Family planning: formal health care providers’ challenges in the district of Antananarivo Avaradrano

Background: Recorded contraceptive prevalence may not represent all the women using contraceptives. Nevertheless, it serves as a fundamental tool in decision-making at Ministry and international level. This study aims to determine the actual contraceptive prevalence and identify factors determining users’ positions about modern contraception and local services deliveries in the district of Antananarivo Avaradrano.Methods: A cross-sectional survey was conducted, where an interviewer-administered questionnaire has been used to collect data. Targeted female respondents aged 18-39 were asked about their contraceptive use, knowledge and information sources on family planning, perception of social support and perception on the local health care providers.Results: Contraceptive prevalence is underestimated. Moreover, it is higher among women aged 35 to 39 and those having two children or more, but lower among those who have reached university level of education. Women who are able to tell two benefits of family planning, informed by the community health agents (CHA), and deciding with their partners on contraception use are more likely to use contraceptives on a regular basis. Women complain on their poor relationship with health care providers and doubt about their real competence.Conclusions: This study demonstrates the evidence of an underestimation of contraceptive prevalence. The challenge is how to collect reliable data, thus recording systems have to be improved. Besides, government efforts in increasing contraceptive use ought to be targeted on adolescents and young people aged 20-25, the couple itself, health-care provider – woman relationship, and on the CHA’s activities.

A 36 ka environmental record in the southern tropics : Lake Tritrivakely (Madgascar) (Un enregistrement de l'environnement depuis 36 ka en zone tropicale sud : le lac Tritrivakely (Madagascar)).

The upper 13 m of a 40 m-long sedimentary profile core taken in a crater lake on the Malagasy Plateau reveals 36,000 yrs of hydroclimatic evolution. A shallow lake occupies the core site from ≃35 to ≃19 ka BP under climatic conditions cooler than today. The water table is very low and biological productivity extremely reduced during the Last Glacial Maximum. A large warming was initiated at ≃14.5 ka BP. The modern bog establishes about 4 ka ag

An approximate inversion method of geoelectrical sounding data using linear and Bayesian statistical approaches. Examples of Tritrivakely volcanic lake and Mahitsy area (Central part of Madagascar)

Consiglio Nazionale delle Ricerche (CNR). Biblioteca Centrale / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients

International audienceThe aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed

Rilpivirine in HIV-1-positive women initiating pregnancy: to switch or not to switch?

International audienceBackgroundSafety data about rilpivirine use during pregnancy remain scarce, and rilpivirine plasma concentrations are reduced during second/third trimesters, with a potential risk of viral breakthroughs. Thus, French guidelines recommend switching to rilpivirine-free combinations (RFCs) during pregnancy.ObjectivesTo describe the characteristics of women initiating pregnancy while on rilpivirine and to compare the outcomes for virologically suppressed subjects continuing rilpivirine until delivery versus switching to an RFC.MethodsIn the ANRS-EPF French Perinatal cohort, we included women on rilpivirine at conception in 2010–18. Pregnancy outcomes were compared between patients continuing versus interrupting rilpivirine. In women with documented viral suppression (<50 copies/mL) before 14 weeks of gestation (WG) while on rilpivirine, we compared the probability of viral rebound (≥50 copies/mL) during pregnancy between subjects continuing rilpivirine versus those switching to RFC.ResultsAmong 247 women included, 88.7% had viral suppression at the beginning of pregnancy. Overall, 184 women (74.5%) switched to an RFC (mostly PI/ritonavir-based regimens) at a median gestational age of 8.0 WG. Plasma HIV-1 RNA nearest delivery was <50 copies/mL in 95.6% of women. Among 69 women with documented viral suppression before 14 WG, the risk of viral rebound was higher when switching to RFCs than when continuing rilpivirine (20.0% versus 0.0%, P = 0.046). Delivery outcomes were similar between groups (overall birth defects, 3.8/100 live births; pregnancy losses, 2.0%; preterm deliveries, 10.6%). No HIV transmission occurred.ConclusionsIn virologically suppressed women initiating pregnancy, continuing rilpivirine was associated with better virological outcome than changing regimen. We did not observe a higher risk of adverse pregnancy outcomes