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Chercheurs associés

RAVIT Marion

Jeune docteure associée, IRD

Axe de recherche au Ceped : Axe 1 - Santé, vulnérabilités et relations de Genre au Sud

Affectation géographique et adresse de laboratoire d’accueil :

Docteure en santé publique , diplôme obtenu le 24 juin 2019 à Sorbonne Université
Thèse : « L’accès à la césarienne dans différents contextes de financement des soins de santé maternelle en Afrique de l’Ouest »

Recherches (en cours)

Champs de recherche :

Santé de la reproduction, Santé publique, Afrique sub-saharienne, Inégalités, Systèmes de santé.

Zones géographiques étudiées :
Afrique Sub-saharienne, Bénin, Mali, Mauritanie,.

Publications récentes



  • Dumont Alexandre, Bessières N., Razafindrafara G., Ravit Marion et Benbassa André (2019) « Intérêt du test HPV dans le dépistage primaire du cancer du col en milieu rural à Madagascar », Revue d'Épidémiologie et de Santé Publique, 67 (2) (avril), p. 120-125. DOI : 10/gf3jjz. https://linkinghub.elsevier.com/retrieve/pii/S0398762018313622.
    Résumé : Background. - Testing for high-risk human papilloma virus (HR-HPV) is an effective approach to the prevention of cervical cancer. This study in the Atsinanana area of Madagascar aimed to compare the management of women screened by visual inspection after coloration with acetic acid (VIA) and the management of women screened by HPV with VIA as a triage test. Method. - During the last two screening campaigns, the first patients (between 28 and 120 women par center) were sampled using a dry swab, just before the acetic acid application, to test 14 genotypes of HR-HPV using Roche Diagnostics Cobas (R) Test. We compared current management practices based on primary VIA to those that would have been implemented if the clinician had followed the recommendations of the World Health Organization for HPV-based primary screening. We used a regression Poisson model with random effect and robust variance. Results. - Among the 250 screened-women, 28 (11.2%) had acidophilic lesions of the uterine cervix or suspected lesions of invasive cancer (IVA +). The HPV test was positive in 62 cases (24.8%). The HPV-based screening strategy would have reduced by 52% the number of women needing thermocoagulation treatment: 24 women (9.6%) with primary VIA-based screening vs. 13 women (5.2%) with primary HPV-based screening; RR: 0.52 and 95%CI: 0.27-1.02. The diagnosis of severe dysplastic lesion or invasive cancer would not have changed. Conclusion. - Primary HPV-based screening is a strategy that could be useful for low-resource countries like Madagascar. It would reduce the rate of false positives and unnecessary treatments compared to the current strategy based on primary IVA. The questions of the feasibility and cost-benefit of this strategy should be further explored.

  • Dumont Alexandre, Loenzien Myriam de, Schantz Clémence et Ravit Marion (2017) « CESARIA - un programme de recherche interventionnelle sur la pratique de la césarienne dans le monde » présenté à Journées de la recherche en santé publique, Paris. https://www.f2rsmpsy.fr/journees-recherche-sante-publique.html.
  • Dumont Alexandre, Philibert Aline, Ravit Marion, Dossa Ines, Bonnet Emmanuel et Ridde Valéry (2017) Impact du forfait obstétrical en Mauritanie : étude statistique à partir des données sociosanitaires de 2001 à 2011, Paris : AFD. (Ex Post - Evaluation et capitalisation).


  • Nyangoh Timoh Krystel, Fauconnier Arnaud, Ravit Marion, Bader Georges, Varas Ramos Catalina et Fritel Xavier (2017) « Do Urinary Leakage Circumstances in Women With Urinary Incontinence Correlate With Physician Diagnosis and Urodynamic Results? A Questionnaire Validation Study », Urology (mai). DOI : 10.1016/j.urology.2017.05.009. http://linkinghub.elsevier.com/retrieve/pii/S0090429517305009.


  • Philibert Aline, Ravit Marion, Ridde Valéry, Dossa Nissou Inès, Bonnet Emmanuel, Bedecarrats Florent et Dumont Alexandre (2016) « Maternal and neonatal health impact of obstetrical risk insurance scheme in Mauritania: a quasi experimental before-and-after study », Health Policy and Planning (octobre 22), p. 13. DOI : 10.1093/heapol/czw142. https://academic.oup.com/heapol/article-lookup/doi/10.1093/heapol/czw142.
  • Ravit Marion (2019) « L’accès à la césarienne dans différents contextes de financement des soins de la santé maternelle en Afrique de l’Ouest », Thèse de doctorat en Santé Publique, option épidémiologie, Paris : Sorbonne Université, 266 p.


  • Ravit Marion, Audibert Martine, Ridde Valéry, Loenzien Myriam de, Schantz Clémence et Dumont Alexandre (2018) « Removing user fees to improve access to caesarean delivery: a quasi-experimental evaluation in western Africa », BMJ Global Health, 3 (1) (janvier), p. e000558 (11 p.). DOI : 10/gcvjxm. http://gh.bmj.com/lookup/doi/10.1136/bmjgh-2017-000558.


  • Ravit Marion, Audibert Martine, Ridde Valéry, Loenzien Myriam de, Schantz Clémence et Dumont Alexandre (2018) « Do free caesarean section policies increase inequalities in Benin and Mali? », International Journal for Equity in Health, 17 (1) (décembre), p. (art 71, 12 p.). DOI : 10/gdk2s3. https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-018-0789-x.

  • Ravit Marion, Philibert Aline, Tourigny C., Traore Mamadou, Coulibaly A., Dumont Alexandre et Fournier Pierre (2015) « The hidden costs of a free caesarean section policy in West Africa (Kayes region, Mali) », Maternal and Child Health Journal, 19 (8), p. 1734-1743. DOI : 10.1007/s10995-015-1687-0.
    Résumé : The fee exemption policy for EmONC in Mali aims to lower the financial barrier to care. The objective of the study was to evaluate the direct and indirect expenses associated with caesarean interventions performed in EmONC and the factors associated with these expenses. Data sampling followed the case control approach used in the large project (deceased and near-miss women). Our sample consisted of a total of 190 women who underwent caesarean interventions. Data were collected from the health workers and with a social approach by administering questionnaires to the persons who accompanied the woman. Household socioeconomic status was assessed using a wealth index constructed with a principal component analysis. The factors significantly associated with expenses were determined using multivariate linear regression analyses. Women in the Kayes region spent on average 77,017 FCFA (163 USD) for a caesarean episode in EmONC, of which 70 % was for treatment. Despite the caesarean fee exemption, 91 % of the women still paid for their treatment. The largest treatment-related direct expenses were for prescriptions, transfusion, antibiotics, and antihypertensive medication. Near-misses, women who presented a hemorrhage or an infection, and/or women living in rural areas spent significantly more than the others. Although abolishing fees of EmONC in Mali plays an important role in reducing maternal death by increasing access to caesarean sections, this paper shows that the fee policy did not benefit to all women. There are still barriers to EmONC access for women of the lowest socio-economic group. These included direct expenses for drugs prescription, treatment and indirect expenses for transport and food.
    Mots-clés : caesarean section, EmONC, Expenses of care, Fee exemption, Maternal health, West Africa.

  • Ravit Marion, Schantz Clémence, Loenzien Myriam de, Dumont Alexandre, Audibert Martine et Ridde Valéry (2017) « No-cost policies and unequal access to reproductive health services: The example of Caesarean sections in West Africa / Politiques de gratuité et inégalités d’accès aux services de santé reproductive : l’exemple de la césarienne en Afrique de l’Ouest » (Communication orale), présenté à XXVIII International Population Conference/ XXVIIIe Congrès international de la population, Cape Town. https://iussp.confex.com/iussp/ipc2017/meetingapp.cgi/Paper/5886.


  • Schantz Clémence, Loenzien Myriam de, Goyet Sophie, Ravit Marion, Dancoisne Aurélien et Dumont Alexandre (2019) « How is women’s demand for caesarean section measured? A systematic literature review », éd. par Kelli K. Ryckman, PLOS ONE, 14 (3) (mars 6), p. e0213352. DOI : 10.1371/journal.pone.0213352. http://dx.plos.org/10.1371/journal.pone.0213352.
    Résumé : Background: Caesarean section rates are increasing worldwide, and since the 2000s, several researchers have investigated women’s demand for caesarean sections. Question: The aim of this article was to review and summarise published studies investigating caesarean section demand and to describe the methodologies, outcomes, country characteristics and country income levels in these studies. .Methods This is a systematic review of studies published between 2000 and 2017 in French and English that quantitatively measured women’s demand for caesarean sections. We carried out a systematic search using the Medline database in PubMed. Findings The search strategy identified 390 studies, 41 of which met the final inclusion criteria, representing a total sample of 3 774 458 women. We identified two different study designs, i.e., cross-sectional studies and prospective cohort studies, that are commonly used to measure social demand for caesarean sections. Two different types of outcomes were reported, i.e., the preferences of pregnant or non-pregnant women regarding the method of childbirth in the future and caesarean delivery following maternal request. No study measured demand for caesarean section during the childbirth process. All included studies were conducted in middle- (n = 24) and high-income countries (n = 17), and no study performed in a low-income country was found. Discussion Measuring caesarean section demand is challenging, and the structural violence leading to demand for caesarean section during childbirth while in the labour ward remains invisible. In addition, the caesarean section demand in low-income countries remains unclear due to the lack of studies conducted in these countries. Conclusion We recommend conducting prospective cohort studies to describe the social construction of caesarean section demand. We also recommend conducting studies in low-income countries because demand for caesarean sections in these countries is rarely investigated.


  • Schantz Clémence, Ravit Marion, Traoré Abou Bakary, Aboubakar Moufalilou, Goyet Sophie, Loenzien Myriam de et Dumont Alexandre (2018) « Why are caesarean section rates so high in facilities in Mali and Benin? », Sexual & Reproductive Healthcare, 16 (juin), p. 10-14. DOI : 10/gctpvx. http://linkinghub.elsevier.com/retrieve/pii/S1877575617303208.
    Résumé : Objective: To assess new estimates of caesarean section (c-section) rates in facilities in two sub-Saharan countries using the Robson classification. Methods: This study is a retrospective study. Workshops were organized in Mali and Benin in 2017 to train health care professionals in the use of the Robson classification. Nine health facilities in Mali and Benin were selected to participate in the study. Data for deliveries performed in 2014, 2015, and 2016 were included. Results: A total of 12,472 deliveries were included. The overall c-section rate was high in facilities in both countries: 31.0% in Mali and 43.9% in Benin. Women classified as high-risk (groups 6-10) were small relative contributors to the overall c-section rate (19.3% in Mali and 25.3% in Benin), while low-risk women (groups 1-4) were high relative contributors (55.4% in Mali and 45.2% in Benin). C-section rates in women who had undergone a previous c-section were especially high in both countries (84.0% in Mali; 82.5% in Benin). This group was the largest contributor to the overall c-section rates in both countries. Conclusions: We found high c-section rates in facilities in Mali and Benin, particularly for low-risk women and for women with a previous c-section. Further investigations should be carried out to understand why the c-section rates are so high in these facilities. Strategies must be implemented to avoid unnecessary c-sections, which potentially lead to further complications, particularly in countries with high fertility rates.
  • Schantz Clémence, Ravit Marion, Traoré Abou Bakary, Moufalilou Aboubacar, Loenzien Myriam de et Dumont Alexandre (2017) « Etat des lieux de la pratique contemporaine de la césarienne au Bénin et au Mali » présenté à 41e Journées Internationales, Lille, France.


  • Varas Catalina, Ravit Marion, Mimoun Camille, Panel Pierre, Huchon Cyrille et Fauconnier Arnaud (2016) « Optimal Combination of Non-Invasive Tools for the Early Detection of Potentially Life-Threatening Emergencies in Gynecology », éd. par Shengtao Zhou, PLOS ONE, 11 (9) (septembre 1), p. e0162301. DOI : 10.1371/journal.pone.0162301. http://dx.plos.org/10.1371/journal.pone.0162301.
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