROUND: Little is known about the impact of psychological support in war and transcultural contexts and in particular, whether there are lasting benefits. Here, we present an evaluation of the late effect of post-rape psychological support provided to women in Brazzaville, Republic of Congo. METHODS: Women who attended the Médecins Sans Frontières program for sexual violence in Brazzaville during the conflict were selected to evaluate the psychological consequences of rape and the late effect of post-rape psychological support. A total of 178 patients met the eligibility criteria: 1) Women aged more than 15 years; 2) raped by unknown person(s) wearing military clothes; 3) admitted to the program between the 1/1/2002 and the 30/4/2003; and 4) living in Brazzaville. RESULTS: The initial diagnosis according to DSM criteria showed a predominance of anxious disorders (54.1%) and acute stress disorders (24.6%). One to two years after the initial psychological care, 64 women were evaluated using the Trauma Screening Questionnaire (TSQ), the Global Assessment of Functioning scale (GAF) and an assessment scale to address medico-psychological care in emergencies (EUMP). Two patients (3.1%) met the needed criteria for PTSD diagnosis from the TSQ. Among the 56 women evaluated using GAF both as pre and post-test, global functioning was significantly improved by initial post-rape support (50 women (89.3%) had extreme or medium impairment at first post-rape evaluation, and 16 (28.6%) after psychological care; p = 0.04). When interviewed one to two years later, the benefit was fully maintained (16 women (28.6%) presenting extreme or medium impairment). CONCLUSION: We found the benefits of post-rape psychological support to be present and lasting in this conflict situation. However, we were unable to evaluate all women for the long-term impact, underscoring the difficulty of leading evaluation studies in unstable contexts. Future research is needed to validate these findings in other settings

Health care seeking behavior for diarrhea in children under 5 in rural Niger: results of a cross-sectional survey

Diarrhea remains the second leading cause of death in children under 5 years of age in sub-Saharan Africa. Health care seeking behavior for diarrhea varies by context and has important implications for developing appropriate care strategies and estimating burden of disease. The objective of this study was to determine the proportion of children under five with diarrhea who consulted at a health structure in order to identify the appropriate health care levels to set up surveillance of severe diarrheal diseases

A rapid screening tool for psychological distress in children 3--6years old: results of a validation study.

International audienceABSTRACT: BACKGROUND: The mental health needs of young children in humanitarian contexts often remain unaddressed. The lack of a validated, rapid and simple tool for screening combined with few mental health professionals able to accurately diagnose and provide appropriate care mean that young children remain without care. Here, we present the results of the principle cross-cultural validation of the "Psychological Screening for Young Children aged 3 to 6" (PSYCAa3-6). The PSYCa 3--6 is a simple scale for children 3 to 6 years old administered by non-specialists, to screen young children in crises and thereby refer them to care if needed. METHODS: This study was conducted in Maradi, Niger. The scale was translated into Hausa, using corroboration of independent translations. A cross-cultural validation was implemented using quantitative and qualitative methods. A random sample of 580 mothers or caregivers of children 3 to 6 years old were included. The tool was psychometrically examined and diagnostic properties were assessed comparing the PSYCa 3--6 against a clinical interview as the gold standard. RESULTS: The PSYCa 3--6 Hausa version demonstrated good concurrent validity, as scores correlated with the gold standard and the Clinical Global Impression Severity Scale (CGI-S) [rho = 0.41, p-value = 0.00]. A reduction procedure was used to reduce the scale from 40 to 22 items. The test-retest reliability of the PSYCa 3--6 was found to be high (ICC 0.81, CI95% [0.68; 0.89]). In our sample, although not the purpose of this study, approximately 54 of 580 children required subsequent follow-up with a psychologist. CONCLUSIONS: To our knowledge, this is the first validation of a screening scale for children 3 to 6 years old with a cross-cultural validation component, for use in humanitarian contexts. The Hausa version of the PSYCa 3--6 is a reliable and a valuable screening tool for psychological distress. Further studies to replicate our findings and additional validations of the PSYCa 3--6 in other populations may help improve the delivery of mental health care to children

De maladie négligée à maladie prioritaire (150 ans d'histoire de la trypanosomiase humaine africaine)

La trypanosomiase humaine africaine est une parasitose d'évolution aiguë pour la forme rhodésiense en Afrique de l'Est, plus chronique pour la forme gambiense dans le reste de l'Afrique sub-saharienne. Après transmission du parasite par piqûre d'une glossine la maladie évolue en deux phases, hémolymphatique puis neurologique, avant d'aboutir au décès inéluctable. Avec 300 000 à 500 000 malades estimés actuellement par l'OMS elle fait peser un lourd fardeau sur l'Afrique. L'OMS tente depuis de nombreuses années d'alerter la communauté médicale et politique de la réémergence de la maladie sur le continent africain. Cette prise de conscience semble aujourd'hui se faire. L'histoire de la maladie du sommeil s'est répétée de façon presque identique durant ces 150 dernières années : les premières épidémies débutèrent vers 1895 faisant en trente ans plus d'un million de morts. Les autorités ne s'en préoccupèrent que dans les années 20. Son accès au statut de maladie prioritaire permit alors son contrôle grâce à des hommes tels que le docteur Eugène Jamot, pour ne laisser persister que de très rares cas au début des années 60. Mais suite à l'indépendance des pays africains elle se propagea progressivement, pour arriver aujourd'hui, au bout de près de quarante ans d'indifférence, à la même situation que celle du début du siècle. Certains facteurs de cette réémergence sont liés à la maladie elle-même : c'est une infection complexe et difficilement contrôlable. Par ailleurs d'autres déterminants politiques, économiques et scientifiques, en condamnant la maladie du sommeil à l'indifférence depuis les années 60, ont contribué a sa réémergence. L'analyse de la période coloniale et de la fin du XXème siècle permet de mettre en évidence des déterminants communs qui ont entraîné la prise en charge de la trypanosomiase. On peut constater que l'accès au statut de maladie prioritaire est influencé par des déterminants politiques, sociologiques et économiques, qui convergent pour aboutir à la prise de conscience de la menace que représente cette maladie. Alors que l'espoir d'endiguer la progression de la maladie du sommeil était faible à la fin du XXème siècle, un nouvel optimisme renaît actuellement, autorisé par ce nouveau statut. Mais tout reste encore à faire.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Negative perceptions of hepatitis B vaccination among attendees of an urban free testing center for sexually transmitted infections in France

Background. Official French health care policy recommends vaccinations against hepatitis B for all infants and at-risk adults. Attendees at our free testing center for sexually transmitted infections (FTC-STI) routinely express hepatitis B vaccine hesitancy. We aimed in this exposed population to explore the extent of knowledge concerning HBV infection, to quantify HBV vaccine refusal, and to identify the reasons for this refusal. Methods. During a 3-month period in 2013, all attendees at the Grenoble FTC-STI were given an anonymous questionnaire exploring their knowledge of hepatitis B, perception of the hepatitis B vaccine, acceptance of free same-day hepatitis B vaccination, and reasons for refusing this offer (where applicable). Results. The questionnaire was completed by 735 attendees (64.7% of those attending during the study period)(59.9% men; age 27.9 ± 9.2). Most respondents identified hepatitis B as a potentially severe, potentially lifelong illness existing in France. Concerning the hepatitis B vaccine, less than 50% totally or mostly agreed that it is safe; when asked whether the vaccine is dangerous, 44.2% answered “I don't know” and 14.0% agreed; when asked whether the vaccine is “not well characterized,” 45.0%, answered “I don't know” and 26.5% agreed. When asked whether they mistrust the hepatitis B vaccine or all vaccines in general, 39.0% and 28.9% of those unvaccinated agreed, respectively. Two thirds refused to get vaccinated on the same day. When asked whether they were afraid of the adverse effects of this vaccine, only 18.7% disagreed. Conclusion. Negative perceptions of the hepatitis B vaccine are widespread in this at-risk population. Consequently, a successful communication strategy must reassure this at-risk population of the vaccine's innocuous nature

Mean and median weight, height or length, age and WH indices upon admission for all children (n = 68,001).

*<p>data missing for 730 children (including presence of edema for 394 children).</p>**<p>data missing for 674 children.</p

Flow diagram of observations retained in the analysis.

<p>Flow diagram of observations retained in the analysis.</p