Adoption d’une culture contraceptive et maîtrise du projet familial. La contraception constitue-t-elle une Capabilité?

Nous examinons les facteurs d’adoption d’une « culture contraceptive », décrite par la connaissance, la pratique et les intentions, et ses liens avec l’espacement des naissances. L’analyse des enquêtes EDS Mali (2006) et Ghana (2008) montre la persistance du fossé entre connaissance et pratique - la connaissance de la contraception ne gomme pas les inégalités de pratique - et le rôle des « facteurs de conversion ». Ainsi l’avantage des habitants des grandes villes disparaît lorsque l’on contrôle pour les caractéristiques personnelles. Les comportements des femmes apparaissent influencés par la réalité de leur situation familiale, alors que ceux des hommes reposeraient plus sur des valeurs. Finalement, ce n’est pas l’adoption de la contraception qui importe pour l’espacement des naissances, mais le profil des femmes qui l’adoptent : la contraception ne constitue pas une Capabilité - une dimension de la liberté de planifier sa famille - mais un moyen parmi d’autres pour espacer les naissances

Seasonality and shift in age-specific malaria prevalence and incidence in Binko and Carrière villages close to the lake in Selingué, Mali

BACKGROUND: Malaria transmission in Mali is seasonal and peaks at the end of the rainy season in October. This study assessed the seasonal variations in the epidemiology of malaria among children under 10 years of age living in two villages in Selingué: Carrière, located along the Sankarani River but distant from the hydroelectric dam, and Binko, near irrigated rice fields, close to the dam. The aim of this study was to provide baseline data, seasonal pattern and age distribution of malaria incidence in two sites situated close to a lake in Selingué. METHODS: Geographically, Selingué area is located in the basin of Sakanrani and belongs to the district of Yanfolila in the third administrative region of Mali, Sikasso. Two cross-sectional surveys were conducted in October 2010 (end of transmission season) and in July 2011 (beginning of transmission season) to determine the point prevalence of asymptomatic parasitaemia, and anaemia among the children. Cumulative incidence of malaria per month was determined in a cohort of 549 children through active and passive case detection from November 2010 through October 2011. The number of clinical episodes per year was determined among the children in the cohort. Logistic regression was used to determine risk factors for malaria. RESULTS: The prevalence of malaria parasitaemia varied significantly between villages with a strong seasonality in Carrière (52.0–18.9 % in October 2010 and July 2011, respectively) compared with Binko (29.8–23.8 % in October 2010 and July 2011, respectively). Children 6–9 years old were at least twice more likely to carry parasites than children up to 5 years old. For malaria incidence, 64.8–71.9 % of all children experienced at least one episode of clinical malaria in Binko and Carrière, respectively. The peak incidence was observed between August and October (end of the rainy season), but the incidence remained high until December. Surprisingly, the risk of clinical malaria was two- to nine-fold higher among children 5–9 years old compared to younger children. CONCLUSIONS: A shift in the peak of clinical episodes from children under 5–9 years of age calls for expanding control interventions, such as seasonal malaria chemoprophylaxis targeting the peak transmission months

Improving malaria control in West Africa: interruption of transmission as a paradigm shift.

With the paradigm shift from the reduction of morbidity and mortality to the interruption of transmission, the focus of malaria control broadens from symptomatic infections in children ≤5 years of age to include asymptomatic infections in older children and adults. In addition, as control efforts intensify and the number of interventions increases, there will be decreases in prevalence, incidence and transmission with additional decreases in morbidity and mortality. Expected secondary consequences of these changes include upward shifts in the peak ages for infection (parasitemia) and disease, increases in the ages for acquisition of antiparasite humoral and cellular immune responses and increases in false-negative blood smears and rapid diagnostic tests. Strategies to monitor these changes must include: (1) studies of the entire population (that are not restricted to children ≤5 or ≤10 years of age), (2) study sites in both cities and rural areas (because of increasing urbanization across sub-Saharan Africa) and (3) innovative strategies for surveillance as the prevalence of infection decreases and the frequency of false-negative smears and rapid diagnostic tests increases