Publications des membres du Ceped

2022



  • Ridde Valéry et Faye Adama (2022) « Challenges in Implementing the National Health Response to COVID-19 in Senegal », Global Implementation Research and Applications (août 9). DOI : 10.1007/s43477-022-00053-4. https://link.springer.com/10.1007/s43477-022-00053-4.
    Résumé : Since the beginning of the COVID-19 pandemic in Africa, many epidemiological or anthropological studies have been published. However, few studies have yet been conducted to understand the implementation of State interventions to fight the COVID-19 pandemic. In Senegal, the national response plan was planned before the country experienced its first official case of COVID-19 on 2 March 2020. This qualitative study, conducted in March and April 2021, based on 189 interviews, aims to understand how the national response has been implemented in several regions of Senegal. Implementation of the response to the pandemic was favoured by good preparation, capacity to adapt, responsiveness of health actors, and commitment for both the political and religious authorities. The implementation response was confronted by several constraining factors such as the coercive approach, the challenges of coordinating actors, and the lack of intersectoral response. The central level has sometimes used reflexivity processes to adapt its response, but it has remained highly politicized, centralized, directive, and with little involvement of civil society. In Senegal, the response to the pandemic has been implemented in a relatively political and directive, even coercive manner, without necessarily considering prior knowledge and the need to adapt it to local contexts and to involve civil society and community actors in the process. In 2021, seroprevalence studies of SARS-CoV-2 (COVID-19) in Africa began to
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  • Ridde Valéry, Guillard E. et Faye A. (2022) « Le retour d'"une seule santé" et la santé mondiale : ne reproduisons pas les mêmes erreurs [éditorial] », Médecine Tropicale et Santé Internationale, 2 (3), p. en ligne [8 p.]. DOI : 10.48327/mtsi.v2i3.2022.255. https://hal.science/hal-03924418.
    Résumé : La pandémie liée à la COVID-19 a fait redécouvrir le concept d' 'une seule santé' et l'idée que l'animal, l'être humain et l'environnement sont intimement liés. Ce concept n'est pourtant pas nouveau, mais il reste labile, ce qui contribue à créer une certaine confusion. Dans la pratique, les actions de terrain manquent encore cruellement et 'une seule santé' ne parvient pas à intégrer les trois dimensions. Cet éditorial vise ainsi à partager six défis que devra relever la mise en oeuvre de l'approche 'une seule santé 'pour éviter les écueils d'autres initiatives de santé mondiale. Ainsi, les programmes dédiés à une seule santé ne pourront être pertinents et pérennes sans impliquer activement les communautés. En outre, ce déploiement implique une indispensable décolonisation de la santé, c'est-à-dire une remise en cause de la manière dont les programmes sont gouvernés, financés, formulés, mis en oeuvre et évalués, avec et pour les personnes et pays concernés. Elle ne pourra se faire sans s'attaquer aux inégalités sociales de santé et aux enjeux de pouvoir. Cette approche pousse à interroger les modèles d'exploitation des ressources tant agricoles que naturelles. Penser 'une seule santé 'implique de penser les problématiques et les interventions dans une perspective tant intersectorielle, inclusive et participative qu'interdisciplinaire, sinon transdisciplinaire et d'appréhender la complexité qui en résulte. Enfin, il conviendra de prendre en compte l'utilisation des résultats des recherches pour construire les actions et les politiques publiques. Prendre en compte ces différents défis et s'inscrire dans une perspective systémique et interdisciplinaire ancrée dans des contextes locaux selon une démarche participative et inclusive nous paraît ainsi essentiel pour répondre de manière appropriée, pertinente et durable aux enjeux associés à 'une seule santé'.
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  • Ridde Valery et Hane Fatoumata (2022) « Historical invariants of community health challenges in emergencies in Africa », Sciences Sociales et Santé, 40 (3), p. 29-37. DOI : 10.3917/sss.313.0029.


  • Ridde Valery et Hane Fatoumata (2022) « Invariants historiques des défis de la santé communautaire face aux urgences en Afrique (Commentaire) », Sciences sociales et santé, 40 (3) (septembre 1), p. 29-37. DOI : 10.1684/sss.2022.0230. https://www.cairn.info/revue-sciences-sociales-et-sante-2022-3-page-29.htm.
    Mots-clés : ⚠️ Invalid DOI.
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  • Ridde Valéry, Kane Babacar, Gaye Ibrahima, Ba Mouhamadou Faly, Diallo Amadou, Bonnet Emmanuel, Traoré Zoumana et Faye Adama (2022) « Acceptability of government measures against COVID-19 pandemic in Senegal: A mixed methods study », éd. par Yodi Mahendradhata, PLOS Global Public Health, 2 (4) (avril 25), p. e0000041. DOI : 10.1371/journal.pgph.0000041. https://dx.plos.org/10.1371/journal.pgph.0000041.
    Résumé : While the first case of COVID-19 was declared on March 2 2020 in Senegal, the government banned the attendance of places of worship on 14 March, as a first measure. On March 23, it introduced a curfew, a ban on movement between regions, and the closure of markets. The objective of this study is to measure and understand the acceptability of these four governmental measures as well as the level of public trust in the state to fight the pandemic. We carried out a mixed-method research. The acceptability variables were defined using the theoretical framework of acceptability (TFA). At the quantitative level, we carried out a telephone survey (June/July 2020) at the national level (n = 813) with a sampling strategy by marginal quotas. We conducted a qualitative survey (August/September 2020) with a nested sample (n = 30). The results show a relatively high acceptability of the measures but a heterogeneity of responses. People considered curfews to be much more important (85.7% [83.2%; 88.0%]) than the closure of places of worship (55.4%; [51.9%; 58.7%]), which is least in line with the values and positive affective attitude. Several positive unintended effects of the curfew were stated (security and social/family cohesion). People over the age of 60 have more confidence in the government to fight the pandemic than people under the age of 25, although not significant (7.72 ± 3.12 vs. 7.07 ± 3.11, p = 0.1); and they are more in favour of the closure of places of worship. The more regions are affected by the pandemic, the less confidence respondents report in the government and the less they perceive the measures as effective. The results confirm the importance of government communication and trust in the state to strengthen the acceptability of pandemic measures. Important differences in acceptability show the need to adapt measures and their explanations, instead of unqualified universal action.
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  • Ridde Valéry, Kane Babacar, Mbow Ndeye Bineta, Senghor Ibrahima et Faye Adama (2022) Résilience de deux unités départementales d'assurance maladie face à la pandémie de COVID-19 au Sénégal (3), Paris, France : Ceped. (Document de travail Unissahel). https://doi.org/10.5281/zenodo.7006810.
    Résumé : Introduction : Dans sa recherche de solutions pour la couverture universelle en santé, le Sénégal a mis en place, en parallèle des mutuelles de santé communautaire communale, deux unités d’assurance maladie professionnelle départementale (UDAM) depuis 2014. Peu d’études sur la résilience des systèmes de santé en Afrique se sont encore penchées sur celle des assurances de santé. L’objectif de cet article est de comprendre comment ces deux UDAM ont été résilientes à la pandémie de COVID-19 et aux mesures restrictives imposées par l’État afin de maintenir les services à leurs membres et les remboursements aux prestataires de soins. Méthodes : La stratégie méthodologique est celle d’une étude de cas multiples avec plusieurs niveaux d’analyse au moyen d’un cadre conceptuel de la résilience et de l’analyse des configurations organisationnelles. Les données empiriques proviennent d’analyse de la documentation, d’observations dans les deux UDAM durant six mois et de 17 entretiens qualitatifs en profondeur auprès d’un échantillon de personnes sélectionnées en fonction de leur connaissance approfondie du fonctionnement et repérées lors d’une étude exploratoire. Résultats : Les résultats ont permis d’identifier trois configurations principales concernant i) la sécurité et l’hygiène, ii) l’organisation et la planification, iii) la communication pour le maintien du paiement. L’analyse de ces configurations montrent que les UDAM ont fait face à la pandémie, parfois en innovant (digitalisation), afin d’absorber le choc et de maintenir les services à leurs membres. Elles ont même contribué aux actions de lutte contre la pandémie dans leurs régions. Les UDAM ont tiré des leçons favorables de cette gestion de crise comme pour le travail à distance ou la capacité de soutenir les adhérents dans leur parcours de soins au sein des hôpitaux éloignés de leur siège. Elles ont innové avec l’organisation du paiement électronique et l’usage des réseaux sociaux pour collecter les fonds et communiquer avec les adhérents. Conclusion : Les deux UDAM ont montré qu’elles avaient été en mesure de s’adapter aux chocs de la pandémie et des mesures gouvernementales pour le maintien des services de leurs membres et de leur routine organisationnelle. Le renforcement de leur efficacité après le choc du départ de leur principal bailleur de fonds en 2017 a participé à l’adaptation, voire la transformation, à ce choc épidémique de 2020 et 2021.
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  • Ridde Valéry, Kane Babacar, Mbow Ndeye Bineta, Senghor Ibrahima et Faye Adama (2022) « The resilience of two departmental health insurance units during the COVID-19 pandemic in Senegal », BMJ Global Health, 7 (Suppl 9) (décembre 1), p. e010062. DOI : 10.1136/bmjgh-2022-010062. http://gh.bmj.com/content/7/Suppl_9/e010062.abstract.
    Résumé : Background In its pursuit of solutions for universal health coverage (UHC), Senegal has set up two departmental health insurance units (UDAMs) since 2014. Few studies on the resilience of health systems in Africa have examined health insurance organisations. This article aims to understand how these two UDAMs have been resilient during the COVID-19 pandemic and the restrictive measures imposed by the State to maintain services to their members and reimbursements to healthcare providers.Methods This study was a multicase study with multiple levels of analysis using a conceptual framework of resilience and analysis of organisational configurations. Empirical data are derived from document analysis, observations for 6 months and 17 qualitative in-depth interviews.Results The results identified three main configurations concerning (1) safety and hygiene, (2) organisation and planning and (3) communication for sustainable payment. The UDAM faced the pandemic with resilience processes to absorb the shock and maintain service to their members. The UDAM learnt positive lessons from crisis management, such as remote work or the ability to support members in their care in hospitals away from their headquarters. They have innovated (transformative resilience) with the organisation of electronic payment and the use of social networks to raise funds and communicate with members. Strengthening their effectiveness after the shock of the departure of the donors in 2017 contributed to the adaptation and even transformation from the pandemic shock of 2020 and 2021. The study shows that leadership, team dynamics and adaptation to contexts are drivers of resilience processes.Conclusion Both UDAMs adapted to the shocks of the pandemic and government measures to maintain the services of their members and their organisational routine. This resilience confirms that UDAMs are one of the possible solutions for UHC in the Sahel.All data relevant to the study are included in the article or uploaded as online supplemental information.
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  • Ridde Valéry, Kane Babacar, Mbow Ndeye Bineta, Senghor Ibrahima et Faye Adama (2022) La pérennité de deux mutuelles de santé départementales au Sénégal : une étude qualitative (7, Octobre 2022), Paris, France : Ceped. (Document de Travail Unissahel). https://doi.org/10.5281/zenodo.7194801.

  • Ridde Valéry et Olivier de Sardan Jean-Pierre (2022) « The Development World: Conflicts of Interest at All Levels », Revue internationale des études du développement, 249 (2), p. 247-269. DOI : 10.4000/ried.1530.

  • Ridde Valéry et Sardan Jean-Pierre Olivier de (2022) « The Development World: Conflicts of Interest at All Levels », Revue internationale des études du développement (septembre 22). https://hal.ird.fr/ird-03783839.
    Résumé : We analyze the multitude of conflicts of interest to which all actors in the development chain are subject. Our aim is to reflect on how the findings of research and evaluations conducted on development interventions of all kinds can be biased as a result. This analysis rests on an inclusive definition of conflict of interest, which exists whenever an actor's public stance is constrained by interests that put pressure on him or her to either express statements that contradict his or her own perceptions or knowledge, or to withhold criticism that he or she would otherwise be prepared to express. We illustrate the analysis with many cases based on our long experience in the field. Identifying problems encountered by a development intervention must be understood as a key step in formulating solutions adapted to local contexts.
    Mots-clés : ⛔ No DOI found.
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  • Rikap Cecilia (2022) « Becoming an intellectual monopoly by relying on the national innovation system: the State Grid Corporation of China's experience », Research Policy, 51 (4) (mai), p. 104472. DOI : 10.1016/j.respol.2021.104472. https://linkinghub.elsevier.com/retrieve/pii/S004873332100264X.
    Résumé : This paper examines the origins of global leaders under intellectual monopoly capitalism. State Grid Corporation of China (SGCC), the leading firm in artificial intelligence applications for the energy sector, became an intellectual monopoly relying heavily on China's national innovation system –particularly public research organizations and public funding, and innovation and energy policies. SGCC is unique because it did not rely on technology transfer from global leaders, unlike other national champions from developing or emerging countries. We provide evidence that contributes to thinking that SGCC first became a national intellectual monopoly and only afterwards expanded that monopoly globally. We empirically study SGCC's innovation networks. We proxy them using big data techniques to analyze the content, co-authors and co-owners of its publications and patents. Results also suggest that SGCC is capturing intellectual rents from its increasingly transnational and technologically diverse innovation networks by leveraging its national innovation system.
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  • Rillon Ophélie et Guidi Pierre (2022) « La politisation de l’intime en Afrique », Revue d'histoire, 20 & 21 (151/2021) (janvier 6). https://hal.science/hal-03539584.
    Résumé : Comment se façonnent et se délitent les liens intimes dans des contextes de violences étatiques ? C'est ce qu’explorent, au sujet de l’Afrique, les articles rassemblés dans ce dossier. Des années 1940 à nos jours, qu’il s’agisse de ségrégation coloniale, de guerres de libération ou de répressions routinières, les pays étudiés (de l’Afrique du Sud à l’Algérie, de la Guinée au Mali, en passant par le Maroc) sont le théâtre de violences répressives qui, en s’exerçant aussi bien sur les rapports au corps que sur la sexualité, la subjectivité et les affects, prennent l’intime pour champ de bataille privilégié. L’étude de ces contextes montre combien les intimités familiales et conjugales constituent tout à la fois une cible pour les pratiques de répression, un refuge face aux violences exercées et un espace de résistance et de politisation.
    Mots-clés : ⛔ No DOI found.
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  • Robert Emilie, Zongo Sylvie, Rajan Dheepa et Ridde Valéry (2022) « Contributing to collaborative health governance in Africa: a realist evaluation of the Universal Health Coverage Partnership », BMC Health Services Research, 22 (1) (décembre), p. 753. DOI : 10.1186/s12913-022-08120-0. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-08120-0.
    Résumé : Abstract Background Policy dialogue, a collaborative governance mechanism, has raised interest among international stakeholders. They see it as a means to strengthen health systems governance and to participate in the development of health policies that support universal health coverage. In this context, WHO has set up the Universal Health Coverage Partnership. This Partnership aims to support health ministries in establishing inclusive, participatory, and evidence-informed policy dialogue. The general purpose of our study is to understand how and in what contexts the Partnership may support policy dialogue and with what outcomes. More specifically, our study aims to answer two questions: 1) How and in what contexts may the Partnership initiate and nurture policy dialogue? 2) How do collaboration dynamics unfold within policy dialogue supported by the Partnership?  Methods We conducted a multiple-case study realist evaluation based on Emerson’s integrative framework for collaborative governance to investigate the role of the Partnership in policy dialogue on three policy issues in six sub-Saharan African countries: health financing (Burkina Faso and Democratic Republic of Congo), health planning (Cabo Verde, Niger, and Togo), and aid coordination for health (Liberia). We interviewed 121 key informants, analyzed policy documents, and observed policy dialogue events. Results The Partnership may facilitate the initiation of policy dialogue when: 1) stakeholders feel uncertain about health sector issues and acknowledge their interdependence in responding to such issues, and 2) policy dialogue coincides with their needs and interests. In this context, policy dialogue enables stakeholders to build a shared understanding of issues and of the need for action and encourages collective leadership. However, ministries’ weak ownership of policy dialogue and stakeholders’ lack of confidence in their capacity for joint action hinder their engagement and curb the institutionalization of policy dialogue. Conclusions Development aid actors wishing to support policy dialogue must do so over the long term so that collaborative governance becomes routine and a culture of collaboration has time to grow. Public administrations should develop collaborative governance mechanisms that are transparent and intelligible in order to facilitate stakeholder engagement.
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  • Cicchelli Vincenzo et Octobre Sylvie (2022) « Unpacking youth cosmo-cultures: global pop culture and the example of its Korean glocalization », in Handbook of Culture and Glocalization, éd. par Victor Roudometof et Ugo Dessì, Edward Elgar Publishing, p. 371-385. ISBN : 978-1-83910-901-0 978-1-83910-900-3. https://www.elgaronline.com/view/book/9781839109010/book-part-9781839109010-32.xml.

  • Rouveau Nicolas, Ky-Zerbo Odette, Boye Sokhna, Simo Fotso Arlette, d'Elbée Marc, Maheu-Giroux Mathieu, Silhol Romain, Kouassi Arsène Kra, Vautier Anthony, Doumenc-Aïdara Clémence, Breton Guillaume, Keita Abdelaye, Ehui Eboi, Ndour Cheick Tidiane, Boilly Marie-Claude, Terris-Prestholt Fern, Pourette Dolorès, Desclaux Alice, Larmarange Joseph et pour l'équipe ATLAS (2022) Décrire, analyser et comprendre les effets de l’introduction de l’autodépistage du VIH en Afrique de l’Ouest à travers l’exemple du programme ATLAS en Côte d’Ivoire, au Mali et au Sénégal, Working Papers du CEPED (52), Paris : Ceped, 26 p. https://www.ceped.org/wp.
    Résumé : Ce working paper est une traduction en français de l’article suivant : Rouveau N, Ky-Zerbo O, Boye S, Simo Fotso A, d’Elbée M, Maheu-Giroux M, Silhol R, Kouassi AK, Vautier A, Doumenc-Aïdara C, Breton G, Keita A, Ehui E, Ndour CT, Boilly MC, Terris-Prestholt F, Pourette D, Desclaux A, Larmarange J for the ATLAS Team. Describing, analysing and understanding the effects of the introduction of HIV self-testing in West Africa through the ATLAS programme in Côte d’Ivoire, Mali and Senegal. BMC Public Health. 2021, 21, 181. doi.org/10.1186/s12889-021-10212-1 Contexte : Le programme ATLAS vise à promouvoir et à déployer l’autodépistage du VIH (ADVIH) dans trois pays d’Afrique de l’Ouest : Côte d’Ivoire, Mali et Sénégal. Sur la période 2019-2021, en étroite collaboration avec les parte-naires nationaux de mise en œuvre de la lutte contre le sida et les communautés, ATLAS prévoit de distribuer 500 000 kits VIHST à travers huit canaux de distribution, combinant des stratégies fixes et des stratégies avancées, une distribution primaire et une distribution secondaire d’ADVIH. Tenant compte de l’épidémiologie ouest-africaine, les cibles du programme ATLAS sont les populations difficiles à atteindre : les populations clés (travailleuses de sexe, hommes ayant des rapports sexuels avec des hommes et usager·e·s de drogues), leurs clients ou partenaires sexuels, les partenaires des personnes vivant avec le VIH et les patients diagnostiqués avec des infections sexuellement transmissibles et leurs partenaires. Le programme ATLAS intégrer ainsi un volet recherche ayant pour objectif d’accompagner cette mise en œuvre et de générer des connaissances sur le passage à l’échelle de l’ADVIH en Afrique de l’Ouest. L’objectif principal est de décrire, d’analyser et de comprendre les effets sociaux, sanitaires, épidémiologiques et économiques de l’introduction de l’autodépistage du VIH en Côte d’Ivoire, au Mali et au Sénégal pour améliorer l’offre de dépistage (accessibilité, efficacité, éthique). Méthodes : La recherche ATLAS est organisée en cinq work packages (WP) multidisciplinaires : WP Populations clés : enquêtes qualitatives (entretiens individuels approfondis, discussions de groupe) menées auprès des acteurs clés, des populations clés et des utilisateurs des services de dépistage du VIH. WP Dépistage des cas index : observation ethnographique de trois services de soins VIH introduisant l’ADVIH pour le dépistage du partenaire. WP Enquête coupons : une enquête téléphonique anonyme auprès des utilisateurs de l’ADVIH. WP Volet économique : analyse des coûts économiques différentiels de chaque modèle de dispensation à l’aide d’une approche descendante avec collecte des coûts programmatiques, complété par une approche ascen-dante auprès d’un échantillon de sites de dispensations de l’ADVIH, et une étude temps-mouvement auprès d’un échantillon d’agent·e·s dispensateurs. WP Modélisation : adaptation, paramétrisation et calibration d’un modèle compartimental dynamique qui prend en compte les diverses populations ciblées par le programme ATLAS et les différentes modalités et stra-tégies de dépistage. Discussion : Le programme ATLAS est la première étude complète sur l’autodépistage du VIH en Afrique de l’Ouest. Le programme ATLAS se concentre particulièrement sur la distribution secondaire de l’ADVIH. Ce protocole a été ap-prouvé par trois comités d’éthique nationaux et par le comité d’éthique de la recherche de l’OMS. Mots-clés : VIH/SIDA, autodépistage du VIH, Afrique de l’Ouest, Sénégal, Côte d’Ivoire, Mali.
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  • Rozée Virginie et Schantz Clémence (2022) « Turbulences, résistances et résiliences dans les maternités françaises », Colloque international présenté à Accoucher en temps de pandémie, juin 8, Campus Condorcet, Paris, France.
  • Rozée Virginie et Schantz Clémence (2022) « Les représentations de l’accouchement en France (en métropole et à la Réunion): ce que révèle la réorganisation des soins en obstétrique pendant la crise du COVID-19 », Journée d'étude présenté à Santé sexuelle et reproductive face aux crises : perspectives internationales, juin 14, Campus Condorcet, Paris, France.


  • Rudasingwa Martin, De Allegri Manuela, Mphuka Chrispin, Chansa Collins, Yeboah Edmund, Bonnet Emmanuel, Ridde Valéry et Chitah Bona Mukosha (2022) « Universal health coverage and the poor: to what extent are health financing policies making a difference? Evidence from a benefit incidence analysis in Zambia », BMC Public Health, 22 (1) (août 13), p. 1546. DOI : 10.1186/s12889-022-13923-1. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13923-1.
    Résumé : Abstract Background Zambia has invested in several healthcare financing reforms aimed at achieving universal access to health services. Several evaluations have investigated the effects of these reforms on the utilization of health services. However, only one study has assessed the distributional incidence of health spending across different socioeconomic groups, but without differentiating between public and overall health spending and between curative and maternal health services. Our study aims to fill this gap by undertaking a quasi-longitudinal benefit incidence analysis of public and overall health spending between 2006 and 2014. Methods We conducted a Benefit Incidence Analysis (BIA) to measure the socioeconomic inequality of public and overall health spending on curative services and institutional delivery across different health facility typologies at three time points. We combined data from household surveys and National Health Accounts. Results Results showed that public (concentration index of − 0.003; SE 0.027 in 2006 and − 0.207; SE 0.011 in 2014) and overall (0.050; SE 0.033 in 2006 and − 0.169; SE 0.011 in 2014) health spending on curative services tended to benefit the poorer segments of the population while public (0.241; SE 0.018 in 2007 and 0.120; SE 0.007 in 2014) and overall health spending (0.051; SE 0.022 in 2007 and 0.116; SE 0.007 in 2014) on institutional delivery tended to benefit the least-poor. Higher inequalities were observed at higher care levels for both curative and institutional delivery services. Conclusion Our findings suggest that the implementation of UHC policies in Zambia led to a reduction in socioeconomic inequality in health spending, particularly at health centres and for curative care. Further action is needed to address existing barriers for the poor to benefit from health spending on curative services and at higher levels of care.
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  • Rudasingwa Martin, Yeboah Edmund, Ridde Valéry, Bonnet Emmanuel, De Allegri Manuela et Muula Adamson Sinjani (2022) « How equitable is health spending on curative services and institutional delivery in Malawi? Evidence from a quasi-longitudinal benefit incidence analysis », International Journal for Equity in Health, 21 (1) (décembre), p. 25. DOI : 10.1186/s12939-022-01624-5. https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-022-01624-5.
    Résumé : Abstract Background Malawi is one of a handful of countries that had resisted the implementation of user fees, showing a commitment to providing free healthcare to its population even before the concept of Universal Health Coverage (UHC) acquired global popularity. Several evaluations have investigated the effects of key policies, such as the essential health package or performance-based financing, in sustaining and expanding access to quality health services in the country. Understanding the distributional impact of health spending over time due to these policies has received limited attention. Our study fills this knowledge gap by assessing the distributional incidence of public and overall health spending between 2004 and 2016. Methods We relied on a Benefit Incidence Analysis (BIA) to measure the socioeconomic inequality of public and overall health spending on curative services and institutional delivery across different health facility typologies. We used data from household surveys and National Health Accounts. We used a concentration index (CI) to determine the health benefits accrued by each socioeconomic group. Results Socioeconomic inequality in both public and overall health spending substantially decreased over time, with higher inequality observed in overall spending, non-public health facilities, curative health services, and at higher levels of care. Between 2004 and 2016, the inequality in public spending on curative services decreased from a CI of 0.037 (SE 0.013) to a CI of 0.004 (SE 0.011). Whiles, it decreased from a CI of 0.084 (SE 0.014) to a CI of 0.068 (SE 0.015) for overall spending in the same period. For institutional delivery, inequality in public and overall spending decreased between 2004 and 2016 from a CI of 0.032 (SE 0.028) to a CI of -0.057 (SE 0.014) and from a CI of 0.036 (SE 0.022) to a CI of 0.028 (SE 0.018), respectively. Conclusions Through its free healthcare policy, Malawi has reduced socioeconomic inequality in health spending over time, but some challenges still need to be addressed to achieve a truly egalitarian health system. Our findings indicate a need to increase public funding for the health sector to ensure access to care and financial protection.
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  • Rungreangkulkij Somporn, Ratinthorn Ameporn, Lumbiganon Pisake, Zahroh Rana Islamiah, Hanson Claudia, Dumont Alexandre, de Loenzien Myriam, Betrán Ana Pilar et Bohren Meghan A. (2022) « Factors influencing the implementation of labour companionship: formative qualitative research in Thailand », BMJ Open, 12 (5) (mai 1), p. e054946. DOI : 10.1136/bmjopen-2021-054946. http://bmjopen.bmj.com/content/12/5/e054946.abstract.
    Résumé : Introduction WHO recommends that all women have the option to have a companion of their choice throughout labour and childbirth. Despite clear benefits of labour companionship, including better birth experiences and reduced caesarean section, labour companionship is not universally implemented. In Thailand, there are no policies for public hospitals to support companionship. This study aims to understand factors affecting implementation of labour companionship in Thailand.Methods This is formative qualitative research to inform the ‘Appropriate use of caesarean section through QUALIty DECision-making by women and providers’ (QUALI-DEC) study, to design, adapt and implement a strategy to optimise use of caesarean section. We use in-depth interviews and readiness assessments to explore perceptions of healthcare providers, women and potential companions about labour companionship in eight Thai public hospitals. Qualitative data were analysed using thematic analysis, and narrative summaries of the readiness assessment were generated. Factors potentially affecting implementation were mapped to the Capability, Opportunity, and Motivation behaviour change model (COM-B).Results 127 qualitative interviews and eight readiness assessments are included in this analysis. The qualitative findings were grouped in four themes: benefits of labour companions, roles of labour companions, training for labour companions and factors affecting implementation. The findings showed that healthcare providers, women and their relatives all had positive attitudes towards having labour companions. The readiness assessment highlighted implementation challenges related to training the companion, physical space constraints, overcrowding and facility policies, reiterated by the qualitative reports.Discussion If labour companions are well-trained on how to best support women, help them to manage pain and engage with healthcare teams, it may be a feasible intervention to implement in Thailand. However, key barriers to introducing labour companionship must be addressed to maximise the likelihood of success mainly related to training and space. These findings will be integrated into the QUALI-DEC implementation strategies.Data are available on reasonable request. Data are available on reasonable request from the corresponding author.
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  • Sabapathy K., Balzer L., Larmarange Joseph, Block L., Floyd S., Iwuji C., Wirth K., Ayles H., Fidler S., Kamya M., Petersen M., Havlir D., Dabis F., Moore J. et Hayes R. (2022) « Achieving the UNAIDS 90–90-90 targets: a comparative analysis of four large community randomised trials delivering universal testing and treatment to reduce HIV transmission in sub-Saharan Africa », BMC Public Health, 22 (1) (décembre 13), p. 2333. DOI : 10.1186/s12889-022-14713-5. https://doi.org/10.1186/s12889-022-14713-5.
    Résumé : Four large community-randomized trials examining universal testing and treatment (UTT) to reduce HIV transmission were conducted between 2012–2018 in Botswana, Kenya, Uganda, Zambia and South Africa. In 2014, the UNAIDS 90–90-90 targets were adopted as a useful metric to monitor coverage. We systematically review the approaches used by the trials to measure intervention delivery, and estimate coverage against the 90–90-90 targets. We aim to provide in-depth understanding of the background contexts and complexities that affect estimation of population-level coverage related to the 90–90-90 targets.
    Mots-clés : Antiretroviral treatment, HIV, Treatment as Prevention, UNAIDS 90-90-90, Universal Testing and Treatment.
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  • Salje Henrik, Kyungah Lim Jacqueline, Ridde Valery, Todagbe Agnandji Selidji, Lell Bertrand, Yaro Seydou, Seung Yang Jae, Hoinard Damien, Weaver Scott, Vanhomwegen Jessica et Yoon In-Kyu (2022) « Seroepidemiological reconstruction of long-term chikungunya virus circulation in Burkina Faso and Gabon », Journal of Infectious Diseases (juin 15). DOI : 10.17863/CAM.85546. https://www.repository.cam.ac.uk/handle/1810/338137.
    Résumé : Chikungunya virus (CHIKV) is a major public health concern worldwide. However, infection levels are rarely known, especially in Africa. We recruited individuals from Ouagadougou, Burkina Faso and Lambaréné, Gabon (age range: 1-55), tested their blood for CHIKV antibodies and used serocatalytic models to reconstruct epidemiological histories. In Ouagadougou, 291/999 (29.1%) individuals were seropositive, ranging from 2% among those <10y to 66% in those 40-55y. We estimated there were 7 outbreaks since the 1970s but none since 2001 resulting in 600,000 infections in the city, none of which were reported. However, we could not definitively conclude whether infections were due to CHIKV or o’nyong-nyong, another alphavirus. In Lambaréné, 117/427 (27%) participants were seropositive. Our model identified a single outbreak sometime since 2007, consistent with the only reported CHIKV outbreak in the country. These findings suggest sporadic outbreaks in these settings and that the burden remains undetected or incorrectly attributed.
    Note Note
    <h2>Other</h2> European Research Council
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  • Samadoulougou Sekou, Negatou Mariamawit, Ngawisiri Calypse, Ridde Valery et Kirakoya-Samadoulougou Fati (2022) « Effect of the free healthcare policy on socioeconomic inequalities in care seeking for fever in children under five years in Burkina Faso: a population-based surveys analysis », International Journal for Equity in Health, 21 (1) (septembre 1), p. 124. DOI : 10.1186/s12939-022-01732-2.
    Résumé : BACKGROUND: In 2016, Burkina Faso implemented a free healthcare policy as an initiative to remove user fees for women and under-5 children to improve access to healthcare. Socioeconomic inequalities create disparities in the use of health services which can be reduced by removing user fees. This study aimed to assess the effect of the free healthcare policy (FHCP) on the reduction of socioeconomic inequalities in the use of health services in Burkina Faso. METHODS: Data were obtained from three nationally representative population based surveys of 2958, 2617, and 1220 under-5 children with febrile illness in 2010, 2014, and 2017-18 respectively. Concentration curves were constructed for the periods before and after policy implementation to assess socioeconomic inequalities in healthcare seeking. In addition, Erreyger's corrected concentration indices were computed to determine the magnitude of these inequalities. RESULTS: Prior to the implementation of the FHCP, inequalities in healthcare seeking for febrile illnesses in under-5 children favoured wealthier households [Erreyger's concentration index = 0.196 (SE = 0.039, p = 0.039) and 0.178 (SE = 0.039, p < 0.001) in 2010 and 2014, respectively]. These inequalities decreased after policy implementation in 2017-18 [Concentration Index (CI) = 0.091, SE = 0.041; p = 0.026]. Furthermore, existing pro-rich disparities in healthcare seeking between regions before the implementation of the FHCP diminished after its implementation, with five regions having a high CI in 2010 (0.093-0.208), four regions in 2014, and no region in 2017 with such high CI. In 2017-18, pro-rich inequalities were observed in ten regions (CI:0.007-0.091),whereas in three regions (Plateau Central, Centre, and Cascades), the CI was negative indicating that healthcare seeking was in favour of poorest households. CONCLUSION: This study demonstrated that socioeconomic inequalities for under-5 children with febrile illness seeking healthcare in Burkina Faso reduced considerably following the implementation of the free healthcare policy. To reinforce the reduction of these disparities, policymakers should maintain the policy and focus on tackling geographical, cultural, and social barriers, especially in regions where healthcare seeking still favours rich households.
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  • Sambou Césarine, Pourette Dolorès, DeBeaudrap Pierre, Raho-Moussa Mariem et Allavena Clotilde (2022) « «Avec le VIH, on ne parle pas de nos problèmes de santé » : secret et polypathologie chez les personnes vivant avec le VIH âgées de 70 ans et plus » (poster PV332), présenté à AFRAVIH, Marseille.


  • Sauvegrain P, Schantz Clemence, Gaucher L et Chantry AA (2022) « Avenues for measuring and characterising violence in perinatal care to improve its prevention: a position paper with a proposal by the National College of French Midwives », Midwifery (octobre 26), p. 103520. DOI : 10.1016/j.midw.2022.103520. https://www.sciencedirect.com/science/article/pii/S0266613822002716.
    Résumé : Background France is somewhat behind other countries in its consideration of the issue of violence in perinatal care. Its consequences on maternal, but also neonatal and infant health are recognised internationally. Nonetheless, research and data measuring its frequency and its determinants are inadequate, and the relevant definitions are not always consensual. In this context, we, as midwives and researchers in public health and as members of the National College of French Midwives, seek to propose a scientific and clinical contribution to this debate. Aim We propose avenues for measuring and characterising violence in in perinatal care. Our objective is to quantify and characterise the situations of violence in perinatal care in population-based studies and based on the perceptions of each woman questioned. Discussion This proposal for questions, simplified compared with those currently in use in the international scientific literature, has the advantage of focusing reflection around three categories: inappropriate medical care, inappropriate human behaviours in care, and sexual abuse. It should also allow the identification of the contexts of care during which violence may be experienced, as well as the categories of health-care workers concerned. Conclusion It seems important to us to distinguish these situations, causal and context, for they require different responses if we hope to reduce the frequency and the effects of violence in perinatal care in the future. We propose questions that could also be used in clinical situations by midwives and other clinicians.
    Mots-clés : Classification, Observational studies, Obstetric care, Prevention, violence in perinatal care, Women's opinion.
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  • Schantz Clémence (2022) « Entre encapacitation et dépossession: la variabilité des expériences de l’accouchement », Journée d'étude présenté à Restitution de la recherche MATER-Covid19, mai 12, Saint-Denis, La Réunion.
  • Schantz Clémence (2022) « Modeler son sexe pour « garder son mari à la maison » Retour sur une pratique souterraine au Cambodge dans un contexte de forte biomédicalisation », Colloque international présenté à Corps, identités de genre et chirurgies sexuelles, mai 23, Université de Chicago, Paris, France.


  • Schantz Clémence, Baxerres Carine et Aboubakar Moufalilou (2022) « Humaniser l’accouchement au Bénin ? Retour sur l’échec d’un projet de la coopération japonaise », Anthropologie et Santé, 24 (mai 31). DOI : 10.4000/anthropologiesante.11560. http://journals.openedition.org/anthropologiesante/11560.
    Résumé : Depuis les années 1970, des mouvements militants internationaux dénoncent une approche médico- et techno-centrée de la naissance. En réponse à cette « techno-bio-médicalisation », le concept d’« accouchement humanisé » a émergé dans les années 1990 en Amérique latine puis s’est globalisé. Cet article propose d’analyser l’échec d’un projet japonais d’accouchement humanisé dans une maternité au Bénin. Sur la base d’observations participantes et d’entretiens, nous montrons que la proposition des actrices et acteurs du développement japonais se heurte à une forte incorporation de la « science obstétricale » par les soignant·e·s, et plus particulièrement par les sages-femmes béninoises. Plus précisément, en interdisant la présence d’un·e accompagnant·e auprès de la femme qui accouche et en refusant que celle-ci adopte une position autre que la position gynécologique, les sages-femmes reproduisent le modèle obstétrical dominant au détriment du confort et du bien-être des femmes. Haut de page ENTRÉES D’INDEX Mots-clés : biomédicalisation, biotechnologies, humanisation de l’accouchement, Bénin, Japon Keywords: biomedicalization, technology, humanization, childbirth, Japan, Benin
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  • Schantz Clémence et Coulibaly Abdourahmane (2022) « Corporéité et cancer du sein au Mali » présenté à Colloque International Sur « Les Droits De La Santé Sexuelle Et Reproductive En Afrique Sub-Saharienne : État Des Lieux Et Perspectives », décembre 6, Campus Universitaire d’Abomey-Calavi, Cotonou, Bénin.
  • Schantz Clémence et Coulibaly Abdourahmane (2022) « Therapeutic mobility and breast cancer: documenting the experiences of African women through a multi-site research project (Mali-France) », Colloque international présenté à IMISCOE, juin 30, Oslo, Norvège.


  • Schantz Clémence, Diarra Idrissa, Traoré Alassane, Traoré Bakary Abou, Chabrol Fanny et Sogoba Sanata (2022) « Radiothérapie et lutte contre les cancers : défis de maintenance de l’unique accélérateur linéaire à l’Hôpital du Mali: », Santé Publique, Vol. 34 (3) (décembre 19), p. 425-428. DOI : 10.3917/spub.223.0425. https://www.cairn.info/revue-sante-publique-2022-3-page-425.htm?ref=doi.
    Résumé : Les taux d’incidence et de mortalité par cancers ne cessent d’augmenter en Afrique de l’Ouest. La cancérologie est une discipline récente au Mali et les moyens disponibles pour traiter les malades sont insuffisants. Le Mali compte un unique appareil de radiothérapie pour le pays et ses dysfonctionnements sont régulièrement relayés par les médias. Afin de comprendre les insatisfactions récurrentes liées à l’accès à la radiothérapie au Mali, nous avons retracé l’historique de cet appareil et en avons décrit le fonctionnement. À partir d’entretiens semi-directifs menés avec des associations de patientes et des professionnels de santé impliqués en cancérologie à Bamako, nous décrivons la façon dont l’appareil de radiothérapie du Mali révèle des enjeux de santé mondiale à travers l’intervention de nombreuses coopérations internationales. De façon complémentaire, et à partir d’une collecte de données sur registres médicaux et de rapports institutionnels, nous signalons que la durée moyenne pour obtenir un rendez-vous en radiothérapie est de trois à six mois au Mali, mais aussi que l’appareil de radiothérapie a fait face à 198 pannes entre le 3 avril 2014 et le 24 septembre 2021, ce qui représente plus de 54 semaines d’arrêts cumulés. La radiothérapie est un élément crucial de la prise en charge des cancers, et le manque d’accès à ce traitement aggrave le pronostic vital des malades. Alors que le gouvernement malien s’est engagé dans des réformes de couverture santé universelle, le renforcement des infrastructures de traitement des cancers doit également être considéré comme une priorité de santé publique pour le Mali.
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  • Schantz Clémence et Ferrere Maurane (2022) « Entre excitation et peur : vécus de soignant.es en maternité pendant la pandémie en France », Journée d'étude présenté à Restitution de la recherche MATER-Covid19, mai 12, Saint-Denis, La Réunion.


  • Schantz Clémence, Rozée Virginie et Molinier Pascale (2022) « Introduction: Un nouvel axe de recherche pour les études de genre, un nouveau défi pour le soin et la société », Cahiers du Genre, 71 (2) (mars 7), p. 5-24. DOI : 10.3917/cdge.071.0005. https://www.cairn.info/revue-cahiers-du-genre-2021-2-page-5.htm?ref=doi.
    Résumé : Les violences obstétricales constituent un nouvel axe de recherche pour analyser l’expérience et le vécu de certaines femmes lors de leur suivi médical de grossesse et de leur accouchement. Si ce concept est utilisé par des chercheur·es et des militant·es en Amérique latine depuis les années 2000, ce n’est qu’à partir des années 2010 qu’il est repris en Europe et notamment en France, en particulier sur les réseaux sociaux. Le concept de « violences obstétricales » entend dénoncer différentes pratiques telles que l’absence de consentement, l’insuffisance de communication, de respect de la pudeur ou de prise en compte de la douleur, au cours d’actes médicaux parfois non médicalement justifiés (certaines césariennes ou épisiotomies, par exemple). Mais ce concept est loin de faire l’unanimité dans l’espace public et politique.
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  • Schultz Émilien, Atlani-Duault Laëtitia, Peretti-Watel Patrick et Ward Jeremy K. (2022) « Does the public know when a scientific controversy is over? Public perceptions of hydroxychloroquine in France between April 2020 and June 2021 », Therapies, 77 (5) (septembre), p. 591-602. DOI : 10.1016/j.therap.2022.01.008. https://linkinghub.elsevier.com/retrieve/pii/S0040595722000105.
    Résumé : Objectives In the early stages of the coronavirus disease 2019 (COVID-19) pandemic, chloroquine and its derivatives such as hydroxychloroquine (HCQ) were widely commented upon both within the scientific community and in the media. This paper explores the different factors that influenced public perceptions in France of the efficacy of HCQ as well as their evolution between April 2020 and June 2021. Methods This article draws on 5 surveys conducted among representative samples of the French population (projects COCONEL and TRACTRUST; quota method, n = 1006; 1004; 2006; 1014 and 1005). We asked questions on the effectiveness of chloroquine against COVID-19. We also collected sociodemographic variables and attitudes toward politics and science. Results Between April and June 2021, the proportion of respondents who believed in the efficacy of HCQ decreased rapidly from 35% to 14%. The proportion of respondents who believed that HCQ is ineffective rose gradually from 6% to 21%. After adjusting for the temporal effect, the logistic regression showed a very strong association between political orientation and the belief in the efficacy of HCQ. Respondents who felt closest to the more radical parties (far-right and far-left) were more likely to believe in the efficacy of HCQ than those who felt closest to the political center (O.R. 2.48 [1.95–3.15] and 1.87 [1.44–2.43]). The role of trust in the government and in science and of the degree of political engagement were investigated in the two waves conducted after the scientific consensus was established during the summer of 2020. High levels of trust in the government and in science and of politicization are associated with belief of HCQ proven inefficacy. Across the whole period, a majority of respondents were uncertain. Even in 2021, 41.5% stated that the data were insufficient to decide whether or not HCQ is effective and 25.2% stating that they did not know. Conclusion Because media coverage of scientific controversies is higher in times of uncertainty than after these controversies have died down, the publicization of therapeutic promises can have lasting consequences on attitudes towards science and medicine.
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  • Schultz Émilien, Mignot Léo et Mirambet Pierre (2022) « La place des médecins chercheurs dans l’innovation médicale » (communication orale), présenté à Workshop "(Re)compositions autour de la médecine de précision en région Nouvelle Aquitaine". https://hal.science/hal-03676791.

  • Schultz Émilien, Mignot Léo, Ward Jeremy K., Bomfim Daniela Boaventura, Chabannon Christian et Mancini Julien (2022) « Public perceptions of the association between drug effectiveness and drug novelty in France during the COVID-19 pandemic ». https://shs.hal.science/halshs-03448961.
    Résumé : During the COVID-19 pandemic, public debates overtly addressed the promises of new innovative treatments. Many of these debates pitted those who advocated for the development of new treatments by pharmaceutical companies against those who favored the repositioning of existing drugs. Our study explored perceptions of the association between drug novelty and effectiveness as well as perceptions of the role of the pharmaceutical industry in drug development. Data were collected in January 2021 from a quota sample of the French population aged 18–75 years (N = 1,000) during the second round of the “Health Literacy Survey 2019” (HLS19). We tested the hypothesis that individuals with a high level of familiarity with the health care system and those with a high level of trust in institutions are more likely to agree that new drugs are more effective than old ones and that drug development should be driven by the pharmaceutical industry. A quarter (25%) of respondents agreed that new drugs are always more effective than old ones. Agreement with this statement was stronger among respondents with a high level of familiarity with the health care system (as measured by the Navigational Health Literacy score, OR 3.34 [2.13-5.24]) and among those with a high level of trust in pharmaceutical companies or politicians. A high level of trust in pharmaceutical companies was reported by 42% of respondents, and 43% agreed that drug development should be driven by the pharmaceutical industry. Respondents who agreed that new drugs are always more effective than old ones were almost four times more likely to agree that drug development should be driven by the pharmaceutical industry (OR 3.85 [2.76-5.39]). A better understanding of public attitudes towards new treatments is needed to elucidate individual preferences in health care and their consequences on health behavior.
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  • Schultz Émilien, Touzani Rajae, Mancini Julien et Ward Jeremy K. (2022) « From contact tracing to COVID-19 pass holder; the tortured journey of the French TousAntiCovid contact tracing app », Public Health, 206 (mai), p. 5-7. DOI : 10.1016/j.puhe.2022.02.009. https://linkinghub.elsevier.com/retrieve/pii/S0033350622000579.
    Résumé : Objectives: Our study aimed to provide an updated overview of the use of the French contact tracing application, TousAntiCovid, and identify evolutions since the beginning of the pandemic. Study design: We conducted a survey study on a representative sample of the French adult population. Methods: Our data were collected by the Obervatoire Re = gional de la Sante = (ORS) using a selfadministered online questionnaire. This was completed by a sample of 2,022 people stratified to match French official census statistics for gender, age, occupation, and area of housing. We conducted statistical analysis using Python (Pandas Scipy Statsmodels) with chi-squared and Wilcoxon rank sum tests to control for statistical significance. Results: A small majority of respondents used TousAntiCovid (55.5%), while 41.0% had never downloaded it. Only one-quarter of the respondents (23.3%) used it for contact tracing with Bluetooth, while a third (32.2%) used it only for storing their health pass. The app's use increased with education level, income, and younger age. A large majority (85%) of non-vaccinated respondents had never downloaded TousAntiCovid. Conclusion: Our results suggest that the role and use of France's official COVID-19 app TousAntiCovid has evolved in line with the government's strategy; while initially focusing on contact tracing, its development has led to the possibility to store test and vaccination documentation. The survey also confirmed previous results pointing to the lasting differences in socio-economic status in terms of adoption of the app. This is problematic because the long-term nature of the pandemic could require the government to keep a range of strategies open, including contact tracing. Public discussion of the current and future roles of the French contact tracing app is therefore needed. (c) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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  • Serviant-Fine Thibaut (2022) « Strange Blood. The Rise and Fall of Lamb Blood Transfusion in 19th Century Medicine and Beyond », NUNCIUS-JOURNAL OF THE HISTORY OF SCIENCE, 37 (2) (juin), p. 498-500. DOI : 10.1163/1S253911-20221005.
    Mots-clés : ⚠️ Invalid DOI.
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  • Sidibé Cheick S., Becquet Valentine, Brückner Tanya Y., Touré Ousmane, Traoré Lalla Fatouma, Broerse Jacqueline E. W. et Dieleman Marjolein (2022) « Adoption of harmonisation policy for the midwives’ training programme in Mali: A policy analysis », PLOS Global Public Health, 2 (11) (novembre 29), p. e0001296. DOI : 10.1371/journal.pgph.0001296. https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001296.
    Résumé : West Africa is engaged in a process of harmonising health workers’ training programmes as a means to regulate regional training standards and thus improve their quality. There is currently a lack of documented information regarding the adoption of these revised training programmes. In 2012 a harmonised programme, the WAHO competency-based curriculum, was introduced in Mali for training midwives. The present study explores the barriers and facilitators of the adoption of this programme and how the content, context, process, and actor-related factors influenced this. We used a qualitative research design consisting of document analysis (n = 25) and semi-structured interviews (n = 21) with policymakers, students, and those in charge of implementing the training programme. Information was collected on education and training policies, the context and process of the harmonised curriculum development, its adoption, and the actors involved in the adoption strategy, along with their role. The study shows that the adoption of the harmonised curriculum in Mali offered midwives an opportunity to attain a higher standard of training and level of qualification than before. It also displayed both the government’s and the public school’s willingness and commitment to improve maternal and child health through enhancing midwives’ training standards. The most salient factors that influenced adoption were the lack of available resources, and the lack of involvement of, and coordination with, relevant actors for successful policy adoption. Mali’s experience of adopting the harmonisation policy of training curricula demonstrates the need for the authorities to collaborate with relevant actors for information dissemination and in the adoption process. It also demonstrates the need for finding innovative ways to secure and diversify funding opportunities, as well as establish a supervisory body for health worker training.
    Mots-clés : Employment, Finance, Graduates, Health care policy, Mali, Midwives, Salaries, Schools.
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  • Silhol Romain, Maheu-Giroux Mathieu, Soni Nirali, Fotso Arlette Simo, Rouveau Nicolas, Vautier Anthony, Doumenc-Aïdara Clémence, Geoffroy Olivier, N’guessan Kouassi Noel, Sidibé Younoussa, Kabemba Odé Kanku, Gueye Papa Alioune, Ndeye Pauline Dama, Mukandavire Christinah, Vickerman Peter, Keita Abdelaye, Ndour Cheikh Tidiane, Ehui Eboi, Larmarange Joseph, Boily Marie-Claude et Team∗ for the ATLAS (2022) « The impact of past HIV interventions and diagnosis gaps on new HIV acquisitions, transmissions, and HIV-related deaths in Côte d’Ivoire, Mali, and Senegal », AIDS (avril 20), p. 10.1097/QAD.0000000000003974. DOI : 10.1097/QAD.0000000000003974. https://journals.lww.com/aidsonline/abstract/9900/the_impact_of_past_hiv_interventions_and_diagnosis.524.aspx.
    Résumé : Objectives:  To estimate the epidemiological impact of past HIV interventions and the magnitude and contribution of undiagnosed HIV among different risk groups on new HIV acquisitions in Côte d’Ivoire, Mali and Senegal. Design:  HIV transmission dynamic models among the overall population and key populations [female sex workers (FSW), their clients, and MSM]. Methods:  Models were independently parameterized and calibrated for each set of country-specific demographic, behavioural, and epidemiological data. We estimated the fraction of new HIV infections over 2012–2021 averted by condom use and antiretroviral therapy (ART) uptake among key population and nonkey population, the direct and indirect contribution of specific groups to new infections [transmission population-attributable fraction (tPAF)] over 2012–2021 due to prevention gaps, and the distribution of undiagnosed PWH by risk group in January 2022 and their tPAF over 2022–2031. Results:  Condom use and ART may have averted 81–88% of new HIV infections over 2012–2021 across countries, mostly because of condom use by key population. The tPAF of all key populations combined over 2012–2021 varied between 27% (Côte d’Ivoire) and 79% (Senegal). Male key population (clients of FSW and MSM) contributed most to new infections (>60% in Mali and Senegal) owing to their higher HIV prevalence and larger prevention gaps. In 2022, men represented 56% of all PWH with an undiagnosed infection in Côte d’Ivoire (male key population = 15%), 46% in Mali (male key population = 23%), and 69% in Senegal (male key population = 55%). If HIV testing and ART initiation rates remain at current levels, 20% of new HIV infections could be due to undiagnosed key population PWH in Côte d’Ivoire over 2022–2031, 53% in Mali, and 65% in Senegal. Conclusion:  Substantial HIV diagnosis gaps remain in Western Africa, especially among male key population. Addressing these gaps is key to impacting the HIV epidemics in the region and achieving the goal of ending AIDS by 2030.
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  • Silhol Romain, Maheu-Giroux Mathieu, Soni Nirali, Simo Fotso Arlette, Rouveau Nicolas, Vautier Anthony, Doumenc-Aïdara Clémence, N'Guessan Kouakou, Mukandavire Christinah, Vickerman Peter, Keita Abdelaye, Ndour Cheikh Tidiane, Larmarange Joseph, Boily Marie Claude et ATLAS Team (2022) « Identifying population-specific HIV diagnosis gaps in Western Africa and assessing their impact on new infections: a modelling analysis for Côte d'Ivoire, Mali and Senegal » (poster), présenté à 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Abstract/Abstract/?abstractid=4243.
    Résumé : BACKGROUND: Progress towards HIV elimination in Western Africa may be hindered by diagnosis gaps among people living with HIV (PLHIV), especially among key populations (KP) such as female sex workers (FSW), their clients, and men who have sex with men (MSM). We aimed to identify largest gaps in diagnosis by risk group in Mali, Côte d'Ivoire, and Senegal, and project their contribution to new HIV infections. METHODS: Deterministic models of HIV transmission/diagnosis/treatment that incorporate HIV transmission among KP were parameterized following comprehensive country-specific reviews of demographic, behavioural, HIV and intervention data. The model was calibrated to country- and group-specific empirical outcomes such as HIV incidence/prevalence, the fractions of PLHIV ever tested, diagnosed, and on treatment. We estimated the distribution of undiagnosed PLHIV by risk group in 2020 and the population-attributable-fractions (tPAFs) (i.e. fraction of new primary and secondary HIV infections 2020-2029 originating from risk groups of undiagnosed PLHIV). RESULTS: From 46% (95% UI: 38-58) to 69% (59-79) of undiagnosed PLHIV in 2020 were males, with the lowest proportion in Mali and the highest proportion in Senegal, where 41% (28-59) of undiagnosed PLHIV were MSM. Undiagnosed men are estimated to contribute most new HIV infections occurring over 2020-2029 (Table). Undiagnosed FSW and their clients contribute substantial proportions of new HIV infections in Mali, with tPAF=20% (10-36) and tPAF=43% (26-56), respectively, while undiagnosed MSM in Senegal are estimated to contribute half of new infections. A lower proportion of new HIV infections are transmitted by undiagnosed KP in Côte d'Ivoire (tPAF=21%(10-38)). CONCLUSIONS: Current HIV testing services and approaches are leaving members of KP behind. Increasing the availability of confidential HIV testing modalities in addition to traditional tests may substantially reduce gaps in HIV diagnosis and accelerate the decrease of new HIV infections in Western Africa since half of them could be transmitted by undiagnosed KP.
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  • Simo Fotso Arlette, Johnson Cheryl, Vautier Anthony, Kouame Konan Blaise, Diop Papa Moussa, Doumenc Aïdara Clémence, Baggaley Rachel, Ehui Eboi, Larmarange Joseph et équipe ATLAS (2022) « Mesure de l’impact populationnel de l’auto-dépistage du VIH par la triangulation de données programmatiques de routine : Exemple du projet ATLAS en Côte d’Ivoire » (poster #PV164), présenté à AFRAVIH, Marseille.
    Résumé : Objectifs L’auto-dépistage du VIH (ADVIH) est recommandé comme stratégie de dépistage par l’OMS. Il a pour avantage de permettre aux personnes de réaliser elles-mêmes leur test et de garantir la discrétion et confidentialité, permettant de toucher des populations non testées et difficiles à atteindre. Cependant, son caractère confidentiel et l'approche de distribution via les réseaux (ciblant les population clés et leurs proches et partenaires) rendent difficile l'estimation de l’impact de l’ADVIH au niveau populationnel. Cette étude propose un moyen de surmonter ce défi et utilise des données programmatiques de routine pour estimer indirectement les impacts du projet ATLAS sur l'accès au dépistage du VIH, le dépistage du VIH conventionnel (c'est-à-dire autre que l’ADVIH), les nouveaux diagnostics du VIH et l’initiation de traitement antirétroviral (TAR) en Côte d'Ivoire. Matériels et Méthodes Les données sur le nombre de kits d’ADVIH distribués par ATLAS proviennent des rapports des partenaires de mise en oeuvre entre le troisième trimestre (T3) de 2019 et le T1 2021. Nous utilisons également les indicateurs de routine du PEPFAR agrégées par districts sanitaires et par trimestre. Les analyses se font par une régression de séries chronologiques écologiques à l'aide de modèles mixtes linéaires. Résultats Entre T3 2019 et T1 2021, 99353 kits d’ADVIH ont été distribués par ATLAS dans les 78 districts sanitaires inclus dans l'analyse. Les résultats (tableau 1) montrent un effet négatif mais non significatif sur le volume de tests conventionnels (-195) ce qui traduirait une légère substitution entre ADVIH et test conventionnel. Malgré cela l’effet net est positif sur l’accès au dépistage : pour 1000 ADVIH distribués via ATLAS, 589 personnes supplémentaires ont eu accès au dépistage du VIH avec l’hypothèse d’un taux d'utilisation d’ADVIH (TU) de 80 % et 393 avec une hypothèse de 60%. L'effet de l’ADVIH sur le diagnostic du VIH était significatif et positif (8). Pas d’effet significatif observé sur l’initiation TAR (-2). Conclusion Nos résultats mettent en évidence qu'une stratégie de distribution de l’ADVIH basée sur les réseaux ciblant les population clés et leurs proches et partenaires augmentent l’accès au dépistage du VIH et améliore le diagnostic. La méthodologie utilisée dans cet article pourrait être reproduite dans différents contextes pour l'évaluation des programmes d’ADVIH, sans nécessité de systèmes de collecte additionnels.
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  • Simo Fotso Arlette, Johnson Cheryl, Vautier Anthony, Kouamé Konan Blaise, Diop Papa Moussa, Silhol Romain, Maheu-Giroux Mathieu, Boily Marie-Claude, Rouveau Nicolas, Doumenc-Aïdara Clémence, Baggaley Rachel, Ehui Eboi, Larmarange Joseph et ATLAS Team (2022) « Estimating the impact of HIV self-testing on HIV testing services, diagnoses, and treatment initiation at the population-level with routine data: the example of the ATLAS program in Côte d'Ivoire » (poster), présenté à 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Abstract/Abstract/?abstractid=5409.
    Résumé : BACKGROUND: HIV self-testing (HIVST) is a critical testing approach particularly for reaching those at HIV risk who are hesitant or unable to access existing services. While the discreet and flexible nature of HIVST is appealing to users, these features can limit the ability for programmes to monitor and estimate the population-level impacts of HIVST implementation. This study triangulates publicly available routine programme data from Côte d'Ivoire in order estimate the effects of HIVST distribution on access to testing, conventional testing (self-testing excluded), HIV diagnoses, and antiretroviral treatment (ART) initiations. METHODS: We used quarterly programmatic data (Q3-2019 to Q1-2021) from ATLAS, a project that aims to promote and implement network-based HIVST distribution in West Africa, in addition to routine HIV testing services program data obtained from the PEPFAR dashboard. We performed ecological time series regression using linear mixed-models. RESULTS: Between Q3-2019 and Q1-2021, 99,353 HIVST kits were distributed by ATLAS in 78 health districts included in the analysis. The results (Table 1) show a negative but non-significant effect of the number of ATLAS HIVST on the volume of conventional tests (-190), suggesting the possibility of a slight substitution effect. Despite this, the the beneficial effect on access to testing is significant: for each 1000 HIVST distributed via ATLAS, 390 to 590 additional HIV tests were performed if 60% to 80% of HIVST are used . The effect of HIVST on HIV diagnosis was significant and positive, with 8 additional diagnoses per 1,000 HIVST distributed. No effect of HIVST was observed on ART initiations. CONCLUSIONS: Our study provides a standard methodology for estimating the population-level impact of HIVST that can be used across countries. It shows that HIVST distribution was associated with increased access to HIV testing and diagnosis in Côte d'Ivoire. Wide-scale adoption of this method will improve HIVST data quality and inform evidence-based programming.
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  • Simo Fotso Arlette, Johnson Cheryl, Vautier Anthony, Kouamé Konan Blaise, Diop Papa Moussa, Silhol Romain, Maheu-Giroux Mathieu, Boily Marie-Claude, Rouveau Nicolas, Doumenc-Aïdara Clémence, Baggaley Rachel, Ehui Eboi, Larmarange Joseph et for the ATLAS Team (2022) « Routine programmatic data show a positive population-level impact of HIV self-testing: the case of Côte d’Ivoire and implications for implementation », AIDS, 36 (13) (septembre 29), p. 1871–1879. DOI : 10.1097/QAD.0000000000003328. https://journals.lww.com/aidsonline/Fulltext/2022/11010/Routine_programmatic_data_show_a_positive.15.aspx.
    Résumé : Objectives:  We estimate the effects of ATLAS's HIV self-testing (HIVST) kit distribution on conventional HIV testing, diagnoses, and antiretroviral treatment (ART) initiations in Côte d’Ivoire. Design:  Ecological study using routinely collected HIV testing services program data. Methods:  We used the ATLAS's programmatic data recorded between the third quarter of 2019 and the first quarter of 2021, in addition to data from the President's Emergency Plan for AIDS Relief dashboard. We performed ecological time series regression using linear mixed models. Results are presented per 1000 HIVST kits distributed through ATLAS. Results:  We found a negative but nonsignificant effect of the number of ATLAS’ distributed HIVST kits on conventional testing uptake (−190 conventional tests; 95% confidence interval [CI]: −427 to 37). The relationship between the number of HIVST kits and HIV diagnoses was significant and positive (+8 diagnosis; 95% CI: 0 to 15). No effect was observed on ART initiation (−2 ART initiations; 95% CI: −8 to 5). Conclusions:  ATLAS’ HIVST kit distribution had a positive impact on HIV diagnoses. Despite the negative signal on conventional testing, even if only 20% of distributed kits are used, HIVST would increase access to testing. The methodology used in this paper offers a promising way to leverage routinely collected programmatic data to estimate the effects of HIVST kit distribution in real-world programs.
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  • Simo Fotso Arlette, Kra Arsène Kouassi, Maheu-Giroux Mathieu, Boye Sokhna, d’Elbée Marc, Ky-zerbo Odette, Rouveau Nicolas, N’Guessan Noel Kouassi, Geoffroy Olivier, Vautier Anthony, Larmarange Joseph et for the ATLAS Team (2022) « Is it possible to recruit HIV self-test users for an anonymous phone-based survey using passive recruitment without financial incentives? Lessons learned from a pilot study in Côte d’Ivoire », Pilot and Feasibility Studies, 8 (4) (janvier 6), p. 1-7. DOI : 10.1186/s40814-021-00965-2. https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-021-00965-2.
    Résumé : Background:  Due to the discreet and private nature of HIV self-testing (HIVST), it is particularly challenging to moni‑tor and assess the impacts of this testing strategy. To overcome this challenge, we conducted a study in Côte d’Ivoire to characterize the profile of end users of HIVST kits distributed through the ATLAS project (AutoTest VIH, Libre d’Accéder à la connaissance de son Statut). Feasibility was assessed using a pilot phone-based survey. Methods:  The ATLAS project aims to distribute 221300 HIVST kits in Côte d’Ivoire from 2019 to 2021 through both primary (e.g., direct distribution to primary users) and secondary distribution (e.g., for partner testing). The pilot survey used a passive recruitment strategy—whereby participants voluntarily called a toll-free survey phone number—to enrol participants. The survey was promoted through a sticker on the HIVST instruction leaflet and hotline invitations and informal promotion by HIVST kit-dispensing agents. Importantly, participation was not financially incentivized, even though surveys focussed on key populations usually use incentives in this context. Results:  After a 7-month period in which 25,000 HIVST kits were distributed, only 42 questionnaires were completed. Nevertheless, the survey collected data from users receiving HIVST kits via both primary and secondary distribution (69% and 31%, respectively). Conclusion:  This paper provides guidance on how to improve the design of future surveys of this type. It discusses the need to financial incentivize participation, to reorganize the questionnaire, the importance of better informing and training stakeholders involved in the distribution of HIVST, and the use of flyers to increase the enrolment of users reached through secondary distribution.
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  • Simo Fotso Arlette et Nawo Larissa (2022) « Child Disability and Deprivation: A Conceptual, theoretical and empirical review of the sub-Saharan African literature », in The Routledge Handbook of African Demography (eds: Odimegwu C.O., Adewoyin Yemi), 1, New York, NY : Routledge. ISBN : 978-0-429-28721-3.
    Résumé : The nexus between disability and deprivation is an increasing interest to policy makers as children with disabilities are being mainstreamed into national and international poverty reduction programs. This literature is vast and has a long history, however, previous literature reviews have not addressed the concepts of poverty and deprivation especially for children living with disabilities in Africa. The aim of this chapter was to provide a comprehensive survey on links between child disability and deprivation in Africa. It shows that the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) is today almost universally recognised as the framework to understand child disability. The Washington Group/UNICEF child functioning screening instrument is now well endorsed to measure disability in children aged 2-17 years, even though not yet routinely integrated into national surveys. The theoretical review highlights the diversity of theoretical framework used in economics and social science studies, while empirical literature showed that children with disability are living a vicious circle of social and material deprivation. By drawing attention to these findings and their limitations, this chapter provides suggestions for future research in order to provide policy makers relevant tools to improve the well-being of children living with disabilities.
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  • Stannah James, Flores Anato Jorge Luis, Mitchell Kate M, Larmarange Joseph, Maheu-Giroux Mathieu et Boily Marie‐Claude (2022) « Improving our understanding of how structural determinants impact HIV epidemics: a scoping review of dynamic models to guide future research » (poster), présenté à 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Abstract/Abstract/?abstractid=6564.
    Résumé : BACKGROUND: Dynamic models of HIV transmission have proven valuable tools for informing HIV prevention strategies. Including structural determinants in models is crucial to estimate their population-level impacts on HIV transmission and inform efforts towards HIV elimination. However, this is challenging due to a lack of coherent conceptual frameworks, limited understanding of their specific causal pathways, and few empirical estimates of their impacts on downstream mediators. METHODS: With the overarching aim to improve models, we conducted a scoping review of studies that used dynamic HIV transmission models to evaluate the impact of structural determinants. From included studies, we extracted information on the types of structural determinants and methods used to model their impacts on HIV transmission. We appraised studies on how they conceptualized structural exposures and represented their causal relationships over time within models. RESULTS: We identified 9 dynamic transmission modelling studies that incorporated structural determinants of HIV, including violence (N=3), incarceration (N=2), stigma (N=2), housing instability (N=2), migration (N=1), and education (N=1). Only one study modelled multiple determinants simultaneously. In most models, structural determinants were conceptualized using current, recent, non-recent and/or lifetime exposure categories. Modelled structural determinants largely impacted HIV transmission through mediated effects on one or more proximate risk factors, including sharing injection equipment, condom use, number of partners, and access to treatment. However, causal pathways were simplistic, with few mediators and/or lack of clear empirical justification. To measure impact, most studies simply assumed the elimination of structural determinants in counterfactual comparison scenarios. Few models included long-term and/or delayed effects of past, recurrent, or acute exposure, potentially overestimating impacts of determinants. CONCLUSIONS: Despite the importance of structural determinants for HIV prevention, methods for including them in dynamic HIV transmission models remain insufficient. Few studies have attempted to incorporate structural determinants in HIV models, and methods vary considerably. To improve inferences, models should adopt precise exposure definitions, deconstruct and estimate their complex causal pathways, and translate them into their mechanistic components. The need for development of coherent frameworks to conceptualize the synergistic interplay between strengthened empirical data analysis and the inclusion of structural determinants in dynamic models is pressing.
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  • Stannah James, Soni Nirali, Lam Jin Keng Stephen, Giguère Katia, Mitchell Kate M., Kronfli Nadine, Larmarange Joseph, Moh Raoul, Nouaman Marcelin N’zebo, Kouamé Gérard Menan, Maheu-Giroux Mathieu et Boily Marie-Claude (2022) « Trends in HIV testing, the treatment cascade, and HIV incidence among men who have sex with men in Africa: A systematic review and meta-regression analysis », medRxiv. DOI : 10.1101/2022.11.14.22282329. https://www.medrxiv.org/content/10.1101/2022.11.14.22282329v1.
    Résumé : Background Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. In Africa, MSM face structural barriers to HIV prevention and treatment including socio-economic disadvantages, stigma, and criminalization that increase their vulnerability to HIV acquisition and transmission and undermine progress towards ending AIDS. This systematic review explores progress towards increases in HIV testing, improving engagement in the HIV treatment cascade, and HIV incidence reductions among MSM in Africa. Methods We searched Embase, Medline, Global Health, Scopus, and Web of Science from January 1980-March 2022 for cross-sectional and longitudinal studies reporting HIV testing, knowledge of status, care, antiretroviral therapy (ART) use, viral suppression, and/or HIV incidence among MSM in Africa. We pooled surveys using Bayesian generalized linear mixed-effects models, used meta-regression to assess time trends, and compared HIV incidence estimates among MSM with those of all men. Findings Of 8,992 articles identified, we included 148 unique studies published from 2005-2022. HIV testing increased over time in Central/Western and Eastern Africa and in 2020, we estimate that 88% (95% credible interval (CrI) 57-97%) of MSM had tested in the past 12 months, but 66% (19-94%) of MSM living with HIV knew their HIV status, although this is probably underestimated given non-disclosure. Current ART use increased over time in Central/Western (ORyear=1.4, 95%CrI 1.1-2.0, N=8) and Eastern/Southern Africa (ORyear=1.4, 1.0-1.8, N=17) and in 2020 we estimate that 75% (18-98%) of MSM living with HIV in Africa were currently on ART. Nevertheless, we did not find strong evidence viral suppression increased, and in 2020 we estimate that only 62% (12-95%) of MSM living with HIV were virally suppressed. HIV incidence among MSM did not decrease over time (IRRyear=1.0, 0.7-1.3, N=38) and remained high in 2020 (5.4 per 100 person-years, 0.9-33.9) and substantially higher (27-150 times higher) than among all men. Interpretation No decreases in HIV incidence have been observed among MSM in Africa over time, despite some increases in HIV testing and ART use. Achieving the UNAIDS 95-95-95 targets for diagnosis, treatment, and viral suppression equitably for all requires renewed focus on this key population. Combination interventions for MSM are urgently required to reduce disparities in HIV incidence and tackle the social, structural, and behavioural factors that make MSM vulnerable to HIV acquisition. Funding US National Institutes of Health, UK Medical Research Council, Canadian Institutes of Health Research, Fonds de Recherche du Quebec - Sante.
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  • Tanguy-Domingos Simonella (2022) « Du « confiage » traditionnel d’enfant à l’adoption internationale: Les transformations autour du placement d’enfants au Bénin », Annales de démographie historique, 142 (2) (janvier 18), p. 165-194. DOI : 10.3917/adh.142.0165. https://www.cairn.info/revue-annales-de-demographie-historique-2021-2-page-165.htm?ref=doi.
    Résumé : La circulation des enfants d’une famille à l’autre est une pratique que l’on retrouve dans la plupart des sociétés africaines. L’adoption dans son acception moderne s’est progressivement implantée dans les pays africains, notamment au Bénin où différentes formes de placements d’enfants ont jusque-là été utilisées pour répondre aux normes de solidarité en vigueur. Cet article retrace l’historicité des pratiques adoptives et assimilées dans un contexte social marqué par une vision biologiste de la filiation, sous l’influence de la globalisation et des transformations sociopolitiques internes.
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  • Joxe Ludovic (2022) « Quand venir du Sud favorise la satisfaction personnelle. Le cas des expatriés les plus novices de l'organisation Médecins sans frontières », in Le bien-être au Nord et au Sud: explorations, éd. par Josiane Tantchou, Frédérique Louveau, et Marc-Eric Gruénais, Louvain-la-Neuve : Académia, p. 71-84. (Investigations d'anthropologie prospective). ISBN : 978-2-8061-0631-5.
    Mots-clés : Africa, Cross-cultural studies, Europe, Quality of life, Social indicators, Well-being.
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