Emmanuelle Guyavarch

La mortalité maternelle en milieu rural au Sénégal

Pison Gilles, Kodio Belco, Guyavarch Emmanuelle, Etard Jean-Francois.- La mortali- dad materna en el medio rural en Senegal En este articulo examinamos la frecuencia y las causas de mortalidad materna en tres areas rurales de Senegal: Bandafassi, Niakhar y Mlomp. Desde hace aňos, la poblacion de estas tres areas ha sido objeto de una observacion demografica continua, que se ha llevado a cabo uti- lizando siempre el mismo metodo, con lo que se obtienen resultados comparables. La proporcion de mujeres que dan a luz en centras de maternidad difiere segun el area- 99% en Mlomp, 15% en Niakhar y 3% en Bandafassi-. Otros factures que las distinguen son la distancia a hospitales que practican cesareas y los medios para evacuar a mujeres con compli- caciones relacionadas con el parto. La mortalidad materna varia de 1 a 2 segun el area: en Mlomp se registran los niveles mas bajos (436 muertes por cien mil nacidos vivos) y en Bandafassi los mas elevados (826); Niakhar se halla en un punto intermedio (516). Estas diferencias estan fuer- temente correlacionadas con los medios de evacuacion urgente de mujeres que sufren complica- ciones en el parto. En cambio, las condiciones del parto -en concreto, la proporcion de partos que tiene lugaren centras de maternidad- no juegan un papel tan importante como se suele creer. La OMS estima que, en Senegal, la mortalidad se elevaba a 1,200 muertes por 100,000 nacidos vivos en 1990. Nuestro estudio muestra que las tres areas examinadas, que se hallan en zonas rurales, registraban niveles mas bajos que este durante el mismo periodo. La OMS parece haber sobre-estimado considerablemente la mortalidad materna para el conjunto del pais.

Treponemal infection rates, risk factors and pregnancy outcome in a rural area of Senegal

A rural population of east Senegal has been under demographic surveillance for more than 30 years and a high rate of infertility has been reported. The aim of the study is to describe HIV and treponemal infection epidemiology and association with outcome of pregnancy in a population of rural Senegal. A population-based cross-sectional study was conducted among 952 randomly-selected adults of a rural community of Senegal. No participant was found to be infected with HIV, 11% had evidence of past syphilis and 5% of active syphilis. Active syphilis was associated among men with age, long-term mobility and having partners in an urban area in the last 12 months and among women with being divorced or widowed. No association was found between past or active syphilis and abortion or stillbirth but women aged 40 and more with past or active syphilis were significantly more likely to have had no history of gestation than women with no evidence of syphilis infection. In conclusion our results call for more research to understand the epidemiology of treponemal infection and to elucidate types of Treponema pallidum involved.

Changement de protocole dans la méthode d’autopsie verbale et mesure de la mortalité palustre en milieu rural sénégalais

In rural Senegal, three populations have been followed up since several decades and the malaria mortality trend has been observed since the mid-1980s. However, limits are associated with the verbal autopsy method used to determine causes of death, especially deaths due to malaria. A change in protocol occurred in recent years in two of these three sites with the involvement of two physicians (instead of only one) in the diagnosis. The objective is here to measure its potential impact on diagnosis of malaria deaths. Five hundred and fifteen diagnoses reported on child deaths occurred from 2000 to 2005 have been analysed. We have identified, on the basis of a multinomial logistic regression model, factors affecting the determination of malaria deaths among the characteristics of the child, the death, the illness and its symptoms, and we also took into account method factors. Factors related to the method do not play on the malaria diagnosis. This result insures the continuity of the series on malaria mortality statistics since 2000 in the two sites despite changes in the method. However, the new protocol leads to vanish possibility of having deaths among ill-defined or unknown causes. In the African context of absence of health statistics, data obtained through the verbal autopsy method in demographic surveillance system can provide accurate information in the epidemiological field, even regarding malaria.

Change of protocol in the verbal autopsy method and measure of malaria mortality in rural areas in Senegal

In rural Senegal, three populations have been followed up since several decades and the malaria mortality trend has been observed since the mid-1980s. However, limits are associated with the verbal autopsy method used to determine causes of death, especially deaths due to malaria. A change in protocol occurred in recent years in two of these three sites with the involvement of two physicians (instead of only one) in the diagnosis. The objective is here to measure its potential impact on diagnosis of malaria deaths. Five hundred and fifteen diagnoses reported on child deaths occurred from 2000 to 2005 have been analysed. We have identified, on the basis of a multinomial logistic regression model, factors affecting the determination of malaria deaths among the characteristics of the child, the death, the illness and its symptoms, and we also took into account method factors. Factors related to the method do not play on the malaria diagnosis. This result insures the continuity of the series on malaria mortality statistics since 2000 in the two sites despite changes in the method. However, the new protocol leads to vanish possibility of having deaths among ill-defined or unknown causes. In the African context of absence of health statistics, data obtained through the verbal autopsy method in demographic surveillance system can provide accurate information in the epidemiological field, even regarding malaria.

Changement de protocole dans la méthode d'autopsie verbale et mesure de la mortalité palustre en milieu rural sénégalais Change of protocol in the verbal autopsy method and measure of malaria mortality in rural areas in Senegal

In rural Senegal, three populations have been followed up since several decades and the malaria mortality trend has been observed since the mid-1980s. However, limits are associated with the verbal autopsy method used to determine causes of death, especially deaths due to malaria. A change in protocol occurred in recent years in two of these three sites with the involvement of two physicians (instead of only one) in the diagnosis. The objective is here to measure its potential impact on diagnosis of malaria deaths. Five hundred and fifteen diagnoses reported on child deaths occurred from 2000 to 2005 have been analysed. We have identified, on the basis of a multinomial logistic regression model, factors affecting the determination of malaria deaths among the characteristics of the child, the death, the illness and its symptoms, and we also took into account method factors. Factors related to the method do not play on the malaria diagnosis. This result insures the continuity of the series on malaria mortality statistics since 2000 in the two sites despite changes in the method. However, the new protocol leads to vanish possibility of having deaths among ill-defined or unknown causes. In the African context of absence of health statistics, data obtained through the verbal autopsy method in demographic surveillance system can provide accurate information in the epidemiological field, even regarding malaria.

La sous-évaluation de la pratique contraceptive par les enquêtes. Un exemple en zone rurale d'Afrique sub-saharienne

En Afrique sub-saharienne, les mesures a large echelle, sur l’ensemble d’un pays ou d’une region, montrent que le recours aux methodes modernes de contraception tend a progresser, mais lentement, donnant l’impression que les evolutions ne peuvent que prendre du temps dans ce domaine. Pour mieux comprendre les raisons de cette faible diffusion, principalement en zone rurale, nous avons etudie de facon detaillee l’histoire de la contraception dans une population rurale du Senegal, residant a Bandafassi. En utilisant plusieurs sources d’information, nous avons pu retracer la progression du recours a la contraception annee apres annee et examiner quels en avaient ete les facteurs. L’etude presentee ici montre que contrairement aux idees recues, la contraception peut se diffuser tres rapidement dans des campagnes africaines peu favorisees sur le plan socio-economique mais que cette diffusion n’est que difficilement mesurable en raison d’une sous-declaration importante de la pratique contraceptive et que sa perennite n’est pas assuree.