The social dynamics of infant immunisation in Africa : perspectives from the Republic of Guinea

Infant immunisation is currently a focus of national and global policy attention in relation to Africa as a key means to address ill-health and contribute to the Millennium Development Goals. Yet vaccination coverage is stagnant or falling in many African countries. Redressing such declines, and ensuring the effectiveness and sustainability of proposed expansion of immunisation programmes, requires a sound understanding of the factors shaping vaccine delivery and acceptance in contemporary African health systems. This paper explores these issues through an anthropological approach. It considers how vaccine delivery is influenced by the wider context of the health care system; how vaccination demand is shaped by socially-differentiated knowledges and political identities, and how interactions with delivery institutions and their frontline health workers unfold. It focuses on urban and rural sites in the Republic of Guinea, where dominant policy perspectives often see increasing immunisation coverage as a matter of (a) improving demand through educational approaches that enhance people’s biomedical understandings of the reasons for vaccination, and quell misguided ‘anti-vaccination’ rumours, and (b) redressing supply difficulties through improvements to vaccine delivery system infrastructure, financing and management. In contrast, our ethnographic findings suggest that high demand already exists, although underlain by socially- embedded forms of knowledge and reasoning that fail to match, and often contradict, biomedical views. Yet people frequently cannot realise effective access to vaccines, less because of inherent problems in vaccine delivery systems, but because of the ways these are embedded in the multiple, pluralised processes through which health services are now provided in the Guinean context. As health workers struggle to cope with provision dilemmas, interactions arise which mothers often experience as negative, and which can deter their future demand. Such an analysis, and its implications for policy, emerge only through detailed ethnography of what vaccination practices actually mean to Guinean parents in the context of everyday child care and social relations. Keywords: immunisation, vaccination, Guinea

Knowledge, attitudes and practices towards viral haemorrhagic fevers amongst healthcare workers in urban and rural public healthcare facilities in the N'zérékoré prefecture, Guinea: a cross-sectional study

BACKGROUND The 2013-2016 Ebola epidemic in West Africa began in Guinea's Forest region, a region now considered to be at high risk for future epidemics of viral haemorrhagic fevers (VHF). Good knowledge, attitudes and practices towards VHF amongst healthcare workers in such regions are a central pillar of infection prevention and control (IPC). To inform future training in IPC, this study assesses the knowledge, attitudes and practices (KAP) towards VHF amongst healthcare workers in public healthcare facilities in the most populated prefecture in Forest Guinea, and compares results from urban and rural areas. METHODS In June and July 2019, we interviewed 102 healthcare workers in the main urban and rural public healthcare facilities in the N'zérékoré prefecture in Forest Guinea. We used an interviewer-administered questionnaire adapted from validated KAP surveys. RESULTS The great majority of respondents demonstrated good knowledge and favourable attitudes towards VHF. However, respondents reported some gaps in preventive practices such as VHF suspect case detection. They also reported a shortage of protective medical equipment used in everyday clinical work in both urban and rural healthcare facilities and a lack of training in IPC, especially in rural healthcare facilities. However, whether or not healthcare workers had been trained in IPC did not seem to influence their level of KAP towards VHF. CONCLUSIONS Three years after the end of the Ebola epidemic, our findings suggest that public healthcare facilities in the N'zérékoré prefecture in Forest Guinea still lack essential protective equipment and some practical training in VHF suspect case detection. To minimize the risk of future VHF epidemics and improve management of outbreaks of infectious diseases in the region, current efforts to strengthen the public healthcare system in Guinea should encompass questions of supply and IPC training

[Commentary] Spillover or endemic? Reconsidering the origins of Ebola virus disease outbreaks by revisiting local accounts in light of new evidence from Guinea

No description supplie

Assessment of Post-abortion Care Services in Two Health Facilities in Conakry, Guinea

High quality post-abortion care (PAC) is needed to curb maternal deaths by providing effective treatment and preventing future unintended pregnancies through PAC family planning. This study aimed at assessing PAC services with a focus on women‘s satisfaction with care they received in two health facilities in Conakry. We conducted a cross-sectional mixed method study with 426 PAC clients from March 1st to August 31st, 2014. Data analyses were performed using Stata software version 14 for quantitative data and using a thematic approach for qualitative data. Overall, 92.5% of women were satisfied with PAC services they received. The short waiting time (< 30 min), the appropriate management of pain during the treatment, the affordable cost of the treatment, the confidentiality of services, the good patient-provider interaction and the cleanliness of the premises were factors statistically significantly associated with the satisfaction of women (P-value ˂ 0.001). This study showed a high rate ofwomen‘s satisfaction. Nevertheless, health authorities should assure a regular follow-up on the application of official prices for the treatment of PAC patients; and providers should further consider aspects such as pain management during treatment, confidentiality of services, patient-provider interaction for optimal satisfaction of clients with PAC services. Keywords: Assessment, Post-abortion care, Health facilities, GuineaDes soins post-avortement (SAA) de haute qualité sont nécessaires pour réduire les décès maternels en fournissant un traitement efficace et en prévenant les futures grossesses non désirées grâce à la planification familiale après-avortement. Cette étude visait à évaluer les services de SAA en mettant l'accent sur la satisfaction des femmes à l'égard des soins qu'elles ont reçus dans deux établissements de santé à Conakry. Nous avons mené une étude transversale à méthodes mixtes auprès de 426 clientes de SAA du 1er mars au 31 août 2014. Les analyses de données ont été réalisées à l'aide du logiciel Stata version 14 pour les données quantitatives et en utilisant une approche thématique pour les données qualitatives. Dans l'ensemble, 92,5% des femmes étaient satisfaites des services de SAA qu'elles ont reçus. Le temps d'attente court (<30 min), la gestion appropriée de la douleur pendant le traitement, le coût abordable du traitement, la confidentialité des services, la bonne interaction patiente -prestataire et la propreté des locaux étaient des facteurs statistiquement significativement associés à la satisfaction des femmes (valeur P ˂0,001). Cette étude a montré un taux élevé de satisfaction des femmes. Néanmoins, les autorités sanitaires devraient assurer un suivi régulier de l'application des prix officiels pour le traitement des patientes de SAA; et les prestataires devraient en outre prendre en compte des aspects tels que la gestion de la douleur pendant le traitement, la confidentialité des services, l'interaction patiente-prestataire pour une satisfaction optimale des clientes à l‘égard des services de SAA. Mots-clés: Évaluation, Soins post-avortement, Établissements de santé, Guiné

Evaluation of caesarean section practices according to Robson's 10-group classification at a level two maternity ward in Conakry, Guinea

Background: The frequency of caesarean sections (CS) increased dramatically in the world over the last twenty years. The objective of this study was to evaluate caesarean section practices based on Robson classification in an urban referral hospital in Conakry, GuineaMethods: We conducted a cross-sectional study of 2,266 birthing records collected at the maternity ward of the Coronthie Communal Medical Center in Conakry, from January 1st to December 31st 2016. We included in the study all women who had a caesarean section and whose medical records were complete. Robson's classification was used to classify women into 10 groups based on maternal and fetal characteristics. The relative size of each group, its gross caesarean section rate as well as its contribution to overall caesarean section rate and the main caesarean section indications were calculated.Results: In 2016, 769 caesarean sections were performed out of 2,266 deliveries, corresponding to a hospital section rate of 33.9%. Groups 5 (11.0%), 1 (4.8%), and 3 (4.3%) of the Robson classification were the most contributors to registered hospital caesarean section rate. The main indications for caesarean section were uterine scar in group 5 and acute fetal distress in groups 1 and 3.Conclusions: The systematic reference to the Robson classification could help to identify and avoid the relative indications of the caesarean section in urban Guinea. Besides, increasing induction of labor and strengthening providers’ capacities in emergency obstetric and newborn care services could contribute to reduce caesarean section rates in Guinea

Antiproliferative and apoptotic effects of pinocembrin in human prostate cancer cells

Pinocembrin, (5, 7-dihydroxyflavanone), has been shown to possess anticancer activity against various cancer cells. However, its effect against prostate cancer cells remained enigmatic. In this study, for the first time, we investigated whether pinocembrin could inhibit growth of human prostate cancer cells. MTT assay and flow cytometric analysis were performed to examine the effects of pinocembrin on cell proliferation, cell cycle, and apoptosis. The results revealed that pinocembrin attenuated the cell viability of both androgen-sensitive (LNCaP) as well as androgen-independent (PC3 and DU-145) prostate cancer cell lines, with different p53 status. Further characterization showed that pinocembrin markedly induced apoptosis of LNCaP cells and arrested cell cycle at S and G2/M phase and involved in the dissipation of mitochondrial membrane potential before culminating in apoptosis in pinocembrin-treated LNCaP cells. These in vitro results suggested that pinocembrin should be further examined for in vivo activity in human prostate cancer

Maternal education is associated with vaccination status of infants less than 6 months in Eastern Uganda: a cohort study

<p>Abstract</p> <p>Background</p> <p>Despite provision of free childhood vaccinations, less than half of all Ugandan infants are fully vaccinated. This study compares women with some secondary schooling to those with only primary schooling with regard to their infants' vaccination status.</p> <p>Methods</p> <p>A community-based prospective cohort study conducted between January 2006 and May 2008 in which 696 pregnant women were followed up to 24 weeks post partum. Information was collected on the mothers' education and vaccination status of the infants.</p> <p>Results</p> <p>At 24 weeks, the following vaccinations had been received: bacille Calmette-Guérin (BCG): 92%; polio-1: 91%; Diphteria-Pertussis-Tetanus-Hepatitis B-Haemophilus Influenza b (DPT-HB-Hib) 3 and polio-3: 63%. About 51% of the infants were fully vaccinated (i.e., had received all the scheduled vaccinations: BCG, polio 0, polio 1, DPT-HB-Hib1, polio 2, DPT-HB-Hib 2, polio 3 and DPT-HB-Hib 3). Only 46% of the infants whose mothers' had 5-7 years of primary education had been fully vaccinated compared to 65% of the infants whose mothers' had some secondary education. Infants whose mothers had some secondary education were less likely to miss the DPT-HB-Hib-2 vaccine (RR: 0.5, 95% CI: 0.3, 0.8), Polio-2 (RR: 0.4, 95%CI: 0.3, 0.7), polio-3 (RR: 0.5, 95%CI: 0.4, 0.7) and DPT-HB-Hib-3 (RR: 0.5, 95%CI: 0.4, 0.7). Other factors showing some association with a reduced risk of missed vaccinations were delivery at a health facility (RR = 0.8; 95%CI: 0.7, 1.0) and use of a mosquito net (RR: 0.8; 95%CI: 0.7, 1.0).</p> <p>Conclusion</p> <p>Infants whose mothers had a secondary education were at least 50% less likely to miss scheduled vaccinations compared to those whose mothers only had primary education. Strategies for childhood vaccinations should specifically target women with low formal education.</p

Genre et classes dans les langues à classes d'Afrique

Tamba Millimouno Marcel. Genre et classes dans les langues à classes d'Afrique. In: Linx, n°21, 1989. Genre et langage. Actes du colloque tenu à Paris X-Nanterre les 14-15-16 décembre 1988, sous la direction de Eliane Koskas et Danielle Leeman. pp. 181-190