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La forte mortalite infanto-juvenile est preoccupante. Le Sommet mondial pour les enfants (1990) ciblait de reduire de 1/3 son niveau de 1990 a 2000. De meme, les Objectifs de Developpement Durable, visaient quant a eux, un niveau de 25‰ au plus d’ici 2030. En Guinee, cette mortalite infanto-juvenile demeure elevee (108‰ en 2018). Des etudes anterieures ont largement mis en evidence les principaux determinants de cette mortalite infanto-juvenile mais leur influence a differents niveaux d’analyse reste tres peu connue et documentee. La presente etude y apporte une contribution en mesurant l’influence des facteurs individuels, familiaux et regionaux. L’application d’une regression logistique multiniveau aux donnees de l’Enquete Demographique et de Sante (2018) montre que les facteurs individuels (rangs de naissance, niveau d’instruction de la mere, l’ethnie, l’âge a l’accouchement), les facteurs familiaux (niveau de vie du menage) et les facteurs regionaux (Degre d’heterogeneite ethnique, couverture vaccinale et alphabetisation des meres) sont significatifs pour expliquer cette mortalite.

Background: In resource-limited contexts, available data indicate that people with disability are disproportionally affected by the HIV epidemic. While disability resulting from chronic HIV infection has received some attention, few epidemiologic studies have examined the vulnerability of people with disability to HIV acquisition. The aims of the study were as follows: to estimate and compare HIV prevalence among people with and without disability living in Bujumbura, Burundi; to examine how the interaction among disability, gender and socioeconomic environment shapes vulnerability to HIV; and to identify potential pathways to higher HIV risk. Methods: In this cross-sectional population-based study, 623 persons with disability (302 with disability onset ≤10 years [“early disability”]) and 609 persons without disability matched for age, sex and location were randomly selected to be tested for HIV and to participate in an interview about their life history, their social environment and their knowledge of sexual health. Findings: A total of 68% of men and 75% of women with disability were affected by multidimensional poverty compared to 54% and 46% of their peers without disability (p

Inégalité et handicap sont deux notions si étroitement liées l’une à l’autre que leur mise en relation nécessite paradoxalement un effort conceptuel qui à la fois les distingue et clarifie leurs liens. Dans le domaine des études de population, ce besoin se double de la nécessité d’opérationnaliser les concepts. Le handicap a progressivement été défini comme un processus socialement construit, ouvrant la voie à une analyse des inégalités et particulièrement des situations d’iniquité. Des relations de causalité réciproques entre handicap et inégalité ont été explorées, accordant une place centrale à la notion de participation sociale. Celle-ci se heurte à la variabilité de sa définition. Plusieurs modèles ont mis en évidence des mécanismes sociaux sous-jacents à ces relations, proposant de nouvelles perspectives comme l’a fait l’approche des capabilités. Ces réflexions toujours en cours témoignent du dynamisme de ce champ de recherche novateur que constituent les « disability studies ». Celui-ci, porteur d’un idéal d’égalité, jette une lumière spécifique sur la notion d’inégalité.

There is growing evidence showing that people with disabilities face more frequently socioeconomic inequities than their non-disabled peers. This study aims to examine to what extent socioeconomic consequences of disability contribute to poorer access to sexual and reproductive health (SRH) services for Cameroonian with disabilities and how these outcomes vary with disabilities characteristics and gender. It uses data from a population-based survey conducted in 2015 in Yaounde, Cameroon. Mediation analysis was performed to determine how much of the total association between disability and the use, satisfaction and difficulties to access SRH services was mediated by education level, material wellbeing lifetime work participation and availability of social support. Overall, disability was associated with deprivation for all socioeconomic factors assessed though significant variation with the nature and severity of the functional limitations was observed. Lower education level and restricted lifetime work mediated a large part of the association between disability and lower use of HIV testing and of family planning. By contrast, while people with disabilities reported more difficulties to use a SRH service, no mediating was identified. In conclusion, Cameroonians with disabilities since childhood have restricted access to SRH services resulting from socioeconomic factors occurring early during the life-course.

Data from Demographic and Health Surveys and the UN Population Division present fertility trends in countries where fertility decline has been slow and irregular, i.e., Cameroon, Comoros, Cote d’Ivoire, Guinea, Mozambique, Senegal, and Tanzania. Using the decomposition method, the chapter highlights the influence of female education as well as the role of some proximate determinants of fertility. The results of the analysis show the predominance of the impact of educational policies and programs on fertility trends. Improving female educational levels appears to be the driving force of fertility decline, while the absence of progress in female education, or its deterioration, are stumbling blocks. Slow fertility declines or their stagnation are compounded by relatively high levels of unmet need for family planning and high mortality levels, which are prone to reversals. Hence the need to reinforce female educational programs, better address the unmet need for family planning, keep up with efforts in improving maternal and child health, and allocate more resources to the health, education, and employment sectors. These conditions all appear to be necessary for an accelerated fertility decline, the opening of a demographic window of opportunity, and the capturing of a first demographic dividend.

Summary Background In resource-limited settings, people with disabilities have been left behind in the response to HIV. In the HandiVIH study, we estimate and compare HIV prevalence and associated risk factors between people with and without disabilities. Methods In this cross-sectional, population-based, observational study, we used two-phase random sampling to recruit adults with disabilities and a control group matched for age, sex, and residential location from households of the general population. We used the Washington Group Short Set of Questions on Disability to identify people with disabilities. We administered an HIV test and a life-course history interview to participants. The primary outcome was the prevalence of HIV among participants with and without disabilities. Findings Between Oct 2, 2014, and Nov 30, 2015, we recruited 807 people with disabilities and 807 participants without disabilities from Yaounde, Cameroon. 28 of 716 people in the control population had a positive HIV test result (crude prevalence 3·9%, 95% CI 2·9–5·3) compared with 50 of 739 people with disabilities (6·8%, 5·0–8·6; conditional odds ratio [OR] 1·7; p=0·04). Women with disabilities were more often involved in paid sexual relationships than were women without disabilities (2·5% vs 0·5%, p=0·05). People with disabilities were also at increased risk of sexual violence than were women without disabilities (11·0% vs 7·5%, OR 1·5; p=0·01). Sexual violence and sex work were strongly associated with increased risk of HIV infection among participants with disabilities but not among controls (OR 3·0, 95% CI 1·6–5·6 for sexual violence and 12·3, 4·4–34·6 for sex work). Analyses were done in men and women. Interpretation The higher prevalence of HIV infection in people with disabilities than people without disabilities reflects a higher exposure to HIV infection as well as the presence of disability-associated HIV infection. The susceptibility of people with disabilities to HIV infection seems to be shaped by social and environmental factors. Research is needed to inform firm recommendations on how to protect this vulnerable population. Funding Agence nationale de recherches sur le sida et les hepatites virales (ANRS-Inserm) and the 5% Initiative.

Introduction In resource-limited countries, people with disabilities seem to be particularly vulnerable to HIV infection due to barriers to accessing information and services, frequent exposure to sexual violence and social exclusion. However, they have often been left behind in the HIV response, probably because of the lack of reliable epidemiological data measuring this vulnerability. Multiple challenges in conducting good quality epidemiological surveys on people with disabilities require innovative methods to better understand the link between disability and HIV. This paper describes how the design and methods of the HandiVIH study were adapted to document the vulnerability of people with disabilities to HIV, and to compare their situation with that of people without disabilities. Methods and analysis The HandiVIH project aims to combine quantitative and qualitative data. The quantitative component is a cross-sectional survey with a control group conducted in Yaounde (Cameroon). A two-phase random sampling is used (1) to screen people with disabilities from the general population using the Washington Group questionnaire and, (2) to create a matched control group. An HIV test is proposed to each study participant. Additionally, a questionnaire including a life-event interview is used to collect data on respondents’ life-course history of social isolation, employment, sexual partnership, HIV risk factors and fertility. Before the cross-sectional survey, a qualitative exploratory study was implemented to identify challenges in conducting the survey and possible solutions. Information on people with disabilities begging in the streets and members of disabled people9s organisations is collected separately. Ethics and dissemination This study has been approved by the two ethical committees. Special attention has been paid on how to adapt the consenting process to persons with intellectual disabilities. The methodological considerations discussed in this paper may contribute to the development of good practices for conducting quantitative health surveys on people with disabilities. Trial registration number NCT02192658.

Background Primary healthcare in developed countries is undergoing important reforms, and these require evaluation strategies to assess how well the population's expectations are being met. Although numerous instruments are available to evaluate primary healthcare (PHC) from the patient perspective, they do not all measure the same range of constructs. To analyze the extent to which important PHC attributes are covered in validated instruments measuring quality of care from the patient perspective. Method We systematically identified validated instruments from the literature and by consulting experts. Using a Delphi consensus-building process, Canadian PHC experts identified and operationally defined 24 important PHC attributes. One team member mapped instrument subscales to these operational definitions; this mapping was then independently validated by members of the research team and conflicts were resolved by the PHC experts. Results Of the 24 operational definitions, 13 were evaluated as being best measured by patients, 10 by providers, three by administrative databases and one by chart audits (some being best measured by more than one source). Our search retained 17 measurement tools containing 118 subscales. After eliminating redundancies, we mapped 13 unique measurement tools to the PHC attributes. Accessibility, relational continuity, interpersonal communication, management continuity, respectfulness and technical quality of clinical care were the attributes widely covered by available instruments. Advocacy, management of clinical information, comprehensiveness of services, cultural sensitivity, family-centred care, whole-person care and equity were poorly covered. Conclusions Validated instruments to evaluate PHC quality from the patient perspective leave many important attributes of PHC uncovered. A complete assessment of PHC quality will require adjusting existing tools and/or developing new instruments.

Introduction Lack of information on the warning signs of complications during pregnancy, parturition and postpartum hampers women’s ability to partake fully in safe motherhood initiatives. We assessed the extent to which women in 19 countries of sub-Saharan Africa recall receiving information about pregnancy complications during antenatal care for the most recent pregnancy, and examined the impact of advice receipt on the likelihood of institutional delivery. Methods A cross-sectional, cross-country analysis was performed on data from the most recent Demographic and Health Surveys (DHS) of 19 countries of sub-Saharan Africa. Multilevel logistic regressions were used to predict the probability of receiving information and delivering in a health centre, by clinical risk factors (age, parity, previous pregnancy termination), social factors (area of residence, education), and the frequency of service utilization (number of visits). Results The percentage of women recalling information about potential complications of pregnancy during antenatal care varied widely, ranging from 6% in Rwanda to 72% in Malawi, and in 15 of the 19 countries, less than 50% of women reported receiving information. Institutional delivery ranged from 29% (Ethiopia) to 92% (Congo Brazzaville). Teenagers (OR ¼ 0.84), uneducated (OR ¼ 0.65) and rural women (OR ¼ 0.70) were less likely to have been advised, compared with women aged 20–34 years, women with secondary education and urban women, respectively. Likelihood of recalling information increased with the number of antenatal visits. Advice reception interacts with the number of antenatal visits to increase the likelihood of institutional delivery. Conclusion There is a high level of unmet need for information on pregnancy complications in sub-Saharan Africa, particularly among those who face significant barriers to accessing care if complications occur. Educational interventions are critical to safe motherhood initiatives; health providers must fully use the educational opportunity in antenatal care.