Assessment of sedentary behaviors and transport-related activities by questionnaire: a validation study

ACTI-Cités consortiumInternational audienceBackground: Comprehensive assessment of sedentary behavior (SB) and physical activity (PA), including transport-related activities (TRA), is required to design innovative PA promotion strategies. There are few validated instruments that simultaneously assess the different components of human movement according to their context of practice (e.g. work, transport, leisure). We examined test-retest reliability and validity of the Sedentary, Transportation and Activity Questionnaire (STAQ), a newly developed questionnaire dedicated to assessing context-specific SB, TRA and PA. Methods: Ninety six subjects (51 women) kept a contextualized activity-logbook and wore a hip accelerometer (Actigraph GT3X + TM) for a 7-day or 14-day period, at the end of which they completed the STAQ. Activity-energy expenditure was measured in a subgroup of 45 subjects using the double labeled water (DLW) method. Test-retest reliability was assessed using intra-class-coefficients (ICC) in a subgroup of 32 subjects who filled the questionnaire twice one month apart. Accelerometry was annotated using the logbook to obtain total and context-specific objective estimates of SB. Spearman correlations, Bland-Altman plots and ICC were used to analyze validity with logbook, accelerometry and DLW data validity criteria. Results: Test-retest reliability was fair for total sitting time (ICC = 0.52), good to excellent for work sitting time (ICC = 0.71), transport-related walking (ICC = 0.61) and car use (ICC = 0.67), and leisure screen-related SB (ICC = 0.64-0.79), but poor for total sitting time during leisure and transport-related contexts. For validity, compared to accelerometry, significant correlations were found for STAQ estimates of total (r = 0.54) and context-specific sitting times with stronger correlations for work sitting time (r = 0.88), and screen times (TV/DVD viewing: r = 0.46; other screens: r = 0.42) than for transport (r = 0.35) or leisure-related sitting-times (r = 0.19). Compared to contextualized logbook, STAQ estimates of TRA was higher for car (r = 0.65) than for active transport (r = 0.41). The questionnaire generally overestimated work-and leisure-related SB and sitting times, while it underestimated total and transport-related sitting times.Conclusions : The STAQ showed acceptable reliability and a good ranking validity for assessment of context-specific SB and TRA. This instrument appears as a useful tool to study SB, TRA and PA in context in adults

Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination

Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require

A systematic review of correlates of sedentary behaviour in adults aged 18–65 years: a socio-ecological approach

Background: Recent research shows that sedentary behaviour is associated with adverse cardio-metabolic consequences even among those considered sufficiently physically active. In order to successfully develop interventions to address this unhealthy behaviour, factors that influence sedentariness need to be identified and fully understood. The aim of this review is to identify individual, social, environmental, and policy-related determinants or correlates of sedentary behaviours among adults aged 18-65 years. Methods: PubMed, Embase, CINAHL, PsycINFO and Web of Science were searched for articles published between January 2000 and September 2015. The search strategy was based on four key elements and their synonyms: (a) sedentary behaviour (b) correlates (c) types of sedentary behaviours (d) types of correlates. Articles were included if information relating to sedentary behaviour in adults (18-65 years) was reported. Studies on samples selected by disease were excluded. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42014009823). Results: 74 original studies were identified out of 4041: 71 observational, two qualitative and one experimental study. Sedentary behaviour was primarily measured as self-reported screen leisure time and total sitting time. In 15 studies, objectively measured total sedentary time was reported: accelerometry (n = 14) and heart rate (n = 1). Individual level factors such as age, physical activity levels, body mass index, socio-economic status and mood were all significantly correlated with sedentariness. A trend towards increased amounts of leisure screen time was identified in those married or cohabiting while having children resulted in less total sitting time. Several environmental correlates were identified including proximity of green space, neighbourhood walkability and safety and weather. Conclusions: Results provide further evidence relating to several already recognised individual level factors and preliminary evidence relating to social and environmental factors that should be further investigated. Most studies relied upon cross-sectional design limiting causal inference and the heterogeneity of the sedentary measures prevented direct comparison of findings. Future research necessitates longitudinal study designs, exploration of policy-related factors, further exploration of environmental factors, analysis of inter-relationships between identified factors and better classification of sedentary behaviour domains

ACCÈS À LA PRÉVENTION ET AUX SOINS DU CANCER DU COL DE L'UTÉRUS À OUAGADOUGOU (BURKINA FASO): Etude socio-anthropologique

Le cancer du col de l’utérus (CCU) est une pathologie qui a un impact considérable en termes de santé publique, en particulier dans les pays du Sud. En Afrique de l’Ouest, cette pathologie féminine représente une des principales causes de mortalité par cancer. Alors qu’il est démontré que l’accès aux services de prévention et de prise en charge aide à réduire significativement l’incidence de la maladie, les pays ouest-africains font face à des défis techniques, logistiques, financiers et socioculturels qui limitent l’accès à la prévention, au dépistage et à la prise en charge du CCU.C’est dans cette optique que Médecins du Monde (MdM) a initié un projet pilote de prévention du CCU en 2018 dans le district sanitaire de Baskuy à Ouagadougou, en vue d’améliorer le dépistage et la prise en charge précoce du CCU répondant aux recommandations internationales dans le pays.La présente étude socio-anthropologique vise à identifier les facteurs qui favorisent ou qui constituent des obstacles au dépistage et à la prise en charge des lésions précancéreuses et du CCU. Il s’agit de documenter les systèmes de contraintes qui entravent l’accès aux services de dépistage et de prise en charge du CCU à Ouagadougou selon une perspective individuelle et institutionnelle

ACCÈS À LA PRÉVENTION ET AUX SOINS DU CANCER DU COL DE L'UTÉRUS À OUAGADOUGOU (BURKINA FASO): Etude socio-anthropologique

Le cancer du col de l’utérus (CCU) est une pathologie qui a un impact considérable en termes de santé publique, en particulier dans les pays du Sud. En Afrique de l’Ouest, cette pathologie féminine représente une des principales causes de mortalité par cancer. Alors qu’il est démontré que l’accès aux services de prévention et de prise en charge aide à réduire significativement l’incidence de la maladie, les pays ouest-africains font face à des défis techniques, logistiques, financiers et socioculturels qui limitent l’accès à la prévention, au dépistage et à la prise en charge du CCU.C’est dans cette optique que Médecins du Monde (MdM) a initié un projet pilote de prévention du CCU en 2018 dans le district sanitaire de Baskuy à Ouagadougou, en vue d’améliorer le dépistage et la prise en charge précoce du CCU répondant aux recommandations internationales dans le pays.La présente étude socio-anthropologique vise à identifier les facteurs qui favorisent ou qui constituent des obstacles au dépistage et à la prise en charge des lésions précancéreuses et du CCU. Il s’agit de documenter les systèmes de contraintes qui entravent l’accès aux services de dépistage et de prise en charge du CCU à Ouagadougou selon une perspective individuelle et institutionnelle

Implementation of HPV-based screening in Burkina Faso: lessons learned from the PARACAO hybrid-effectiveness study

International audienceBackground: Cervical cancer screening in sub-Saharan countries relies on primary visual inspection with acetic acid (VIA). Primary human papillomavirus (HPV)-based screening is considered a promising alternative. However, the implementation and real-life effectiveness of this strategy at the primary-care level in limited-resource contexts remain under explored. In Ouagadougou, Burkina Faso, free HPV-based screening was implemented in 2019 in two primary healthcare centers. We carried out a process and effectiveness evaluation of this intervention. Methods: Effectiveness outcomes and implementation indicators were assessed through a cohort study of screened women, observations in participating centers, individual interviews with women and healthcare providers and monitoring reports. Effectiveness outcomes were screening completeness and women's satisfaction. Logistic regression models and concurrent qualitative analysis explored how implementation variability, acceptability by women and the context affected effectiveness outcomes. Results: After a 3-month implementation period, of the 350 women included in the cohort, 94% completed the screening, although only 26% had their screening completed in a single visit as planned in the protocol. The proportion of highly satisfied women was higher after result disclosure (95%) than after sampling (65%). A good understanding of the screening results and recommendations increased screening completeness and women's satisfaction, while time to result disclosure decreased satisfaction. Adaptations were made to fit healthcare workers' workload. Conclusion: Free HPV-based screening was successfully integrated within primary care in Ouagadougou, Burkina Faso, leading to a high level of screening completeness despite the frequent use of multiple visits. Future implementation in primary healthcare centers needs to improve counseling and reduce wait times at the various steps of the screening sequence

The challenge of achieving immunity through multiple-dose vaccines in Madagascar

International audienceMany childhood vaccines require multiple doses be delivered within a narrow time window to provide adequate protection and reduce disease transmission. Accurately quantifying vaccination coverage is complicated by limited individual-level data and multiple vaccination mechanisms (routine and supplementary vaccination programs). We analyzed 12,541 vaccination cards from six districts across Madagascar for children born in 2015 and 2016. For three vaccines – pentavalent diphtheria-tetanus-pertussis-HepB-Hib vaccine (DTP, 3 doses), pneumococcal conjugate vaccine (PCV10, 3 doses) and rotavirus vaccine (2 doses), we used the dates of vaccination and birth to estimate coverage at one-year of age and timeliness of delivery. Vaccination coverage at one-year of age for the first dose was consistently high with decreases for subsequent doses: DTP (91%, 81%, 72%), PCV10 (82%, 74%, 64%) and rotavirus (73%, 63%). Coverage between urban districts and their rural counterparts did not differ consistently. For each dose of DTP, the overall percentage of individuals receiving late doses was 29%, 7%, and 6%; estimates were similar for other vaccines. Vaccination weeks, designed to catch-up children who had missed routine care, did not appear to increase the likelihood of being vaccinated. Maintaining population-level immunity with multiple-dose vaccines requires a robust standalone routine immunization program

Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination

Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require

Survey of current policies towards widening cervical screening coverage among vulnerable women in 22 European countries.

BACKGROUND: This study aimed to investigate the status of cervical cancer screening (CCS) implementation in Europe by investigating national or regional policies towards broadening coverage of CCS amongst vulnerable subgroups of the population at high risk for CC. METHODS: A web-based survey was conducted between September 2021 and February 2022 with CCS programme managers and experts to identify and rank six population subgroups at high risk considered most vulnerable to CC and to map existing policies that addressed the coverage of CCS towards population sub-groups at risk. RESULTS: A total of 31 responses were received from experts covering 22 European countries. The results of this survey suggest that whilst many countries identify lower coverage of CCS amongst population subgroups at high risk of CC as a public health problem, few countries have developed dedicated policies towards broadening coverage among these subgroups. The six countries who reported having done so were concentrated in the Northern or Western European regions, suggesting the existence of geographical disparities within the continent. A key challenge in this respect is the difficulty to categorize subgroups of the target population; many individuals are burdened by intersectionality thereby resting in multiple categories, which may hinder the effectiveness of interventions targeted to reach specific subgroups. CONCLUSION: A greater clarity on the conceptualization of vulnerability can help countries to develop and subsequently implement strategies to increase coverage to subgroups of the target population currently underserved with regards to CCS