Yannick Jaffré

Midwives in Niger: An Uncomfortable Position Between Social Behaviours and Health Care Constraints

Maternal mortality rates are very high in developing countries. In Niamey, the capital of Niger, maternal mortality rate is 280/100,000, in spite of a high concentration of health services and of health personnel. Several studies demonstrated that the efficiency of maternal health services was low, both because the quality and the quantity of work were insufficient. The usual response to the poor performances of health services in developing countries is mainly technical. If improvement of the training of health personnel and re-organization of health services are necessary, they are not sufficient. A good effectiveness of care cannot be achieved without a mutual confident relationship between providers and patients. Focus group discussions were held in Niamey with women users of maternal health services, with student midwives and experienced midwives. Sources of complaints between providers and patients appeared to be numerous. However, they are centered around two themes, delivery techniques and cultural requirements, which correspond to two types of constraints: technical constraints and social representations and practices of the population. A description of traditional practices and beliefs related to delivery were obtained through discussion groups with old women and traditional birth attendants (TBAs). Both women and midwives are tied up by the same social rules (e.g. linguistic taboos, respect and shame) but technical constraints force midwives to violate those rules, making the application of their technical skills very difficult. Thus, the mutual relationship between users and providers is source of dissatisfaction, which often degenerates into an open confrontation. Midwives must learn how to implement obstetrical techniques within specific cultural environments.

Determinants of refusal of A/H1N1 pandemic vaccination in a high risk population: a qualitative approach.

Background Our study analyses the main determinants of refusal or acceptance of the 2009 A/H1N1 vaccine in patients with cystic fibrosis, a high-risk population for severe flu infection, usually very compliant for seasonal flu vaccine. Methodology/Principal Findings We conducted a qualitative study based on semi-structured interviews in 3 cystic fibrosis referral centres in Paris, France. The study included 42 patients with cystic fibrosis: 24 who refused the vaccine and 18 who were vaccinated. The two groups differed quite substantially in their perceptions of vaccine- and disease-related risks. Those who refused the vaccine were motivated mainly by the fears it aroused and did not explicitly consider the 2009 A/H1N1 flu a potentially severe disease. People who were vaccinated explained their choice, first and foremost, as intended to prevent the flus potential consequences on respiratory cystic fibrosis disease. Moreover, they considered vaccination to be an indirect collective prevention tool. Patients who refused the vaccine mentioned multiple, contradictory information sources and did not appear to consider the recommendation of their local health care provider as predominant. On the contrary, those who were vaccinated stated that they had based their decision solely on the clear and unequivocal advice of their health care provider. Conclusions/Significance These results of our survey led us to formulate three main recommendations for improving adhesion to new pandemic vaccines. (1) it appears necessary to reinforce patient education about the disease and its specific risks, but also general population information about community immunity. (2) it is essential to disseminate a clear and effective message about the safety of novel vaccines. (3) this message should be conveyed by local health care providers, who should be involved in implementing immunization.

[Preparedness for influenza A/H5N1 pandemic in Niger: a study on health care workers' knowledge and global organization of health activities].

RésuméDans les pays industrialisés, l’émergence de virus influenza à potentiel pandémique a suscité des réactions à la mesure de la menace que représentent ces agents infectieux. Cependant, à l’heure de la mondialisation, le contrôle des épidémies repose tout autant sur une coordination mondiale efficace des moyens de lutte que sur une préparation des systèmes de santé nationaux du Nord et du Sud, au centre desquels se trouvent les personnels soignants. Notre étude a pris place dans le principal hôpital nigérien, l’Hôpital national de Niamey. L’objectif était d’évaluer les connaissances des professionnels de soins en matière de pandémie grippale et de contrôle du risque infectieux. Sur la base d’un questionnaire, nous avons interrogé 178 soignants, médicaux et paramédicaux. Cette étude — la première à notre connaissance à explorer ces questions dans le contexte africain — a d’abord mis en lumière une certaine maîtrise des connaissances théoriques sur la grippe aviaire par les soignants. Cependant, au-delà des savoirs théoriques, l’enquête a également permis d’identifier des limites importantes compromettant les capacités de prévention et de lutte contre une pandémie grippale, notamment en termes d’organisation des soins et de contrôle du risque infectieux hospitalier.AbstractIn industrialized countries, the emergence of potentially pandemic influenza virus has invited reactions consistent with the potential threat represented by these infectious agents. However, with globalization, controlling epidemics depends as much on an effective global coordination of control methods as on preparedness of northern and southern national health care systems, at the core of which are health care workers. Our study was conducted in the National Hospital of Niamey, the main Nigerian hospital. Its objective was to evaluate the knowledge of health care professionals regarding flu pandemic and control of infection. We interviewed 178 nursing staff, doctors and paramedics on the basis of a survey. This study — the first to our knowledge to explore these issues in the African context-revealed that caregivers have a rather good mastery of theoretical knowledge. Nevertheless, beyond theoretical knowledge, miscellaneous factors compromise the effectiveness of the health care structure. Some of them seem to occupy a critical position, particularly the absence of shared references among sanitary authorities and health care professionals, and the weaknesses of global coordination of preventive activities and case management.In industrialized countries, the emergence of potentially pandemic influenza virus has invited reactions consistent with the potential threat represented by these infectious agents. However, with globalization, controlling epidemics depends as much on an effective global coordination of control methods as on preparedness of northern and southern national health care systems, at the core of which are health care workers. Our study was conducted in the National Hospital of Niamey, the main Nigerian hospital. Its objective was to evaluate the knowledge of health care professionals regarding flu pandemic and control of infection. We interviewed 178 nursing staff, doctors and paramedics on the basis of a survey. This study - the first to our knowledge to explore these issues in the African context-revealed that caregivers have a rather good mastery of theoretical knowledge. Nevertheless, beyond theoretical knowledge, miscellaneous factors compromise the effectiveness of the health care structure. Some of them seem to occupy a critical position, particularly the absence of shared references among sanitary authorities and health care professionals, and the weaknesses of global coordination of preventive activities and case management.

Pandémie grippale A/H5N1 et niveau de préparation du Niger: une étude sur les connaissances des soignants et l’organisation générale des soins

RésuméDans les pays industrialisés, l’émergence de virus influenza à potentiel pandémique a suscité des réactions à la mesure de la menace que représentent ces agents infectieux. Cependant, à l’heure de la mondialisation, le contrôle des épidémies repose tout autant sur une coordination mondiale efficace des moyens de lutte que sur une préparation des systèmes de santé nationaux du Nord et du Sud, au centre desquels se trouvent les personnels soignants. Notre étude a pris place dans le principal hôpital nigérien, l’Hôpital national de Niamey. L’objectif était d’évaluer les connaissances des professionnels de soins en matière de pandémie grippale et de contrôle du risque infectieux. Sur la base d’un questionnaire, nous avons interrogé 178 soignants, médicaux et paramédicaux. Cette étude — la première à notre connaissance à explorer ces questions dans le contexte africain — a d’abord mis en lumière une certaine maîtrise des connaissances théoriques sur la grippe aviaire par les soignants. Cependant, au-delà des savoirs théoriques, l’enquête a également permis d’identifier des limites importantes compromettant les capacités de prévention et de lutte contre une pandémie grippale, notamment en termes d’organisation des soins et de contrôle du risque infectieux hospitalier.AbstractIn industrialized countries, the emergence of potentially pandemic influenza virus has invited reactions consistent with the potential threat represented by these infectious agents. However, with globalization, controlling epidemics depends as much on an effective global coordination of control methods as on preparedness of northern and southern national health care systems, at the core of which are health care workers. Our study was conducted in the National Hospital of Niamey, the main Nigerian hospital. Its objective was to evaluate the knowledge of health care professionals regarding flu pandemic and control of infection. We interviewed 178 nursing staff, doctors and paramedics on the basis of a survey. This study — the first to our knowledge to explore these issues in the African context-revealed that caregivers have a rather good mastery of theoretical knowledge. Nevertheless, beyond theoretical knowledge, miscellaneous factors compromise the effectiveness of the health care structure. Some of them seem to occupy a critical position, particularly the absence of shared references among sanitary authorities and health care professionals, and the weaknesses of global coordination of preventive activities and case management.In industrialized countries, the emergence of potentially pandemic influenza virus has invited reactions consistent with the potential threat represented by these infectious agents. However, with globalization, controlling epidemics depends as much on an effective global coordination of control methods as on preparedness of northern and southern national health care systems, at the core of which are health care workers. Our study was conducted in the National Hospital of Niamey, the main Nigerian hospital. Its objective was to evaluate the knowledge of health care professionals regarding flu pandemic and control of infection. We interviewed 178 nursing staff, doctors and paramedics on the basis of a survey. This study - the first to our knowledge to explore these issues in the African context-revealed that caregivers have a rather good mastery of theoretical knowledge. Nevertheless, beyond theoretical knowledge, miscellaneous factors compromise the effectiveness of the health care structure. Some of them seem to occupy a critical position, particularly the absence of shared references among sanitary authorities and health care professionals, and the weaknesses of global coordination of preventive activities and case management.

Pandémie grippale A/H5N1 et niveau de préparation du Niger : une étude sur les connaissances des soignants et l'organisation générale des soins Preparedness for influenza A/H5N1 pandemic in Niger: a study on health care workers' knowledge and global organization of health activities

RésuméDans les pays industrialisés, l’émergence de virus influenza à potentiel pandémique a suscité des réactions à la mesure de la menace que représentent ces agents infectieux. Cependant, à l’heure de la mondialisation, le contrôle des épidémies repose tout autant sur une coordination mondiale efficace des moyens de lutte que sur une préparation des systèmes de santé nationaux du Nord et du Sud, au centre desquels se trouvent les personnels soignants. Notre étude a pris place dans le principal hôpital nigérien, l’Hôpital national de Niamey. L’objectif était d’évaluer les connaissances des professionnels de soins en matière de pandémie grippale et de contrôle du risque infectieux. Sur la base d’un questionnaire, nous avons interrogé 178 soignants, médicaux et paramédicaux. Cette étude — la première à notre connaissance à explorer ces questions dans le contexte africain — a d’abord mis en lumière une certaine maîtrise des connaissances théoriques sur la grippe aviaire par les soignants. Cependant, au-delà des savoirs théoriques, l’enquête a également permis d’identifier des limites importantes compromettant les capacités de prévention et de lutte contre une pandémie grippale, notamment en termes d’organisation des soins et de contrôle du risque infectieux hospitalier.AbstractIn industrialized countries, the emergence of potentially pandemic influenza virus has invited reactions consistent with the potential threat represented by these infectious agents. However, with globalization, controlling epidemics depends as much on an effective global coordination of control methods as on preparedness of northern and southern national health care systems, at the core of which are health care workers. Our study was conducted in the National Hospital of Niamey, the main Nigerian hospital. Its objective was to evaluate the knowledge of health care professionals regarding flu pandemic and control of infection. We interviewed 178 nursing staff, doctors and paramedics on the basis of a survey. This study — the first to our knowledge to explore these issues in the African context-revealed that caregivers have a rather good mastery of theoretical knowledge. Nevertheless, beyond theoretical knowledge, miscellaneous factors compromise the effectiveness of the health care structure. Some of them seem to occupy a critical position, particularly the absence of shared references among sanitary authorities and health care professionals, and the weaknesses of global coordination of preventive activities and case management.In industrialized countries, the emergence of potentially pandemic influenza virus has invited reactions consistent with the potential threat represented by these infectious agents. However, with globalization, controlling epidemics depends as much on an effective global coordination of control methods as on preparedness of northern and southern national health care systems, at the core of which are health care workers. Our study was conducted in the National Hospital of Niamey, the main Nigerian hospital. Its objective was to evaluate the knowledge of health care professionals regarding flu pandemic and control of infection. We interviewed 178 nursing staff, doctors and paramedics on the basis of a survey. This study - the first to our knowledge to explore these issues in the African context-revealed that caregivers have a rather good mastery of theoretical knowledge. Nevertheless, beyond theoretical knowledge, miscellaneous factors compromise the effectiveness of the health care structure. Some of them seem to occupy a critical position, particularly the absence of shared references among sanitary authorities and health care professionals, and the weaknesses of global coordination of preventive activities and case management.