Perrine Humblet

Premature avoidable deaths by road traffic injuries in Belgium: trends and geographical disparities.

Road traffic injuries are a major public health problem. In this study, we chose Years of Potential Life Lost (YPLL) to analyse the trends during the period 1974–1994 and the relative impact of the traffic injuries death on total mortality and on total avoidable mortality in Belgium. We analysed the geographical trends over a 20-year period at the district level. The YPLL age-adjusted rates were analysed for four successive 5-year periods: 1974–1978, 1980–1984, 1985–1989, 1990–1994 and the ratios of YPLL rates were used to describe changes between 1974 and 1994 at district level. The YPLL rates decrease for ‘all causes mortality’, ‘total avoidable causes’ and ‘road traffic injuries’. This trend can be observed during the four periods of 5 years. A slowing down of the decrease of the YPLL rates for road traffic injuries, both for men and women is observed: 11.7% between periods 2 and 1, and only 3% between periods 4 and 3 for men (16.2 and 7.5% for women). The geographical analysis shows marked differences between districts. Even though a favourable trend is observed for the traffic injuries deaths in Belgium it is important to highlight the important slowing down of this trend during the most recent years. It is also necessary to underline the importance of geographical disparities in the distribution of YPLL rates within the entire population.

The transition to preschool: a problem or an opportunity for children? A sociological perspective in the context of a ‘split system’

This article discusses the central issue of the transition to preschool. Individual semi-structured interviews with school professionals and parents in the Brussels region revealed that this issue is crucial for the well-being of young children, from both an educational and a social perspective. We discovered that the education system works under the assumption that nearly every child has attended daycare before entering preschool. This has serious implications since using these services, which help to prepare children for preschool, is socially differentiated. Children who have to cope with their first socialisation outside the family environment and their first encounter with the school environment at the same time face many problems. Not only does it define their first school experience; more importantly, it contributes to shape their entire experience of preschool, with potential long-term harmful effects. The article discusses the corresponding implications for the school system and puts forward recommendations.

A 15th Century “Bambino” is the Symbol of Global Maternal and Child Health

Having observed similar swaddled infants, often referred to as ‘‘Bambini’’ as the insignia of many Maternal and Child Organizations (Fig. 1), we were intrigued by what would have encouraged organizations from different countries to use this symbol. We seek to show that this choice was likely influenced by a large global movement. The insignia is derived from one of the fifteenth century terra cotta bas-reliefs from Andrea Della Robbia [1, 2]. The ten ‘‘Bambini’’ can still be seen on the facade of the ‘‘Ospedale degli Innocenti’’ in Florence, Italy (Fig. 2 for a set of two). The first of its kind, this Foundling Hospital of the Renaissance symbolizes the beginning of a humanistic movement to protect infants and children [1]. Movements advocating for child protection emerged in the XIX century, and were reinforced by the needs created by World War I [3]. Major child health organizations were founded in the immediate aftermath. The Save the Children International Union (SCIU) (Union Internationale de Secours aux Enfants), a Geneva-based organization, was founded in 1920 at the initiative of the Save the Children Fund (SCF) and the Swiss Committee for Children Relief (Comite Suisse de Secours aux Enfants) to implement child protection allover the world [4]. Eglantyne Jebb (1876–1928) and her sister Dorothy Buxton (1881–1962) played a central role in founding the SCF in England in May 1919 [5] and the SCIU. One of the main achievements of the SCIU was precisely the adoption of the Declaration of the Rights of the Child, or the ‘‘Declaration of Geneva,’’ which was approved by the Fifth Assembly of the League of Nations in 1924 and is the precursor to the United Nations Convention on the Rights of the Child adopted on November 20, 1989 [5, 6]. Between 1923 and 1933, the SCIU had members from 33 countries and nine affiliated organizations [7, 8]. In the United States (US), Save the Children was created in 1932 as the ‘‘International Save the Children Fund of America’’ and became a member of the SCIU [9]. The name of the US organization was changed to the ‘‘Save the Children Federation’’ in 1939 [9] and is now known as ‘‘Save the Children USA.’’[10] One of Della Robbia’s ‘‘Bambini’’ was chosen as the insignia by SCIU and the majority of its members and associate member organizations (Fig. 1) [7, 8]. It appeared on the 1924 Declaration of Geneva (Fig. 3) [11]. Other ‘‘Bambini’’ were chosen at the same period. It was the case of the Save the Children Federation and it is probably the inspiration for the current logo of Save the Children (personal communication, Save the Children, 2005). In Belgium, the National Children’s Relief Organization (Oeuvre Nationale de l’Enfance, Nationaal Werk voor Kinderwelzijn) used a ‘‘Bambino’’ since 1924, but became member of the SCIU only in 1942 [12]. The American Academy of Pediatrics (AAP) adopted a ‘‘Bambino’’ as insignia around 1930, modified it in 1941, and made it official in 1955 [2]. Several Latin American pediatric societies have followed AAP in adopting the ‘‘Bambino.’’ For example, the Brazilian Pediatric Society started using a ‘‘Bambino’’ in 1936 [13]. The ‘‘Bambini’’ vary by their degree of swaddling. Swaddling is described in the Bible and was widely used in Europe, Asia, and South America [14, 15]. Among the 10 original ‘‘Bambini’’ of the ‘‘Ospedale degli Innocenti’’, P. Buekens (&) School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Ste. 2430, New Orleans, LA 70112, USA e-mail: pbuekens@tulane.edu

Adherence to ivermectin is more associated with perceptions of community directed treatment with ivermectin organization than with onchocerciasis beliefs

Background The fight against onchocerciasis in Africa has boomed thanks to the Community Directed Treatment with Ivermectin (CDTI) program. However, in Cameroon, after more than 15 years of mass treatment, onchocerciasis prevalence is still above the non-transmission threshold. This study aimed to explore a possible association between people’s beliefs/perceptions of onchocerciasis and of CDTI program, and their adherence to ivermectin in three regions of Cameroon. Methodology/Principal findings A cross sectional survey was carried out in three health districts with persistent high onchocerciasis prevalence. Participants were randomly selected in 30 clusters per district. Adherence to ivermectin was comparable between Bafang and Bafia (55.0% and 48.8%, respectively, p>0.05) and lower in Yabassi (40.7%). Among all factors related to program perceptions and disease representations that were studied, perceptions of the program are the ones that were most determinant in adherence to ivermectin. People who had a “not positive” opinion of ivermectin distribution campaigns were less compliant than those who had a positive opinion about the campaigns (40% vs 55% in Bafang, and 48% vs 62% in Bafia, p<0.01), as well as those who had a negative appreciation of community drug distributors’ commitment (22% vs 53% in Bafang, 33% vs 59% in Bafia, 27% vs 47% in Yabassi; p<0.01). The most common misconception about onchocerciasis transmission was the lack of hygiene, especially in Bafia and Yabassi. In Bafang, high proportions of people believed that onchocerciasis was due to high consumption of sugar (31% vs less than 5% in Bafia and Yabassi, p<0.001). Conclusion/Significance There are still frequent misconceptions about onchocerciasis transmission in Cameroon. Perceptions of ivermectin distribution campaigns are more strongly associated to adherence. In addition to education/sensitisation on onchocerciasis during the implementation of the CDTI program, local health authorities should strive to better involve communities and more encourage community distributors’ work.

HIV testing among women in delivery rooms in Lubumbashi DR Congo: A catch-up strategy for prevention of mother-to-child transmission.

BACKGROUND Although HIV testing is offered during antenatal care, the proportion of women giving birth without knowing their HIV status is still important in DR Congo. The objective of this study was to determine the acceptability of rapid HIV testing among parturients in labor room, and to identify factors that are associated with the acceptability of HIV testing. METHODS Intervention including rapid HIV testing among pregnant women in labor rooms in Lubumbashi for 5 months, from September 2010 to February 2011. Pregnant women who tested HIV positive were attended by prevention of mother-to-child transmission service. Descriptive statistical analysis and logistic regression were performed. RESULTS Among 474 pregnant women who enter the labor room, 433 (91.4%; confidence interval [CI]: 95%: 88.4-93.7%) had voluntary testing for HIV in the labor room after counseling. The acceptance of rapid testing for HIV was significantly higher when the duration of counseling was less or equal to 5 minutes (adjusted Odds ratio [aOR]=5.8; [CI] 95%: 2.6-13); among those who did not report having this screening test during antenatal care (aOR=3.8; [CI] 95%: 2-7.8), among those who were in early labor (aOR=2.3; [CI] 95%: 1.2-4.7) and lower in adolescents than in adults (aOR=0.1; [CI] 95%: 0.0-0.7). CONCLUSION Counseling and voluntary HIV testing are accepted in our labor rooms. Consistently offering this service in the labor room could be a catch-up strategy to be combined with antenatal care testing.

Dépistage du VIH en salle de travail à Lubumbashi, République Démocratique du Congo. Une stratégie de rattrapage dans le cadre de la prévention de la transmission de la mère à l'enfant.

BACKGROUND Although HIV testing is offered during antenatal care, the proportion of women giving birth without knowing their HIV status is still important in DR Congo. The objective of this study was to determine the acceptability of rapid HIV testing among parturients in labor room, and to identify factors that are associated with the acceptability of HIV testing. METHODS Intervention including rapid HIV testing among pregnant women in labor rooms in Lubumbashi for 5 months, from September 2010 to February 2011. Pregnant women who tested HIV positive were attended by prevention of mother-to-child transmission service. Descriptive statistical analysis and logistic regression were performed. RESULTS Among 474 pregnant women who enter the labor room, 433 (91.4%; confidence interval [CI]: 95%: 88.4-93.7%) had voluntary testing for HIV in the labor room after counseling. The acceptance of rapid testing for HIV was significantly higher when the duration of counseling was less or equal to 5 minutes (adjusted Odds ratio [aOR]=5.8; [CI] 95%: 2.6-13); among those who did not report having this screening test during antenatal care (aOR=3.8; [CI] 95%: 2-7.8), among those who were in early labor (aOR=2.3; [CI] 95%: 1.2-4.7) and lower in adolescents than in adults (aOR=0.1; [CI] 95%: 0.0-0.7). CONCLUSION Counseling and voluntary HIV testing are accepted in our labor rooms. Consistently offering this service in the labor room could be a catch-up strategy to be combined with antenatal care testing.