Une approche socioculturelle de l'hygiène au Cambodge : pratiques soignantes et risques de transmission virale

Les modalités de la transmission nosocomiale du VIH, du virus de l'hépatite B (VHB) et le virus de l'hépatite C (VHC), et les logiques socioculturelles sous-jacentes qui la favorisent semblent assez mal connues et peu étudiées à l'échelle mondiale. La question de l'hygiène en milieu sanitaire a été abordée à l'heure actuelle, essentiellement d'un point de vue biologique [1,2].Or, celle-ci est traversée et modelée par des normes et des représentations socioculturelles qui sous-tendent les pratiques favorisant ou limitant la transmission des pathologies, toujours inscrites au sein de relations sociales [3-5]. De 2006 à 2009, une équipe d'anthropologues du centre de recherche cultures, santé, sociétés de l'université d'Aix- Marseille a conduit un projet de recherche1 dont l'objectif était de produire des connaissances sur les conditions de la transmission iatrogène des VIH, VHB, VHC, en s'intéressant aux dimensions socioculturelles de l'hygiène hospitalière au Cambodge. Ce projet contribue à montrer comment, dans une perspective d'application, il est indispensable de mieux connaître les logiques sous-jacentes aux pratiques d'hygiène pour adapter des formations destinées aux professionnels de santé, voire aux populations

Transmission of HIV, HBV, HCV in health settings: an anthropological approach on hygiene in Cambodia

International audienceBackground: The modalities of HIV, HBV, HCV healthcare-associated infections and the underlying social and cultural logics contributing to this transmission are not precisely known, since hospital hygiene has mainly been studied from a biological point of view until now. However, hospital hygiene is shaped by norms and social-cultural representations, which increase or limit the transmission of infectious agents, always taking place within social relations. In 2006-2009, an anthropological research project (ANRS 12102) aimed at documenting those issues in various health settings in Cambodia. Practices related to hygiene were analyzed from a cultural point of view, especially since norms are interpreted at local level according to social and symbolic logics.Methods: We collected qualitative data in formal and informal sectors of care, mainly in general hospital services, maternity wards, primary health centers and in traditional practitioners’ private clinics. We interviewed many participants regarding hygiene practices and social relationships amongst the staff and between health care workers and patients. We also investigated the local representations of hygiene, their impact on the relationships between health care workers and patients and perceptions of transmission risks by health care workers.Results: In a context were hygiene practices were limited by the lack of adequate materials and equipments, other factors were identified, which influence and distort hygiene practices. They include: (1) informal and formal social relationships in hospitals, (2) major infection control roles played by cleaners in absence of professional acknowledgment, (3) lack of consideration for hygiene by health professionals that rely on low-ranking staff for hygiene practices. Besides these issues, various questions emerged regarding social science theory. Indeed, doing research on infectious disease transmission led us to include investigations and interpretations related to anthropology of development, historical and social perspectives on public health institutions, and social organization in hospital settings. The social condition of working class (the workers), the legal and illegal systems of care, various aspects related to the politics of reproduction were issues at stake, which leads to more general issues on social changes in Cambodia. Moreover, hygiene issue may be seen as an encounter of the biological body and the social body, whose construction and effects are deeply inscribed in the historical and contemporary forms of social organization and power distribution in Cambodia.Conclusion: Our anthropological findings illustrate the importance of comprehensive understanding of hygiene practices; they need to be considered when designing intervention to improve infection control practices in a Cambodian medical setting

Environmental Contamination during Influenza A Virus (H5N1) Outbreaks, Cambodia, 2006

To determine potential risk for bird-to-human transmission during influenza A virus (H5N1) outbreaks among backyard poultry in rural Cambodia, we collected environmental specimens. Viral RNA was detected in 27 (35%) of 77 specimens of mud, pond water, water plants, and soil swabs. Our results underscore the need for regular disinfection of poultry areas

Changes in Poultry Handling Behavior and Poultry Mortality Reporting among Rural Cambodians in Areas Affected by HPAI/H5N1

BACKGROUND: Since 2004, 21 highly pathogenic avian influenza H5N1 outbreaks in domestic poultry and eight human cases have been confirmed in Cambodia. As a result, a large number of avian influenza education campaigns have been ongoing in provinces in which H5N1outbreaks have occurred in humans and/or domestic poultry. METHODOLOGY/PRINCIPAL FINDINGS: Data were collected from 1,252 adults >15 years old living in two southern provinces in Cambodia where H5N1 has been confirmed in domestic poultry and human populations using two cross-sectional surveys conducted in January 2006 and in November/December 2007. Poultry handling behaviors, poultry mortality occurrence and self-reported notification of suspect H5N1 poultry cases to animal health officials in these two surveys were evaluated. Our results demonstrate that although some at risk practices have declined since the first study, risky contact with poultry is still frequent. Improved rates of reporting poultry mortality were observed overall, but reporting to trained village animal health workers decreased by approximately 50%. CONCLUSIONS/SIGNIFICANCE: Although some improvements in human behavior have occurred, there are still areas--particularly with respect to the handling of poultry among children and the proper treatment of poultry and the surrounding household environment--that need to be addressed in public health campaigns. Though there were some differences in the sampling methods of the 2006 and 2007 surveys, our results illustrate the potential to induce considerable, potentially very relevant, behavioral changes over a short period of time