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In Québec, one in three people is at risk of being affected by a mental health problem during his lifetime. Women are twice as likely as men to suffer from mild mental health issues such as depression and anxiety. Poverty, violence and sexual abuse, difficulty to have access to adequate and affordable housing and poor working conditions are among the risk for women of being affected by a mental health problem. Objectives This study was conducted upon the request of a Réseau des groupes de femmes and provides a portrait of women's mental health who attend community organizations in a Quebec region. Method A quantitative descriptive research design was used to collect data guided by the theoretical model of Desjardins et al. (2008). A total of 171 volunteers from 16 different community organizations completed a self-administered questionnaire. Results The analysis of the data highlights the protective factors of mental health such as self-esteem and social support and risk factors such as low income and stressful life. It reveals that while the majority of the women have good mental health, some of them live with poorer mental health associated with several other factors, especially violence and poverty. Conclusion Results could lead to the development of actions meeting the specific needs of women living with poor mental health. This study also highlights the contribution of the community organizations for supporting the people living with mental health issues.

The way in which the COVID-19 pandemic was handled resulted in public health measures that had varying impacts on different segments of society. We consider the experience and feelings of a group of ATD Fourth World activists in precarious living situations, specifically during the end of the first lockdown period.In this article we will analyze, from their speech, the risk perception and the related attitudes in this specific period (April to July 2020).The end of lockdown represented a liminal state where fear was ever-present. Their behaviors were affected, some not daring to go outside while others feeling liberated. The masks, an essential element of protection in order to go outside, and their financial accessibility, did not seem to be equally available to all. Moreover, they had many questions about the consequences of positive test results or even the possibility of being a "contact case". These questions seemed provoked out of fear of social control, and personal fear of disruption of their daily lives.Our data, based on a collection gathered over time in order to grasp the evolution of risk representation as well as the contradiction between representation and attitudes, also reveals different levels of rationality that prevail in their ambivalent attitudes in a context of scientific uncertainty. The lifting of confinement measures produced a change in prevention model, from a constraining one to a hybrid one, involving individual responsibility.

The rate of participation in organized colorectal cancer screening (DOCCR) remains insufficient in France, with strong disparities between departments.The aim of this work was to assess the relationship between the DOCCR response rates for the communes of the Bouches-du-Rhône (BdR) department and the boroughs of Marseille and their poverty levels. The DOCCR response rate was assessed for the 2017-2018 campaign. The Pearson coefficient was calculated to assess correlations with the average poverty rate per commune/borough, the density of general practitioners (GPs) and Potential Localized Accessibility (PLA) to GPs.Among the DOCCR guests, 29.7% (± 4.7) responded. The rate of respondents differed significantly between the communes/boroughs of the department (P lt; 0.001). The rate of respondents was inversely correlated with the rate of people living below the poverty line, both for the communes/boroughs of the department, with a high correlation (r = - 0.795, P lt; 0.001) and for the Marseille boroughs, with an even higher correlation (r = - 0.910, P lt; 0.001). It was inversely correlated with the density of GPs (r = - 0.430, P lt; 0.001). On the other hand, there was a weak positive correlation with Potential Localized Accessibility to GPs (r = 0.193, P lt; 0.001), as well as with the age of guests (r = 0.476, P lt; 0.001).The poverty rate in the BdR, which is higher than the national average, may partly explain the low rate of DOCCR respondents; other factors such as the density of GPs and their accessibility may play a role.

Poverty is an absolute evil. It corrodes society. France is not the most affected country, because a social protection system allows the most vulnerable to avoid falling into extreme poverty. The current health crisis is, however, aggravating situations of exclusion. It is therefore urgent to question the effectiveness of public policies and to construct indicators capable of measuring the well-being of citizens who are both contributors and beneficiaries.

This article addresses the issue of health inequalities and the measures allowing to reduce them. Starting from the observation that, in Switzerland like in the rest of the world, health gaps between the riches and the poorest are still very marked, this article questions the role that health promotion and prevention can play in the fight against this phenomenon. The main approaches allowing to reduce inequalities are presented and illustrated with examples : the universal approach, the targeted approach and proportionate universalism. This last approach appears as the ideal towards which all health promotion and prevention actions should converge in order to reduce health inequalities all along the social gradient. However, its translation into prevention measures remains subject to interpretation. Therefore, the article ends with a set of recommendations for the elaboration of measures aiming to reduce health inequalities.Cet article traite de la problématique des inégalités sociales de santé et des mesures permettant de les réduire. En partant du constat que, en Suisse comme dans le reste du monde, les écarts de santé entre les plus riches et les plus pauvres demeurent toujours très marqués, cet article s’interroge sur le rôle que la promotion de la santé et la prévention peuvent jouer dans la lutte contre ce phénomène. Trois approches principales de réduction des inégalités sont présentées et illustrées à l’aide d’exemples, à savoir : l’approche universelle, l’approche ciblée et l’universalisme proportionné. Cette troisième approche apparaît comme l’idéal vers lequel toute action de promotion de la santé et de prévention devrait tendre afin de réduire les inégalités de santé tout au long du gradient social. Sa traduction dans des mesures concrètes de prévention demeure cependant sujette à interprétation. De ce fait, l’article se termine avec un ensemble de préconisations pratiques pour la conception de mesures visant à réduire les inégalités de santé.

International audience; Despite the existence of an effective vaccine, HBV infects 257 million people worldwide and is the cause of the majority of HCC. With an annual mortality rate of 887 000 patients in 2015, this cancer is the second deadliest. Low-income countries such as ones in sub-Saharan Africa are the most at risk due to the limited access to healthcare. To overcome this and born from an international research collaboration within an EU project, the Prolifica study aimed at evaluating a screen-and-treat program to prevent HBV complications, and more particularly HCC. Based on communities, facilities and hospitals HBsAg+ detection, the study lasted from 2011 to 2016. From the "cost effectiveness" feasibility of such a program to the development of simple scores for antiviral treatment, Prolifica uncovered data of crucial importance in a region with low HBV infection awareness, transmissions modes and prevention means which could have impacts on public health policies.

A number of studies have highlighted differences and even discrimination in health care offer according to social category, and shown that they contribute to the production of inequality. On the other hand, when the health care system treats every patient equally, and does not take personal difficulties into consideration, some authors have suggested inequality "by omission". That is why public health actors at different levels have recommended systematic collection of information on patients' social status. The objective of this article is to analyze data gathering on patients' socio-economic condition and its repercussions.The survey is based on more than 50 semi-structured face-to-face interviews with doctors and dentists in private practice. Their answers were subjected to socio-anthropological analysis.While some practitioners collect information on patients' social status proactively by systematic interrogation, others proceed indirectly and in accordance with subjective criteria. Quite often, patient status remains ignored, usually due to lack of interest, and less frequently because practitioners wish to guard against any risk of stigmatizing underprivileged patients. Different rationales may explain these attitudes: need to prioritize relevant information, wish to observe equity and equality, determination to refrain from social labeling, desire to protect patient self-esteem and to reinforce the practitioner-patient relationship. When identification does occur, it is essentially justified by a desire to adapt the care pathway to potential socio-economic obstacles.When a patient's social situation is sought out by private doctors and dentists, they are mainly concerned with customizing care pathways by taking financial impediments into close consideration. In most cases, their justifications for asking questions are subjective; by doing so, they inadvertently introduce arbitrariness in an area where the French state endeavors to produce social justice via provisions such as "CMU" ("universal", across the board health coverage). Systematic questioning on a patient's social status can represent a form of supplementary if unconscious symbolic violence toward frequently disqualified persons; what is more, it runs the risk of inducing stereotypes and manifesting prejudice. Only when contextualized does such questioning seem appropriate. On the other hand, when a practitioner misses out on social issues liable to impede care and treatment, he will probably have no "second chance" to address these concerns. Some practitioners have emphasized a need for suitable timing and contextualizing of questions on a patient's social status, and for putting them forward in a climate of trust.

French Guiana faces singular health challenges: poverty, isolation, structural lag, difficulties in attracting health professionals. Hospital stays exceed the recommended durations. The present study aimed to model the impact of precariousness and geographic isolation on the hospital duration performance indicator and to recalculate the indicator after incrementing severity by 1 unit when patients were socially precarious.Cayenne hospital data for 2017 were used to model the hospital duration performance indicator (IP-DMS) using quantile regression to study the impact of geographic and social explanatory variables. This indicator was computed hypothesizing a 1 unit increment of severity for precarious patients and by excluding patients from isolated regions.Most excess hospitalization days were linked to precariousness: the sojourns of precarious patients represented 47% of activity but generated 71% of excess days in hospital. Quantile regression models showed that after adjustment for potential confounders, patients from western French Guiana and Eastern French Guiana, precarious patients and the interactions terms between residence location and precariousness were significantly associated with IP-DMS increases. Recalculating the IP-DMSafter exclusion of patients from the interior and after increasing severity by 1 notch if the patient was precarious led to IP-DMS levels close to 1.The results show the nonlinear relationship between the IP-DMS and geographical isolation, poverty, and their interaction. These contextual variables must be taken into account when choosing the target IP-DMS value for French Guiana, which conditions funding and number of hospital beds allowed in a context of rapid demographic growth.

The national programme El Sistema was created in Venezuela. Since 10 years, an association based on this project emerge in France. El Sistema France use music for social development and fulfilment for deprived families. Three programmes exist which have set up a multicultural choir, a symphony orchestra in schools and staged an opera.

In 2014, a symposium focusing on access to healthcare was organized with input from socially excluded people, using the ATD Fourth World Guidelines for the Merging of Knowledge and Practices as the ethical framework. Can this approach be transferred to other settings?Prospective assessment of a participatory approach in the context of a symposium.Strict conditions are required to ensure effective participation of extremely vulnerable people. Support, temporality and a strictly defined agenda are key factors.This risky but carefully controlled experiment allowed the creation of a guide to effective participation of the poorest people in the events that concern them.

The purpose of this article is to analyse healthcare pathways for precarious people, based on the results of a field study conducted in 2011 and 2012 in the north of France and Burgundy. About 40 semi-directed interviews were conducted in order to collect healthcare pathways narratives revolving around various health events during the subject's life, and putting them in perspective with individual, familial stories as well as their environment (social environment, healthcare organization, etc.).The results indicate various types of determinants, firstly concerning norms and rules determining access to health insurance and health services. Despite the positive effects of CMUc (means-tested complementary health insurance) and ACS (financial support to purchase complementary insurance), healthcare pathways are still strongly constrained economically, especially for those people above the threshold and those without complementary health insurance. Moreover, we identified a deprivation culture acquired during childhood that continues to shape adulthood pathways. Finally, subjective experiences of disqualification and symbolic violence frequently reported by precarious people contribute to avoidance of social welfare and/or health institutions in order to preserve a weakened identity. Despite these determinations, every healthcare pathway appears to be unique because it belongs to a life story and occurs in a context with renewed meaning. Personhood is negotiated through the health care pathway.

Treatment of congenital ptosis is exclusively surgical; the frontalis sling method is most appropriate when the ptosis is severe, with no upper eyelid levator function. This surgery typically utilizes various materials (autologous fascia lata, silicone, nylon, or polypropylene bands, etc.).This was a retrospective descriptive study of 22 children under 16 years of age, treated for congenital ptosis by frontalis suspension of the levator muscle of the upper eyelid using the polypropylene technique, between January 1, 2014 and June 30, 2017 at the African Institute of Tropical Ophthalmology teaching hospital.In our study, the surgical result (prior to correction of recurrences) was satisfactory in 81.82 % of cases, with a recurrence rate of 13.64 %. The mean follow-up was 14 months, ranging from 4 to 25 months.The use of polypropylene provides encouraging results in ptosis surgery, while also offering the advantage of being low cost and more available. Its use in developing countries deserves special attention.

Short and long interpregnancy intervals are associated with adverse perinatal outcomes such as miscarriage and preterm delivery, but cultural differences in interpregnancy intervals are understudied. Identifying cultural inequality in interpregnancy intervals is necessary to improve maternal-child outcomes. We assessed interpregnancy intervals for Anglophones and Francophones in Quebec.We obtained birth records for all infants born in Quebec, 1989-2011. We identified 571 461 women with at least two births, and determined the interpregnancy interval. We defined short interpregnancy intervals (18 months) as the 20th percentile of the distribution, and long intervals (≥ 60 months) as the 80th percentile. Using quantile regression, we evaluated the association of language with short and long intervals, adjusted for maternal characteristics. We assessed differences over time and by maternal age for disadvantaged groups defined as no high school diploma, rural residence, and material deprivation.In adjusted regression models, Anglophones who had no high school diploma had intervals that were 1.0 month (95% CI: -1.5 to -0.4) shorter than Francophones at the 20th percentile of the distribution, and 1.9 months (-0.5 to 4.3) longer at the 80th percentile. Results were similar for Anglophones in rural and materially deprived areas. The trends persisted over time, but were stronger for women30 years. There were no differences between advantaged Anglophones and Francophones.Disadvantaged Anglophones are more likely to have short and long interpregnancy intervals relative to Francophones in Quebec. Public health interventions to improve perinatal health should target suboptimal intervals among disadvantaged Anglophones.On sait que les intervalles courts comme les intervalles longs entre les grossesses sont associés à des issues périnatales défavorables, comme des fausses couches et des accouchements prématurés, mais les différences culturelles à ce sujet sont mal connues. Repérer les inégalités culturelles dans les intervalles entre les grossesses est nécessaire afin d'améliorer les résultats relatifs à la santé de la mère et de l’enfant. Nous avons ainsi évalué les intervalles entre les grossesses chez les anglophones et les francophones du Québec.Nous avons obtenu les dossiers de naissance de tous les enfants nés au Québec entre 1989 et 2011. Nous avons recensé 571 461 femmes ayant eu au moins deux naissances et déterminé l’intervalle entre leurs grossesses. Les intervalles courts entre les grossesses (moins de 18 mois) ont été définis comme étant le 20e percentile de la distribution, et les intervalles longs (60 mois ou plus), comme le 80e percentile. À l’aide de régressions quantiles, nous avons évalué l’association entre la langue et les intervalles courts et longs, ajustés en fonction des caractéristiques de la mère. Nous avons évalué les différences au fil du temps et selon l’âge de la mère pour les groupes défavorisés, qui ont été définis par l’absence de diplôme d’études secondaires, la résidence en milieu rural et le fait de vivre dans un quartier défavorisé matériellement.Dans les modèles de régression ajustés, les anglophones sans diplôme d’études secondaires avaient des intervalles plus courts de 1,0 mois (intervalle de confiance [IC] à 95 % : −1,5 à −0,4) par rapport à leurs homologues francophones au 20e percentile de la distribution et plus longs de 1,9 mois (−0,5 à 4,3) au 80e percentile. Les résultats étaient similaires pour les anglophones des régions rurales et des quartiers matériellement défavorisés. Les tendances se sont maintenues au fil du temps, et se sont révélées plus fortes chez les femmes de moins de 30 ans. Aucune différence n’a été relevée entre les francophones favorisées et les anglophones favorisées.Au Québec, les anglophones défavorisées étaient plus susceptibles d’avoir des intervalles courts ou des longs entre leurs grossesses que les francophones défavorisées. Les interventions de santé publique visant à améliorer la santé périnatale devraient donc cibler les intervalles sous-optimaux chez les anglophones défavorisées de la province.

The prevalence of breastfeeding in France is lower among deprived women than in the rest of the population. The Haute-Normandie region is severely affected by deprivation, especially among women.To describe breastfeeding promotion in deprived women living in Haute-Normandie. Secondary objectives: to describe the prevalence of breastfeeding and identify barriers to breastfeeding in the same population.This cross-sectional observational study was carried out in Haute-Normandie between March and June 2015, in three steps: 1) mailing questionnaires to actors working with deprived women, 2) analysis of child health certificates and 3) sociological interviews with 15 deprived women.Only 4 of the 29 responding structures had implemented actions to promote breastfeeding among deprived women, with positive feed-back. Barely half of all deprived women had initiated breastfeeding in Haute-Normandie (Eure: 50%, Seine-Maritime: 54%). Finally, the same factors usually known to affect breastfeeding and its duration were also identified among deprived women living in Haute-Normandie.Guidelines for actions to support breast-feeding among deprived mothers have been developed to guide local policies designed to reduce social inequalities in health in Haute-Normandie.

Around ten homeless people were invited to take part in a programme of physical activities to improve their health status. Only motricity and walking pathways were followed assiduously for eight weeks. The assessment of the physical condition and quality of life showed an improvement in these areas, in particular for one of the participants. However, the lack of motivation and assiduity remains an obstacle to regular activity.

Objectives: The socioeconomic profile of households and families of children attending hospital for hydrocephalus were documented and analysed. Main costs related to diagnosis and care were reviewed. The emotional fallout and social well-being of families were also analysed. Methods: This retrospective cross-sectional study (January 2006 to January 2015) was based on costs borne by households and families for neurosurgical care of children with hydrocephalus. Results: Sixty children (1 day to 12 years old) had been hospitalized for hydrocephalus in Cotonou-Benin. In 19 cases, the families were single-parent families. In 44 cases, the parents were self-employed workers or private company employees. Public servants, eligible for national health system assistance, accounted for a mere 16 cases. Twenty six children did not receive any financial support, whereas the total average care-related out-of-pocket expenditure for families during the hospital stay was approximately €1,777 (1,117,500 FCFA), i.e. almost 14 times the average monthly income reported by the parents (82,600 FCFA – approximately €120). After hospitalization, 31 mothers had lost their jobs and 21 couples experienced marital issues and their plans to have children. Twelve recent separations were recorded, as well as one indirect maternal death related to depression. Conclusion: In Benin Republic, surgical care for paediatric hydrocephalus represents catastrophic out-of-pocket expenditures for households and families and other living expenses. Families experience significant emotional fallout with effects on couple relationships and survival.

Homelessness is a complex issue linked to poverty and structural conditions. It is increasing in Western countries with younger people and multiple generations being affected. Hard and unstable living conditions and inappropriate access to care predispose people to increase morbidity with poor health outcomes. This article reviews recent evidence about homeless health and strategies to improve health outcomes while harnessing societal benefits.Le défaut de logement stable est fortement lié à la pauvreté et à des causes structurelles. Les sans-abri constituent une population croissante dans les pays occidentaux, diverse dans son degré de précarité et d’accès au logement, de plus en plus jeune et multigénérationnelle. Leur santé est fortement influencée par les conditions de vie précaires et leur accès aux soins souvent mal adaptés aux besoins. Cet article passe en revue les données épidémiologiques et cliniques récentes et présente des stratégies innovantes de prise en charge globale susceptibles d’apporter des bénéfices à l’échelle de l’individu, du système de santé et de la société.

National audience; Studies at the population level must take into account the effect of social insecurity and socioeconomic inequalities on the patient outcomes. Socioeconomic inequalities depend on many determinants that are socially determined. In renal transplantation, these social determinants are not registered in the databases. The European Deprivation Index (EDI) is a composite index of social vulnerability with a French version. The EDI is an ecological measure of deprivation including the individual perception of basic needs for daily life that is called "subjective poverty". The Townsend index, Carstairs index and the Index of Multiple Deprivation are other ecological index available. It has been demonstrated in the United States that socioeconomic indicators of deprivation were associated with both the access to the waiting list for renal transplantation and transplantation failure. In France, socioeconomic deprivation may also affect the access to the waiting list and outcome of transplantation. This article is a review about deprivation and renal transplantation.

Employment is recognized as a weaning factor in many studies. Our aim was to evaluate the impact of employment on women's breastfeeding (BF) with a duration longer than 6 months in a Moroccan population.A cross-sectional study was conducted between November 2015 and April 2016 in four hospitals in the region of Rabat-Salé, Morocco. All ages were included with the condition that the woman had at least one living child. A questionnaire-based interview collected data on the duration of BF for each child, breast milk storage practices, woman's opinion on BF, and the perception of work conditions during BF. Factors associated with BF lasting longer than 6 months were analyzed using logistic regression carried out in SPSS 13.0 software.A total of 502 surveyed women were analyzed. The median duration of breastfeeding (exclusive or mixed) in working women was 8 months versus 15 months for those without employment (P0.001). Only 26 % stored breast milk. For working women, BF practiced due to religious conviction or perceived as mandatory were higher than for unemployed women (18% vs 15% and 11% vs. 7%, respectively; P0.001). Working conditions during BF were perceived as daunting in 61% of cases. In multivariate analysis, factors correlated with prolonged BF longer than 6 months were: (i) early baby initiation to BF (OR=3; 95% CI [1.9-4.6]), (ii) education level: middle and high school (OR=0.1; 95% CI [0.01-0.5]), and (iii) the social status of working women (OR=0.3; 95% CI [0.1-0.6]).Employment has a negative impact on the duration of breastfeeding, work perception, and practices of breastfeeding women.

In Quebec, women living on low income receive a number of additional prenatal care visits, determined by their area of residence, of both multi-component and food supplementation programs. We investigated whether increasing the number of visits reduces the odds of the main outcome of small for gestational age (SGA) birth (weight10th percentile on the Canadian scale).In this ecological study, births were identified from Quebec's registry of demographic events between 2006 and 2008 (n = 156 404; 134 areas). Individual characteristics were extracted from the registry, and portraits of the general population were deduced from data on multi-component and food supplement interventions, the Canadian census and the Canadian Community Health Survey. Mothers without a high school diploma were eligible for the programs. Multilevel logistic regression models were fitted using generalized estimating equations to account for the correlation between individuals on the same territory. Potential confounders included sedentary behaviour and cigarette smoking. The odds ratios (ORs) were adjusted for mother's age, marital status, parity, program coverage and mean income in the area.Mothers eligible for the programs remain at a higher odds of SGA than non-eligible mothers (OR = 1.40; 95% confidence interval [CI]: 1.30-1.51). Further, areas that provide more visits to eligible mothers (4-6 food supplementation visits) seem more successful at reducing the frequency of SGA birth than those that provide 1-2 or 3 visits (OR = 0.86; 95% CI: 0.75-0.99).Further studies that validate whether an increase in the number of prenatal care interventions reduces the odds of SGA birth in different populations and evaluate other potential benefits for the children should be done.Au Québec, les femmes vivant avec un faible revenu reçoivent un certain nombre de visites de soins prénataux supplémentaires, en fonction de leur lieu de résidence, dans le cadre d’un programme à multiples composantes et d’un programme d’intervention comprenant des suppléments alimentaires. Nous avons examiné si l’augmentation du nombre de visites réduisait le risque de faible poids pour l’âge gestationnel à la naissance (poids inférieur au 10e percentile sur l’échelle canadienne).Pour cette étude écologique, nous avons sélectionné les naissances dans le registre des événements démographiques du Québec entre 2006 et 2008 (n = 156 404; 134 secteurs). Les caractéristiques individuelles ont été extraites du registre des naissances alors que les portraits de la population générale ont été déduits de données sur l’intervention à multiples composantes et du programme d’intervention comprenant des suppléments alimentaires, ainsi que des recensements canadiens et des Enquêtes sur la santé dans les collectivités canadiennes. Ont été considérées comme admissibles aux programmes les mères sans diplôme d’études secondaires. Les modèles de régression logistique multiniveaux ont été ajustés à l’aide d’équations d’estimation généralisées pour tenir compte de la corrélation entre les individus vivant sur un même territoire. Les principaux facteurs confusionnels potentiels étaient la sédentarité et le tabagisme. Les rapports de cotes (RC) ont été ajustés en fonction de l’âge, de l’état matrimonial et de la parité de la mère ainsi que de la couverture du programme et du revenu moyen dans le secteur.Les mères admissibles aux programmes se sont révélées plus à risque de donner naissance à un bébé de faible poids pour l’âge gestationnel à la naissance que les autres mères (RC = 1,40; intervalle de confiance [IC] à 95 % : 1,30 à 1,51). De plus, les secteurs offrant un plus grand nombre de visites aux mères admissibles (4 à 6 visites dans le cadre du programme d’intervention comprenant des suppléments alimentaires) semblent mieux réussir à réduire la fréquence du faible poids pour l’âge gestationnel à la naissance que ceux offrant soit 1 ou 2 visites, soit 3 visites (RC = 0,86; IC à 95 % : 0,75 à 0,99).Il est nécessaire de conduire des études supplémentaires pour valider qu’une augmentation du nombre d’interventions en soins prénataux réduit le risque de faible poids pour l’âge gestationnel à la naissance au sein de différentes populations et pour en évaluer d’autres avantages potentiels pour les enfants.

Affections gravissimes à pronostic très réservé particulièrement dans notre contexte de sous médicalisation et de pauvreté. Notre but en initiant ce travail est de déterminer les étiologies de ces urgences et discuter de leur prise en charge thérapeutique. Étude de type rétrospective et descriptive sur 05 ans, au total 52 dossiers cliniques ont été inclus. Ces infections ont représenté 0,33% de nos consultations. La moyenne d'âge de nos patients a été 23 ans. Le jeune âge, les traitements inappropriés et certaines affections ORL ont été retrouvés comme facteurs favorisants. Les motifs de consultation ont été variés en fonction du siège de l'infection, cependant deux signes cliniques ont été constants: la douleur et la fièvre. L'adénophlegmon, le phlegmon péri-amygdalien, les cellulites ont été nos principales étiologies avec le streptocoque et le staphylocoque comme principaux germes en cause. L'antibiothérapie probabiliste a été utilisée en première intention notamment l'association céphalosporine de 3ème génération + aminoside + imidazolé. L'évolution clinique de nos patients a été marquée par la survenue de complications locales et générales. Urgence diagnostic et thérapeutique leur évolution reste encore émaillée de complication en raison de la consultation tardive de nos patients.

The objective is to describe the prevalence of arterial hypertension (hypertension) and cardiovascular risk factors (FDR) and specify their association with the socio-economic factors in a collectivity of Saint-Martin.CONSANT-SM is a cross-sectional descriptive study carried out on a representative sample of 400 people. The data collection was conducted by investigators at home.The low income level is significantly associated with abdominal obesity (OR=2.3), with cardiovascular FDR accumulated (OR=3.58). Low level of education (OR=2.86) and abdominal obesity (OR=3.73) are significantly associated with hypertension.The link between cardiovascular FDR and precariousness (in our study represented by the variable low levels of income and education) is found in this study carried out on a representative sample of the population of the community of Saint-Martin.The strong link between hypertension, obesity and others cardiovascular risk factors (FDR) with precariousness (in our study represented by the variable low levels of income and education) is found in this afro-Caribbean population. This data is an important information for the health program developed by the healthy system.

The objective of this study was to determine the source of health care funding for heads of households related to the management of severe malaria in children admitted to a Kinshasa reference hospital.This cross-sectional study was conducted on 1,350 hospitalised children under the age of 15 years treated for severe malaria in Kinshasa reference hospitals from January to November 2011 and the heads of households of these children.Only 46% of heads of households reported having sufficient funds directly available in the household budget. The remaining 54% had to call upon external sources of funding (sale of assets, loans, pawning goods). The use of a loan tended to increase significantly mainly for households with a low (adjusted odds ratio = 6.2), and intermediate socioeconomic status (adjusted odds ratio = 3.8) and for households working in the informal sector (adjusted odds ratio = 2.5). Similarly, the sale of assets was more frequently reported for households working in the informal sector (adjusted odds ratio = 2.4) and for female heads of households (adjusted odds ratio = 3.9).The management of severe malaria is a burden on household income. The majority of heads of households concerned needs to use external funding sources. A State subsidy for this management would help to reduce the risk of debt and sale of assets, especially for the poorest households.

Disparity in healthcare is widening in France. From the doctors' perspectives, their relationship with patients in a precarious economic situation raises a number of specific difficulties. The objective of this qualitative study of people in a precarious economic position, was to identify the specific challenges and aspects that can facilitate patient-doctor relationships.This qualitative study was based on a series of individual, semi-structured interviews between GPs and patients over the age of 18 years with a regular GP, and who were financially vulnerable (recipients of state benefits), and/or covered by universal complementary health care insurance, and/or who frequently attended charitable organisations for free food and clothes.A total of 19 people were interviewed. The participants highlighted the expected human dimension: respect, charisma and open-mindedness. A high quality of receptiveness and communication also facilitated the relationship. On the other hand, lack of availability, an authoritative tone and intrusion hindered the relationship. The patients did not appear to have any additional demands related to their economic vulnerability.In conversation with their GPs, the patients did not define themselves by their unstable financial position. The patients' experience and expectations in relation to interactions with their doctors appeared to be similar to those of the general population.

In Senegal, due to the young age of the population (60%) the concerns of the old tend to be put in the background. And yet, problems related to old age are a reality. These problems come up not in terms of demography (the old represent only 4.7% of the population), but in terms of the breaking-up of the social fabric, urbanization and the dismantling of the solidarity and poverty networks. This work is based on a collection of qualitative data from three studies conducted between 2008 and 2011 with the elderly to assess their real- life experiences, their perception of aging, their challenges and coping strategies. The results showed a transformation in the role and status of the old; this transformation being caused by social and society-related mutations. As a result, the inter-generation solidarity links have much loosened in the urban areas making the old people more vulnerable (in economic, social, health terms), especially those in charge of a family. The situation has been made worse by the unemployment affecting their offspring. In addition, the old people, who are often suffering from chronic diseases, find it hard to take charge of their medical expenses, despite the institution of the National Sesame Health Plan for the old or free health care policy. This has made them even more vulnerable. Yet before this precarious situation, the elderly develop strategies to cope with difficulties. Some recommendations have been made with a view to improving their lives and socioeconomic condition.

The social workers tell to be more and more often exposed to the religious reference table of the people they help and confronted to internal conflicts in the teams when it is a question of delimiting the borders of the religious freedom of expression in a laic frame. Besides they observe processes of affiliations-reaffiliations which pass by unchecked uses of religious practices, in particular when it concerns muslims people, which tends to become among young people of popular districts, and more marginally among the middle-class teenagers, in search of a reassuring orthopraxie, the support of a militant action for a project of new value identities disqualified or assigned, at risk of falling over to the communitarianism or the radicalization.

Free access to medicines is an important element in the implementation of health care access policies. Paradoxically, this aspect is rarely addressed in the literature on this subject. The Ville-Evrard psychiatric hospital introduced so-called "poverty prescriptions" allowing free drug dispensing, independently of specific PASS (Permanent Access to Health_ Care) systems. This paper presents the results of a study of all poverty prescriptions issued by the facility in 2011./t provides an analytical description of this system and shows that, despite the absence of strict controls, it was used relatively rarely.

Every year, thousands of children worldwide remain unimmunized or partially immunized, especially in developing countries. It therefore appears important to examine soda-demographic factors associated with incomplete immunization of children in West Africa. The present cross-sectional study examined factors associated with incomplete immunization of children aged 12 to 59 months in Cote d'lvoire, Ghana, Burkina Faso, Mali, Guinea, and Liberia, based on Demographic and Health Surveys data. The findings of the study showed that birth at home, absence of access of mothers to media, no religion, poverty, and illiteracy were associated with incomplete immunization of children. Health officials should take these immunization status predictors into account when making policies and immunization strategies in countries included in this study in order to achieve immunization coverage targets.

People living in poor conditions are at high risk of developing different medical diseases of which dermatological diseases are very common. We present 4 clinical cases of skin diseases, which are the most prevalent amongst the majority of socially and economically vulnerable patients. Early diagnosis and appropriate treatment are of paramount importance, in order to avoid their spread in close- knit communities where these patients often live.

At the last United Nations General Assembly, an ambitious target has been set for HIV treatment: ending AIDS as a public health threat by 2030. This article proposes to review the situation of HIV treatment in francophone limited resources settings and the challenges faced by those countries. It also proposes innovative actions that should be set up urgently to increase ART coverage towards scaling up.

Uterine fibromyomata in Africa, which represents the most frequent benign uterine disease, is a real public health. This pathology is frequent and most of times discovered at a late stage where the volume of the uterus is responsible for invalidating symptoms that impairs patients' quality of life. Subtotal hysterectomy, which preserves the cervix, is faster than total hysterectomy and reduces intraoperative (duration of operation, blood loss) and postoperative morbidity (urinary infection, vaginal cicatrization). Subtotal hysterectomy is adapted to countries with limited resources. Its realization requires the preoperative assessment of normal cervix and a regular post-operative follow-up of the cervix left in place.

Liver abscess is a serious infection that can cause life-threatening complications.To describe the epidemiology, diagnosis, and progression of liver abscess at the Dakar National Albert-Royer Children's Hospital.A retrospective study was conducted from over a period of 5 years (1st January 2010 to 31st December 2014). All children aged 0-15 years hospitalized for liver abscess with ultrasound confirmation were included. We collected demographic data (age, gender, socioeconomic status, origin), clinical data (general and hepatic symptoms), diagnostic data (ultrasound, bacteriology) and progression (death, complications, sequelae). The data were analyzed with Epi-info (P0.05 was considered significant).We collected 26 cases of liver abscesses, representing a hospital prevalence of 100 cases per 100,000 admissions. Males predominated (sex ratio: 1.36). The children's average age was 7.2 years. Most of the children came from urban areas of Dakar. Low socioeconomic status and precarious lifestyle were the contributing factors. Anemia (69.2%), malnutrition (42.3%), and abdominal trauma (15.3%) were the main causes found. The Fontan triad characteristic of the liver abscess was found in 57.7% of cases. At ultrasound, a single abscess was found in 21 cases. The abscess was located in the right lobe in 18 cases, the left lobe in three cases, and in both lobes in three cases. Segment VI (four cases) was the most frequently involved. Bacteriologically, the abscess was pyogenic in 17 cases and an amoebic abscess in nine cases. The main pyogenic sources found were Klebsiella pneumoniae in two cases, Pseudomonas aeruginosa in one case, Streptococcus pneumoniae in one case, and Staphylococcus aureus in one case. The average duration of antibiotic treatment was 14.5 days. Liver drainage was carried out in 24 cases. The outcome was favorable in all children.The prevalence of liver abscesses at the Albert-Royer Children's Hospital is relatively high, compared to the literature data. Percutaneous drainage combined with antibiotics remains the treatment of choice. The prognosis is favorable.

The French therapeutic communities ("Appartements de Coordination Therapeutique (ACT)") are mostly members of the "National Federation of Accommodation for HIV+ and other chronic diseases. They provide accommodation for people living with chronic conditions (HIV hepatitis, cancers...) and in a situation of high psychosocial frailty. As a result of their coordinated multidisciplinary intervention, these structures provide the required support to access health care and facilitate social inclusion. They are designed to provide an appropriate response to people with cumulative medical and social conditions (chronic diseases, precariousness, addictions and other comorbidities). Our innovative local experiment integrates Adapted Physical Activities (APA) into the global medical and social follow-up, in line with the patient's individual health care project. The characteristics of each APA project (nature of the activities proposed, intensity, duration, frequency, individual vs. team activity and accompanying methods) are defined on an individual basis, according to the user's motivations and inputs from the support team (medical, psychological and social coordination). The follow-up ensured by our APA professionals allows the residents to participate in a regular and attractive physical activity and could contribute to their social inclusion. The multidisciplinary approach proposed by ACTs determines the beneficial effects observed in such vulnerable patients.

Analysis of national health insurance accounts in the Democratic Republic of Congo (DRC) clearly shows the importance of international sanitary aid, particularlyfor thefunding ofgeneral referral hospitals, the management of inpatients with AIDS, administration of health zones andfunding of preventive care providers. It The targeted changes described in this article could possibly optimize the efficiency ofinternational aidfor the DRC population, mainly for disorders considered to be a health care priority (i.e. malaria, AIDS, tuberculosis) as well as in the fight against malnutrition. Recommendations target the implementation of procedures for control offood chain security, changes in lifestyle and dietary habits of the population but also comprise extensive restructuring of the health care administration. A dramatic change of the structure in charge of drug distribution as well as eradication of the transfer of part of public health structure income to public health administrative personnel could result in the allocation of significantfunds to thefight against the most important diseases. Better collaboration between the various departments in charge of health care professional training, together with enhanced responsibility of health care personnel is essential. Independent and respected non-governmental organizations should be involved in an audit process, targeting all aspects of the current DRC health system. Eventually, in an equal opportunity perspective, taking into consideration the very high degree of poverty ofDRC inhabitants, implementation of health insurance programmes, use ofgeneric drugs and generalization ofmicro-credit initiatives should also be implemented.

The health status of the so-called "Roma" is usually much poorer than that of neighbouring non-Roma populations with a life expectancy gap of 5-15 years. This results from prolonged exposure to adverse determinants of health and to persistent exclusion from social and political arenas. Scientific and social research has only poorly addressed the health issues of Roma and evidences are scarce. Insufficient access to public services, including to health care and non optimal clinical practices are modifiable factors. If correctly addressed, this could contribute to reduce health disparities, including in Switzerland.

This study is based on scientific publications, statistics and field observations. It shows the importance of livestock in the economy and in the risk management strategies implemented by poor farming households. A comparison of livestock performance trends with the evolution of rural poverty in developing countries indicates that growth in livestock production alone is not enough to reduce rural poverty. To help reduce poverty, sustainable production should be based on productivity gains. Prerequisites for improving productivity include better public policies, enhanced research and the reduction of animal disease risk. The study draws attention to the economic, social and environmental consequences of inadequate support for animal health and production in the least developed countries, especially those of sub-Saharan Africa.

Acute bacterial cellulitis of the leg (erysipelas) is a common problem involving considerable morbidity in dermatology practice in Africa. Previous studies conducted in Europe and North Africa have highlighted lymphoedema and toe-web intertrigo as independent factors associated with leg erysipelas. The aim of this case-control study was to identify risk factors associated with leg erysipelas in sub-Saharan Africa, within a different socio-economic and culture context.We conducted a prospective case-control study in hospital dermatology departments in 8 sub-Saharan African countries over a 12-month period (October 2013 to September 2014). Each case of acute leg cellulitis was matched with 2 controls for age (±5 years) and sex. We analysed the general and local factors.During the study period, 364 cases (223 female, 141 male) were matched with 728 controls. The mean age was 42.15±15.15 years for patients and 42.11±36 years for controls. Multivariate analysis showed the following to be independent risk factors associated with leg erysipelas in our study: obesity (odds ratio [OR]=2.82 ; 95% confidence interval: 2.11-3.76), lymphoedema (OR=3.87, 95%CI: 2.17-6.89), voluntary cosmetic depigmentation (OR=4.29, 95%CI: 2.35-7.83), neglected traumatic wound (OR=37.2, 95%CI: 24.9-57.72) and toe-web intertrigo (OR=37.86, 95%CI: 22.27-64.5).The results of this study confirms the major role of local risk factors (toe-web intertrigo, lymphoedema) previously identified in other geographical settings. However, the originality of our study consists of the identification of voluntary cosmetic depigmentation as a risk factor for leg erysipelas in sub-Saharan Africa.

The health status of the so-called "Roma" is usually much poorer than that of neighbouring non-Roma populations with a life expectancy gap of 5-15 years. This results from prolonged exposure to adverse determinants of health and to persistent exclusion from social and political arenas. Scientific and social research has only poorly addressed the health issues of Roma and evidences are scarce. Insufficient access to public services, including to health care and non optimal clinical practices are modifiable factors. If correctly addressed, this could contribute to reduce health disparities, including in Switzerland.

Malnutrition is owing to an alimentation regarding quantity and quality food. aim: To examine the different forms of malnutrition among Tunisian boys of the north and south regions, to form an idea about the state of their health and their living conditions.Our empirical investigation was carried out on 1082 northern boys and 1016 southern boys, aged from 10 to 14 years including 1057 non pubescent boys and 1041 prepubescent boys. Age, weight and height were recorded for the entire population according to the norms of the standard World Health Organization and the nutritional status of these young was described by two indices: Height for age and body mass index for age. The classification used to describe the build is the Cachera Rolland,Malnutrition are significantly more pronounced among the southern boys than their counterparts in the North. Particularly, short stature (19.2% vs 14.4%) and underweight (28% vs 22.5 %). However, the risk of overweight and obesity is more pronounced among the northern boys. However, the comparison between non pubescent and prepubescent boys shows that the prevalence of stunting increases with age.The mechanisms responsible for these inter-individual differences beings regions appear related to living conditions during the first year after birth, particularly, socio-economic status, family size, type of housing, and the education level of parents.