Évaluation d’un programme de promotion de la santé des jeunes au Cameroun

La baisse de plus en plus marquée de l’âge au premier rapport sexuel et l’augmentation de l’âge au premier mariage impliquent une durée plus longue d’exposition au risque des grossesses prénuptiales et aux infections sexuellement transmissibles incluant le VIH/sida. C’est pourquoi des interventions ont été mises en place en vue de protéger la santé des adolescents et jeunes. L’Observatoire de Population en Épidémiologie Socio-Clinique (POSE) conçu et mis sur pied au Cameroun depuis 1995, a fait de la santé des adolescents et jeunes une de ses priorités de santé publique en Afrique à travers le programme de promotion de la santé reproductive des adolescents et jeunes au Cameroun (CAREH). Le Programme CAREH mène des activités d’intervention dans la préfecture de Bandjoun depuis juillet 2000, et dans plusieurs autres régions du Cameroun depuis 2003. Cette thèse vise à évaluer certains aspects de cette intervention, en examinant dans quelle mesure entre 2000 et 2002, les activités d’intervention menées auraient contribué : 1) au report à plus tard du premier rapport sexuel chez les adolescents de 10 à 20 ans ; 2) à la prévention des grossesses non désirées chez les jeunes de 10 à 29 ans ; et 3) à la prévention de l’infection à VIH chez les jeunes de 10 à 29 ans. Les données proviennent de l’Enquête sur la Famille et la Santé au Cameroun (EFSC), menée à Bandjoun en 2002. Un devis post-intervention a été utilisé après stratification des adolescents et jeunes en quatre groupes à savoir : jeunes exposés à l’intervention en milieu communautaire, jeunes exposés à l’intervention en milieu scolaire, jeunes non scolarisés non-exposés à l’intervention et jeunes scolarisés non-exposés à l’intervention. Les analyses descriptives et les analyses multivariées utilisant la régression logistique ont été utilisées pour examiner les associations présumées entre les variables d’intervention et les variables dépendantes considérées par rapport aux hypothèses de recherche émises. Nos analyses suggèrent que les adolescents scolarisés qui n’avaient pas déclaré avoir été exposés à l’intervention (RC = 1,973 ; IC =1,195-3,260) sont plus portés à avoir une perception négative de la sexualité prémaritale, que les adolescents non scolarisés n’ayant pas déclaré avoir été exposés aux activités d’intervention. Il n’y avait cependant pas de report significatif du premier rapport sexuel dans les groupes d’adolescents exposés à l’intervention par rapport à ceux non-exposés. Les connaissances sur la prévention des grossesses sont significativement plus élevées chez les jeunes scolarisés non-exposés (RC=1,953; IC=1,452 – 2,627), jeunes exposés à l’intervention en milieu communautaire (RC = 3,074 ; IC = 2,157 - 4,382) et les jeunes exposés à l’intervention en milieu scolaire (RC = 4,962 ; IC = 3,367 - 7,311) que chez les jeunes non scolarisés n’ayant pas déclaré avoir été exposés aux activités d’intervention. Il n’y a aucune différence statistiquement significative entre ces différents groupes quant à l’utilisation de la contraception moderne. La discussion sur la prévention des grossesses ou l’utilisation de la contraception avec un formateur était significativement associée à une amélioration des connaissances en prévention de grossesses chez les jeunes exposés à l’intervention en milieu scolaire (RC = 1,549 ; IC = 1,056 – 2,272), comparativement à leurs camarades exposés aux activités d’intervention en milieu communautaire sans avoir bénéficié d’une telle discussion. Les jeunes exposés à l’intervention en milieu communautaire (RC = 2,106 ; IC = 1,514 – 2,930) et ceux exposés l’intervention en milieu scolaire (RC = 3,117 ; IC = 2,192 – 4,433) connaissent mieux les modes de prévention de l’infection à VIH que les jeunes scolarisés mais n’ayant pas été exposés aux activités d’intervention. Il n’y avait toutefois pas de différences entre les groupes quant à l’utilisation du condom. Ces conclusions sont interprétables dans les limites des données disponibles. En effet, il n’a pas été possible de déterminer les niveaux de connaissances en prévention de grossesses ou du VIH avant l’exposition des jeunes à l’intervention. Ainsi, chez les jeunes exposés en milieu communautaire ou scolaire, on ne peut savoir quel aurait été leur niveau de connaissance en l’absence de l’intervention. Toutefois, il est très probable que l’intervention ait eu plus d’effets bénéfiques sur l’amélioration des connaissances que des comportements.Early sexual initiation and delayed marriage are concurrently happening in most environments in Africa where traditionally early marriage and sexual initiation within marital union were more prevalent. This lengthens the time of exposure of young people to the risk of premarital sex and unwanted pregnancies as well as sexually transmitted infections including HIV/AIDS. Hence, several interventions have been carried out to promote the sexual and reproductive health of adolescents and young people. The Population Observatory in Socio-Clinical Epidemiology (POSE) designed and implemented since 1995 in Cameroon, had targeted the reproductive health promotion of adolescents and young people as one of its priorities, through the Cameroon Adolescent and Youth Reproductive Health Promotion Program (CAREH). The CAREH Program has been carrying out a series of intervention activities in the prefecture of Bandjoun since July 2000 and many other parts of Cameroon since 2003. This thesis evaluates some aspects of this intervention by examining the extent to which the intervention activities undertaken between 2000 and 2002 have contributed to: 1) delaying first sexual intercourse among adolescents aged 10 to 20 years, 2) preventing unwanted pregnancies among young people aged 10 to 29 years, and 3) preventing HIV infection among young people aged 10 to 29 years. Data came from the 2002 Cameroon Family and Health Surveys (CFHS). A post-test design was used which divided adolescents and youth into four intervention groups (out-of-school youth unexposed to the intervention, young people enrolled in schools and unexposed to the intervention, young people exposed to the intervention in the community and young people exposed to the intervention in school settings). Descriptive analyses and multivariate logistic regression were used to assess the possible associations between intervention and outcomes variables, given the enunciated research hypotheses. Adolescents attending school who reported no exposure to the intervention (OR = 1.973; CI = 1.195 to 3.260) were more likely to have a negative perception of premarital sex than out-of-school and unexposed adolescents. However, there were no significant differences in delaying the first sexual intercourse among adolescents exposed to the intervention compared to those not exposed. Knowledge about the prevention of pregnancy was significantly higher among unexposed students (OR = 1.953, CI = 1.452-2.627), youth exposed to the intervention in the community (OR = 3.074; CI = 2.157-4.382) and youth exposed to the intervention in school (OR = 4.962, CI = 3.367 to 7.311) than among those not exposed and not in school. No statistically significant difference was found between these groups regarding the use of modern contraception. The discussion about pregnancy prevention or contraceptive use led by a CAREH peer-educator significantly improved knowledge about pregnancy prevention for youth exposed to the intervention in school compared to their peers exposed in community where such discussion did not occur (OR = 1.549, CI = 1.056 to 2.272). Young people exposed to the intervention in community settings (OR = 2.106, CI = 1.514-2.930) and those exposed in school settings (OR = 3.117, CI = 2.192-4.433) significantly improved their knowledge about HIV prevention more than out-of-school youth unexposed to the intervention. Nevertheless, there were no significant differences between groups regarding the use of condom. These findings should be interpreted within the limits of available data. Indeed, it was not possible to determine the level of knowledge about pregnancy prevention or HIV prevention among young people exposed to the intervention before hand. Therefore, it is impossible to know what level of knowledge young people exposed to the intervention would have had in the absence of the intervention. However, given the results comparing the four stratified groups, it is likely that the intervention had more beneficial effects on improving knowledge than behaviours

Effects of soil–structure interaction on the design of tuned mass damper to control the seismic response of wind turbine towers with gravity base

This paper studies the effect of soil–structural interaction (SSI) on gravity‐based wind turbine towers equipped with tuned mass dampers (TMDs) subjected to earthquake loading. A small‐scale shaking table test of wind turbine towers with TMD was conducted, and the results showed that using TMD designed considering SSI resulted in larger vibration suppression. A simplified analytical numerical model was developed for SSI analysis considering TMD. The effect of soil site class and the earthquake intensity on the response reduction efficiency of the TMD was also discussed using the simplified model. It is concluded that the TMD efficiency depends not only on the soil stiffness but also on the characteristics of the applied ground motions, both of which are affected by the site classes and earthquake intensity levels. Moreover, the peak acceleration ratio (PAR), the root mean square acceleration ratio (RAR), the peak displacement ratio (PDR), and the root mean square displacement ratio (RDR) of the top of the wind turbine tower were obtained with and without TMD for different earthquake intensities and sites. These parameters can be used as references for the rational selection of TMD parameters considering SSI

Global fire activity patterns (1996-2006) and climatic influence: an analysis using World Fire Atlas

Vegetation fires have been acknowledged as an environmental process of global scale, which affects the chemical composition of the troposphere, and has profound ecological and climatic impacts. However, considerable uncertainty remains, especially concerning intra and inter-annual variability of fire incidence. The main goals of our globalscale study were to characterise spatial-temporal patterns of fire activity, to identify broad geographical areas with similar vegetation fire dynamics, and to analyse the relationship between fire activity and the El Ni˜no-Southern Oscillation. This study relies on 10 years (mid 1996–mid 2006) of screened European Space Agency World Fire Atlas (WFA) data, obtained from Along Track Scanning Radiometer (ATSR) and Advanced ATSR (AATSR) imagery. Empirical Orthogonal Function analysis was used to reduce the dimensionality of the dataset. Regions of homogeneous fire dynamics were identified with cluster analysis, and interpreted based on their eco-climatic characteristics. The impact of 1997–1998 El Ni˜no is clearly dominant over the study period, causing increased fire activity in a variety of regions and ecosystems, with variable timing. Overall, this study provides the first global decadal assessment of spatialtemporal fire variability and confirms the usefulness of the screened WFA for global fire ecoclimatology researc

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Barriers and facilitators to HIV and syphilis rapid diagnostic testing in antenatal care settings in low-income and middle-income countries: A systematic review

Background Testing and treatment during pregnancy is a well-established and cost-effective prevention strategy, which relies largely on use of rapid diagnostic tests (RDTs). Yet, in many low-income and-middle-income countries, the uptake of RDTs is suboptimal. A qualitative meta-synthesis was conducted to identify the barriers and enablers to use of HIV and syphilis RDTs among pregnant women in low-income and middle-income countries. Methods This review was conducted using PRISMA guidelines. Eligible studies included peer-reviewed publications, which used qualitative methods to explore HIV and syphilis RDT in antenatal care clinics in low-income and middle-income countries. Studies focusing on perspectives of pregnant women, healthcare workers and/or stakeholders were included. We used an inductive approach informed by a modified socioecological model to synthesise the data. Results 62 manuscripts met the eligibility criteria. For pregnant women, initial acceptance of the RDT and continuation in antenatal care depends on the perception that engaging in testing will be a beneficial experience for their baby and themselves, often influenced by the provision of services that are gender-sensitive, confidential, respectful, flexible and considers their well-being into the future. Local sociocultural beliefs about pregnancy and diseases, awareness of diseases and gender roles in society also influenced RDT acceptability among pregnant women. For healthcare workers, the ability to provide high-quality RDT care required ongoing training, accurate and easy to use tests, support from supervisors and communities, sufficient resources and staffing to provide services, and reliable salary. At the stakeholder level, well-developed guidelines and health system infrastructures were imperative to the delivery of RDT in antenatal clinics. Conclusion Our findings highlight clear gaps to the provision of sustainable and culturally acceptable maternal HIV and/or syphilis screening using RDTs. In addition, greater attention needs to be paid to community stakeholders in promoting the uptake of RDT in antenatal clinics. PROSPERO registration number CRD42018112190

Knowledge, attitudes and practices of obstetrical ultrasound in Conakry, Guinea

Background: The authors report an initial assessment of the practice of obstetrical ultrasound in Conakry in order to make suggestions to improve the quality of services in Guinea.Methods: It is about a cross-sectional study of three months (August 1st to October 31st, 2013) conducted in Conakry. The study population consisted of health personnel performing fetal ultrasounds in Conakry and who agreed to participate in the survey. The data collected were about the socio-professional characteristics of the service providers, their knowledge and attitudes. The data were analyzed in a simple descriptive statistical analysis way. The results were analyzed according to the norms and standards issued by the French Fetal Ultrasound College and the National Technical Committee for Prenatal Diagnosis Ultrasound.Results: Twenty one service providers over twenty-six (80.8%) were male (80.8%) aged 40-49 years old (46.2%), obstetrician-gynecologists (76.9%), working in a public hospital (46.2%) and not having an ultrasound degree (59.2%). Eight service providers over twenty-six ((30.8%) affirmed knowing the recommended period for a fetal biometry. The majority (60%) indicated measuring the nuchal translucency and 85.2% (22/26) the craniocaudal length. The anatomical landmarks were not correctly identified in 75.2% of cases for the biparietal and the head circumference and in 63.8% of cases for abdominal circumference. Nine service providers over twenty-six (34.6%) affirmed explaining the limitations of ultrasound. Eighteen devices over twenty-six (69.2%) had more than 9 years of age, 73% (19/26) of them did not have a vaginal probe and 65.3% (17/26) did not have a pulsed wave Doppler.Conclusions: Improving the quality of the practice of obstetrical ultrasound in Guinea goes through training of service providers, establishing distribution and compliance with norms and standards as well as quality control of ultrasound devices

Pancreaticogastrostomy After Pancreatoduodenectomy

The aim of this study was to evaluate the place of pancreaticogastrostomy (PG) in reducing pancreatic fistula after pancreatoduodenectomy. From January 1988 to June 1991, 32 consecutive patients (mean age, 57 years) were operated on, 25 for malignant disease (78%). The pancreatic remnant was normal in 17 patients (53%) and sclerotic in the others. There was one operative death (3.1%) unrelated to PG. Post-operative complications occurred in five patients (16%). Only two complications were related to PG: 1 patient had anastomotic intra-gastric bleeding and was reoperated on, 1 patient with a normal pancreatic remnant developed a pancreatic fistula (3.1%) treated conservatively

Theory of Light Emission in Sonoluminescence as Thermal Radiation

Based on the model proposed by Hilgenfeldt {\it at al.} [Nature {\bf 398}, 401 (1999)], we present here a comprehensive theory of thermal radiation in single-bubble sonoluminescence (SBSL). We first invoke the generalized Kirchhoff's law to obtain the thermal emissivity from the absorption cross-section of a multilayered sphere (MLS). A sonoluminescing bubble, whose internal structure is determined from hydrodynamic simulations, is then modelled as a MLS and in turn the thermal radiation is evaluated. Numerical results obtained from simulations for argon bubbles show that our theory successfully captures the major features observed in SBSL experiments.Comment: 17 pages, 20 figure

Impacts of sorghum and millet research in West and Central Africa (WCA): A synthesis and lessons learnt. Working Paper Series no. 22

In a time of increasing scrutiny about the usefulness of investments in agricultural research, impact assessment studies assist to demonstrate the value of continued investments in research. Lessons learnt from impact assessments can be used to improve future research strategies, plans and management. This paper reviews and synthesizes the findings of various studies on the adoption and impact of the research on sorghum and millet technologies in West and Central Africa (WCA). The review covers Burkina Faso, Cameroon, Chad, Mali, Nigeria and Niger, where relatively more breeding research has been conducted. Furthermore, the information presented in this paper is mainly drawn from the diffusion and impacts of varieties generated by ICRISAT and the national agricultural research systems (NARS) of WCA. Findings from reviewed studies show that returns to research (and diffusion) investments are quite high, but the performance varies across countries. These results could be of use to policy makers, donors and other scientists within the region of WCA. This fundamental information about the levels of adoption and impact of sorghum and millet is critical for priority setting and impact assessment. However, the results of the studies reviewed also indicate that if improved technology is to make a meaningful impact at the farm level, it must be accompanied by at least three complementary factors: (1) an effective extension service, (2) an efficient inputs distribution system, and (3) appropriate economic incentives